Obsessive Compulsive Disorder (OCD)

All kids worry sometimes but in children with Obsessive Compulsive Disorder (OCD), the worries are pervasive, invading the child’s thoughts and compelling them toward behaviours that help them to cope with their anxiety. It is estimated that about 1% of children in the UK suffer from OCD and it is typically diagnosed between the ages of 7 and 12. Because many kids are embarrassed by their troubling thoughts and behaviours, they are secretive about their symptoms, postponing treatment.

What Is Obsessive Compulsive Disorder?

An anxiety disorder, OCD is sometimes thought of as an “overactive alarm system,” falsely leading sufferers to believe that if they don’t do a specific thing, negative (sometimes even life-threatening) consequences will result. While most children with OCD intellectually understand that they don’t actually have to perform the action, their anxiety is so encompassing that they repeat the behaviour to alleviate some of the tension.

The two components of OCD are:

Obsessions: Repeated thoughts that cause stress and anxiety, such as worries about germs or whether or not a door is locked.

Compulsions: Behaviours aimed at relieving the anxiety caused by the obsessions – for example, repeated hand-washing (often to the point of causing skin irritation) or checking a locked door many times.

Symptoms of Obsessive Compulsive Disorder

Because it is commonplace for kids with OCD to hide their behaviours, it can take months or even years before parents are aware that the problem exists. Many kids with OCD try to merge their compulsive behaviours into their regular activities until they are simply unable to keep their worries to themselves any longer. Oftentimes, children with OCD ask for constant reassurance about their worrisome thoughts, which may help to alert parents to the condition. For example, children may frequently ask if they’ve touched something that is contaminated or can make them sick. The questions may be asked repeatedly and if the parents are unable to assure their children that they are okay, tantrums or compulsive behaviours may result. Onset of OCD may coincide with stressful events, such as starting a new school, moving, or the death of a loved one. Parents who notice the following signs may want to schedule an evaluation for their children:

• a persistent fear of illness
• raw, chapped hands or skin
• taking an exceptionally long time to get ready for school or bed
• unusually high soap usage or dramatic increase in laundry
• expressions of fear for the health or safety of family members
• sudden drops in grades on schoolwork
• excessive time in completing homework assignments
• holes erased through test and homework papers
• requests for family members to repeatedly answer the same question

Diagnosing of Obsessive Compulsive Disorder

When children are taken for testing to see whether their thoughts and behaviours may be related to OCD, parents will be asked about any family history of OCD or Tourettes Disorder, since a genetic component can make children prone to the development of OCD. The child will also be screened for depression, Attention Deficit Disorder (ADD), trichotillomania (compulsive hair pulling), and additional anxiety disorders. It will also be important to mention if the child has recently been ill with a streptococcus infection, since there appears to be a connection between such infections and the sudden onset of OCD. This phenomenon is known as PANDAS (Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections), and while the vast majority of kids who have strep infections do not develop OCD, it can happen, so healthcare professionals are trained to ask.

During the evaluation, children who show symptomatic tendencies toward OCD are asked a series of questions such as:

• Do you have a lot of worries?
• Do you have to wash your hands a lot?
• Do you feel the need to check things (like homework or door locks) over and over?
• Do you count to a certain number or do things a set number of times?
• Are you uncomfortable if things aren’t “just right?”
• Are there certain things that you have to do to get ready for bed?

Treatment of Obsessive Compulsive Disorder

Kids with OCD are often treated with cognitive-behavioural therapy (CBT), sometimes alone and at times in tandem with medication. CBT involves exposing children with OCD to the things that they fear (such as dirt) until they learn to relax and let go of the associated anxiety. Oftentimes, this exposure is coupled with response prevention, stopping the children from engaging in the compulsive behaviours that they had previously relied on to ease their discomfort. This process takes practice, so the support of family members is crucial for its success. While many kids do well with therapy alone, some do require the use of medications to reduce the impulses associated with OCD. In any case, children should be provided with continuing support and encouragement from parents and other family members.