Obsessive-compulsive disorder (OCD) is a mental health disorder that causes excessive thoughts (obsessions) leading to repetitive behaviors (compulsions). Obsessive thoughts may include unwanted and recurrent ideas, images, doubts, or impulses.
Children may have an urge to do some actions (compulsions) to lessen the anxiety due to obsessive thoughts. These behaviors may interfere with a child’s education and social relationships. Most children with OCD require cognitive-behavioral therapy to manage their obsessions and compulsions.
Read this post to know more about the causes, signs, diagnosis, treatment, and ways to deal with a child with obsessive-compulsive disorder at home and school.
Causes And Risks Factors For OCD
The exact cause of OCD is not yet known. However, the following factors may play a role in the development of OCD in children (1).
- Some researchers suggest that it can be due to lower serotonin levels than others.
- Children with a positive family history of OCD and related disorders have a higher risk of developing OCD. This may indicate a genetic basis for the disease.
- Some children may have an acute onset of severe forms of OCD with distressing and confusing symptoms. The sudden onset of OCD in children is called pediatric acute-onset neuropsychiatric syndrome (PANS). Infectious diseases, such as mononucleosis, Lyme disease, flu (H1N1), and mycoplasma (causes walking pneumonia), are common PANS triggers.
- If the acute onset of OCD is related to a strep infection, it’s called PANDAS (pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections). These conditions can be recurrent and often increase in severity with each recurrence. There are specialist who are learning more about PANDAS and its appropriate treatment.
- OCD may be related to mental health disorders, such as body dysmorphic disorders, hoarding disorders, skin picking, trichotillomania, and tic disorders, in some children
Symptoms And Signs Of OCD In Children
Most children may not show any apparent signs and symptoms of obsessive-compulsive disorder since it has a gradual onset. Children may become obsessed with fears and worries of getting harmed or injured. They may fear injuring others or themselves or contracting a disease. These fears may compel them to do certain things to balance or neutralize its effects repeatedly.
Some children are aware that the obsessions and compulsions are abnormal and try to hide them. However, many may perceive it as valid. The following behaviors are seen in children with OCD (2).
- Excessive hand washing: Children may wash their hands excessively, causing the skin to become chapped. They believe that washing hands often is required to prevent deadly diseases.
- Extreme hygiene measures: Children with OCD may clean and arrange certain things frequently. They may avoid touching certain things since they believe it can be harmful.
- Extreme desire for perfection: The child may make several corrections in schoolwork or during other tasks for perfection.
- Frequent counting of items: Children with OCD may count various things, such as steps, tiles on the ceiling, footsteps, or the number of items in a container. They may count in their mind or aloud.
- Particular about eating rituals: Children with OCD may eat food in a specific order, tap a spoon or fork a certain number of times, may refuse to eat some foods, chew a specific number of times, or slice food into a certain number of pieces. They may not eat if these rituals are not allowed. Some of the eating-related symptoms can also be seen in eating disorders, such as bulimia and anorexia nervosa.
- Seek excessive reassurance: Children with OCD may request reassurance in many things more than usual. They may either reassure themselves or ask someone for reassurance. Fear of something, asking whether they have done some harm to others, and extreme safety concerns are a few subjects on which the child with OCD may seek reassurance. Some children may also check the locked door or ensure to turn on the alarm many times more than usual.
- Hoard things: Some children may hoard old newspapers or some things which are not useful since they believe that throwing them may cause harm. OCD hoarding is different from people with hoarding disorders. Normal hoarders may find pleasure in keeping old things than fear of throwing them.
- Superstitions: Older children may have extreme beliefs of things or actions that can be lucky or unlucky.
- Odd behaviors: The child with OCD could display unusual behaviors, such as sitting, getting up, and then sitting down on a chair.
Children may become distressed and anxious if they cannot carry out their compulsions or are restrained from doing them.
Diagnosis Of OCD
Symptoms may indicate OCD in children. Children could also share their symptoms since many children with OCD are aware of their unusual behavior. Multiple counseling sessions are often required for children to share their obsessions and compulsions with the pediatric counselors. Knowing the reasons for their compulsions and obsessions is necessary to diagnose OCD since the same symptoms can be seen in other disorders due to various reasons. The obsessions and compulsions are analyzed based on the DSM-5 OCD diagnostic criteria (3).
Obsessions and compulsion may interfere with the child’s abilities and often result in distress. If an infection, such as PANDAS or PANS, is involved in developing OCD, doctors may refer to the concerned specialists for diagnosis and treatment of it.
Treatment For OCD In Children
The following treatments are usually given for children with OCD (4).
- Cognitive-behavioral therapy is the most effective OCD treatment for children, and other treatment options are given with it. Cognitive therapy helps the child to manage obsessive thoughts without resorting to compulsive behaviors. A trainer may teach alternative methods to manage obsessions and compulsions. Other forms of cognitive-behavioral therapy involve repeated exposure and response prevention (ERP). Continuous exposure may help to overcome the fear during ERP therapies.
- Medications, such as the antidepressants called selective serotonin reuptake inhibitors (SSRI), are often prescribed in some cases. Clomipramine (another type of antidepressant) is given if the SSRIs are not effective. Medications may cause side effects and may not be sufficient alone to control OCD symptoms. So doctors may suggest cognitive therapies along with medication.
- Family therapy may help the family members to understand and deal with the OCD issues of the child.
- Group therapy can be beneficial for older children. This involves interactions with OCD sufferers and often helps to reduce the feeling of isolation.
- Antibiotic treatment is generally recommended for OCD due to PANDAS and PANS depending on the current state of infection.
If the training sessions and medical treatments are not effective in managing OCD, children may require inpatient treatment in special centers with intensive behavioral therapies.
Prevention Of OCD In Children
OCD cannot be prevented in most children since the biological factors may cause it (5). However, early diagnosis and appropriate treatment may prevent the worsening of the condition. If the child has first-degree relatives with hoarding or cleaning symptoms, seeking early medical care for obsessive behavior is recommended.
Preventing infections can be beneficial if the OCD is related to streptococcal or other infections (PANDAS and PANS). Treating strep throat and other infections on time with prescription medications may reduce the incidence of neuropsychiatric complications such as OCD in some cases.
How To Help A Child With OCD At Home?
The following tips may help to manage a child with OCD at home (6).
- Consistently set limits for behaviors. A child may display an outburst or meltdown in the beginning, but gradually they feel less anxious.
- Ensure that the caregivers and other family members are not allowing the child to fulfill their compulsions.
- Never accommodate your child’s OCD. Accommodating OCD means other family members change their habits according to the child’s wish or participate in certain activities and rituals suggested by the child. However, awareness and consideration are needed to help alleviate some of the symtpoms.
- Reassure the child about dealing with their compulsions and obsessions. However, do not give excessive reassurances that are a part of the child’s obsessive-compulsive behavior.
- Reward and praise the child when they display voluntary efforts to curtail their obsessions and compulsions.
- Parents and caregivers should understand and actively participate in child’s behavioral therapies.
Accommodating isolated OCD symptoms may eventually result in disorder. Thus, parents should take a firm stand and set limits to control OCD symptoms from its beginning.
How To Help A Child With OCD In School?
OCD children may face challenges while completing school work. They may have disputes between other students and teachers due to compulsions and obsessions. The following tips may help an OCD child cope with the curriculum and school environment (7).
- Give more time to complete school works and tests since they may take more time due to extensive corrections for perfection.
- Let the child use the laptop to take notes or to do assignments instead of writing. Rewriting and erasing can be problematic compared to typing and changing.
- Allow fostering friendship or a buddy system to prompt them to do tasks. A peer coach who sits next to them can be helpful for many children with OCD.
- Let them give tests in a private room since researchers suggest that children have more control of their thoughts and behavior in a quiet environment.
- Spare reading loud tasks since children with OCD tend to reread sentences for perfection, and reading tasks can be a nightmare for them.
- Listening to audiobooks can be helpful for children with OCD who take more time to read books.
- Break homework into smaller sections since lots together can cause anxiety, and they may start worrying about making mistakes.
- Give an escape plan from the OCD thoughts and compulsions. Let the child signal the teacher and leave the classroom if they have OCD symptoms coming in. Frequently asking permission and interrupting the class can be embarrassing and often result in bullying from other children.
- Give advance notice of things since children with OCD can become more anxious and irritable due to changes in routine.
- Let the child sit in a place where they can concentrate on their work better. Children with OCD may find it challenging to pay attention if they are sitting at certain places, such as near the door or window.
- Peer awareness of OCD and how to behave with them can be helpful.
Awareness programs for teachers by psychologists can help them learn about common mental health disorders in children and provide appropriate facilities or permissions at school. Forcing an OCD child to be like their peers in school can be distressing and harmful for them. You may ensure to provide them special care to reach academic goals.
It can be extremely concerning for parents to see their children change from easy going kids to ones that are more anxious and compulsive. As parents, it is imperative to spend time with our children and learn about their personality. Knowing a baseline can be paramount if their habits change.
2. Obsessive-Compulsive Disorder (OCD) in Children; Cedars-Sinai Medical Center
3. Obsessive-Compulsive Disorder (OCD) in Children;University of Rochester Medical Center (URMC)
4. Treatment for OCD; Child Mind Institute
5. Obsessive-Compulsive Disorder in Children; Centers for Disease Control and Prevention
6. Kids and OCD: The Parents’ Role in Treatment; Child Mind Institute
7. How Teachers Can Help Kids With OCD; Child Mind Institute
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