Obsessive compulsive disorder, commonly referred to as OCD, is a mental health disorder that affects nearly 1-3% of children and adolescents in the United States (Rapoport et al., 2000). While many children experience occasional intrusive and distressing thoughts, children with OCD have these symptoms to an extent that interferes with their ability to function at home, school, and/or with peers (Freeman et al., 2014). Specifically, the defining feature of OCD is the experience of either obsessions or compulsions, or a combination of both (American Psychiatric Association, 2013).
Obsessions are defined as recurrent and persistent thoughts that are unwanted and intrusive (American Psychiatric Association, 2013). For example, common obsessions experienced by children with OCD center on themes of contamination (e.g. fear of dirt, germs), safety (e.g. thoughts of something bad happening to the child or their family, thoughts of the child accidentally hurting someone), and symmetry (e.g. order, organization). Obsessions can be especially difficult to identify in young children, who may have difficulty recognizing and verbalizing their distressing thoughts. Compulsions are characterized by repetitive behaviors that the child feels like they have to do in order to reduce the anxiety caused by their obsessions or negative thoughts (American Psychiatric Association, 2013). Common compulsions of children with OCD include hand washing, cleaning, counting/repetition, and checking (e.g. locks, doors, appliances). One common misconception about children with OCD is that they are overly clean, tidy, and organized. This can be problematic, since some kids who don’t exhibit cleaning obsessions and compulsions may be less likely to be suspected as having OCD and not get the treatment they need. While some kids with OCD may present in this way, having obsessions and compulsions about cleanliness is not a requirement for OCD.
In pediatric OCD, it’s especially important to recognize that young children may not be able to understand or explain their reason for completing a compulsion, but they continue to perform them because the behavior ultimately reduces their anxiety. Another common experience of children with OCD is the feeling that certain behaviors or compulsions need to be done until the child feels “just right.” This can be very difficult for families to deal with, as people with OCD cannot typically verbalize what “just right” means and doing behaviors until it feels “just right” can be very time consuming.
How do parents know where to start if they suspect their child may have OCD? First, we recommend seeing a psychologist or mental health care provider for an evaluation to determine whether or not treatment for OCD is the best next step for your child. Given the prevalence of OCD and the level of distress and impairment it can cause families, multiple treatments for pediatric OCD have been developed and tested by researchers:
Cognitive Behavioral Therapy: Currently, the most common and effective treatment for pediatric OCD is cognitive behavioral therapy (CBT; Freeman et al., 2018). CBT is a type of psychotherapy that aims to reduce symptoms of OCD by teaching children how their thoughts, feelings, and behaviors all work together and influence each other, resulting in how we experience the world (Beck, 2011). In this approach to therapy, clinicians teach children how their obsessions (thoughts) can make them feel anxious, which prompts them to perform compulsions (behaviors) (Piacentini et al., 2007). Critical to CBT is the idea that we are able to change our own thoughts, so working to change our negative thoughts in therapy can lead to positive changes in feelings and behavior.
The most effective component of CBT for OCD is exposure and response prevention (ERP), a technique in which children are exposed to situations that are anxiety-/compulsion-provoking (Abramowitz et al., 2005). In time, children learn that they can tolerate their anxiety on their own and that they don’t need to engage in compulsive behaviors. This improved ability to tolerate anxiety will lead to an overall decrease in anxiety.
Another important part of CBT for children with OCD is parental involvement. Parental involvement in therapy can take various forms, including learning about the child’s symptoms and why they may be occurring, implementing changes at home, completing therapy homework, and facilitating exposures outside of the therapy session (Piacentini et al., 2007).
Medication: Medication is another common treatment for OCD in children, both in combination with therapy, or alone. Specifically, serotonin-reuptake inhibitors (SSRIs) are the most common type of medication prescribed for children and adolescents with OCD and have been shown to have moderate effects on symptom reduction (Ivarsson et al., 2015). Studies have shown that the most effective treatment for pediatric OCD involves a combination of medication and CBT therapy (as compared to either medication only or therapy only; POTS, 2004). Generally, we recommend that you consult with your child’s mental health provider and pediatrician about the best plan for your family when deciding what treatment to pursue.
Overall, having a child with OCD can be a difficult experience for the whole family. Thankfully, considerable research has been done to determine the best ways in which to help alleviate negative symptoms of OCD in children and their impairing effects. For more information about childhood OCD, check out some of these resources:
References
Abramowitz, J. S., Whiteside, S. P., & Deacon, B. J. (2005). The effectiveness of treatment for pediatric obsessive-compulsive disorder: A meta-analysis. Behavior Therapy, 36(1), 55-63. https://doi.org/https://doi.org/10.1016/S0005-7894(05)80054-1
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Beck, J. (2011). Cognitive Behavior Therapy: Basics and Beyond (2nd ed.). New York, NY: The Guilford Press.
Freeman, J., Benito, K., Herren, J., Kemp, J., Sung, J., Georgiadis, C., Arora, A., Walther, M. & Garcia, A. (2018). Evidence base update of psychosocial treatments for pediatric obsessive-compulsive disorder: Evaluating, improving, and transporting what works. Journal of Clinical Child and Adolescent Psychology, 47(5), 669-698. https://doi.org/10.1080/15374416.2018.1496443
Freeman, J., Garcia, A., Frank, H., Benito, K., Conelea, C., Walther, M., & Edmunds, J. (2014). Evidence base update for psychosocial treatments for pediatric obsessive-compulsive disorder. Journal of Clinical Child & Adolescent Psychology, 43 (1), 7-26. DOI:10.1080/15374416.2013.804386
Ivarsson, T., Skarphedinsson, G., Kornør, H., Axelsdottir, B., Biedilæ, S., Heyman, I., Asbahr, F., Thomsen, P. H., Fineberg, N., March, J., & Accreditation Task Force of The Canadian Institute for Obsessive Compulsive Disorders (2015). The place of and evidence for serotonin reuptake inhibitors (SRIs) for obsessive compulsive disorder (OCD) in children and adolescents: Views based on a systematic review and meta-analysis. Psychiatry research, 227(1), 93–103. https://doi.org/10.1016/j.psychres.2015.01.015
Piacentini, J., Langley, A., & Roblek, T. (2007). Cognitive-behavioral treatment of childhood OCD: It’s only a false alarm. New York, NY: Oxford UP.
Pediatric OCD Treatment Study (POTS) Team (2004). Cognitive-behavior therapy, sertraline, and their combination for children and adolescents with obsessive-compulsive disorder: The pediatric OCD treatment study (POTS) randomized control trial. The Journal of the American Medical Association, 292 (16), 1969-1976. DOI: 10.1001/jama.292.16.1969
Rapoport, J. L., Inoff-Germain, G., Weissman, M. M., Greenwald, S., Narrow, W. E., Jensen, P. S., Lahey, B. B., & Canino, G. (2000). Childhood obsessive-compulsive disorder in the NIMH MECA study: parent versus child identification of cases. Methods for the Epidemiology of Child and Adolescent Mental Disorders. Journal of anxiety disorders, 14(6), 535–548. https://doi.org/10.1016/s0887-6185(00)00048-7