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OCD in Children

Children with a Grown Up Problem: OCD in Kids

Marolyn Morford, Ph.D.

2010


  • A preschooler was refusing to go to school, after having a wonderful start to the year. The mother was puzzled by this and called the teacher who shared with her that the child had recently refused to use classroom crayons that had been 'touched by the other kids.’


  • The little boy was brought in by his parents after a long evening when he needed to rewind the DVD for a movie to get to the 'right place'. The child was screaming at his parents and in tears because he couldn't get it ' right'.


Children with a Grown Up Problem

Many are aware of obsessive compulsive disorder, a type of anxiety accompanied by unusual thoughts and actions, from movies such as “The Aviator” or television programs such as “Monk.” Children with OCD, however, can be misdiagnosed and misunderstood. Adults may think a child's unusual behaviors are due to abusive experiences, oppositional defiant disorder, reactive attachment disorder, or even a type of autism. It has been called “the hidden epidemic”.


  • The 5 year old was dressed in a flowery summer outfit, with sparkly sandals and a blue barrette in her long blonde hair. Go ahead, said her mother, you can tell her, she wants to help. The little girl looked tentatively at her mother, shyly at me. She took a deep breath and whispered: "I think I'm going to get a knife and kill my sister, but I wouldn't really do that."


OCD can be very serious in childhood, causing a great deal of distress for both the child and the family. Children don't realize that their thinking or actions are unusual and may not realize they can tell their family. Parents who see their child repeating behaviors over and over may not realize it can be hard for the child to stop herself; parents whose child 'confesses' sexual thoughts at a young age may be embarrassed or wonder what happened to their child and if they did something wrong as parents.


  • Jasmine's mother became alarmed when she started to ask unusual questions such as did she come out of her dad's bottom, would she turn into her mom's 'peepee'. The questions persisted even after the parents took the time to explain to her about bodies and their functions.


How common is OCD in children?

The rate of occurrence of OCD in children is estimated at 1-3% of population, or 2-6 children per 200. That means that there are 4-8 such children in an average elementary school and about 20-30 in a middle to large high school. A preschool teacher may only see 1 or 2 such children every few years due to small care settings.


What does OCD look like in children?

OCD can look somewhat different in different people, but it always has two different components: obsessions and compulsions. Obsessions are thoughts or images that appear repetitively to the child. Compulsions are behaviors that the child feels s/he 'has' to do or that other people 'must' do. If these actions are not carried out, the child can become exceedingly distressed, sometimes crying, shrieking, yelling, often at the parent. Families become afraid to take the child in public once these behaviors start to occur. Many children with OCD seem “jumpy”, have excessive tantrums, and have sleep onset or maintenance problems. Parents are often sleeping with or in the room of the child since OCD can “travel with” other problems such as Separation Anxiety.


Obsessions seen in young children are:

  • worry about germs or getting dirty (avoiding door knobs/car handles, chair seats, clothing) “I am dirty” “I haven't gotten it all off,” “I can't stand this”

  • worry about harm coming to the self or family members, including worry that the child will harm someone, “Is there glass in this food? Did I put it there?,”

  • worry about things needing to be the same, or situated so they 'feel right' or 'ok'

  • worry about offending God or breaking a church rule, “I'm a bad person for thinking that”

  • sexual themes, “What if I touched my little cousin where I shouldn't have 2 years ago?"

  • worry about making a mistake or not remembering something important, “I didn't do this the 'right' number of times” “The teacher wants it a certain way”


Compulsions (behaviors) seen in young children with OCD are:

  • Ordering, including the need for order of the sequence of events of the day or the need to order others’, especially the parent's behavior

  • Self contamination worries and avoiding things or places: avoiding certain foods, sitting on or touching certain things

  • Reassurance seeking (often related to repeating behaviors): “Am I going to die? Are you going to die?” “Did I get it all off?” “Did I do this right?”

  • Repeating behaviors: mostly verbal repetition, typically questions, sometimes about very common topics repeated constantly from 5 minutes to an hour at a time: “Are we going to the park today?” “Will I have a substitute teacher today?” “What time is it?” (Some people call this 'crazy questioning.')

  • Confessing behaviors (often to the mother) having to do with offending God, sexual thoughts, or thoughts of having harmed someone

  • Eating behaviors or demanding certain conditions for eating

  • Skin hypersensitivities: avoidance of restrictions on body or touch of certain fabrics


OCD is a Brain Disorder: Parents are not responsible for OCD. How do we know? Brain imaging studies suggest certain information pathways may look different in a person with OCD. We also know that it “runs in” families: a parent, grandparent, aunt, or uncle may have similar behaviors and thoughts. It can respond well to certain kinds of medication that are given for depression or anxiety, but not all children respond to medication and some children are too young to try on medications. The nature of some of the compulsions, such as licking, picking, washing, evening up, along with a related disorder, trichotillomania (hair/eyelash pulling) has led some to call OCD “grooming behavior gone awry.” OCD can suddenly appear in children who have recently had strep throat. These are called PANDAS, or Pediatric Autoimmune Neuropsychiatric Disorders Associated with Strep.


OCD is treatable

We are lucky to live in a time when research into children's disorders is producing effective psychological treatments. A program that combines medication (when appropriate) and psychosocial activities that weave parents into the treatment with the child can be very effective. The goals of this method, a form of cognitive behavioral therapy, are to educate both the child and the parent about OCD and teach them numerous techniques to manage this sometimes lifelong disorder.

  • Learn as much as you can about OCD

  • Do not fear or be angry with the child

  • Help your child find a name for the OCD

  • Work with your psychologist to “map” the OCD

  • Do not participate in rituals or compulsions!

  • Communicate to your child that you know it is hard, but that you believe s/he can beat the bossy OCD


Helping children step by step to see the OCD thinking as something that they can alter, helping them learn flexibility, tolerate their fear, and see that terrible things will not happen if their demands are not met are important ways adults can help children. Early identification and treatment may prevent serious behavior limitations and reduce problems with peers and family that can affect later social development.


Childhood OCD is:

  • Different from normal temporary worries or needs for sameness that some young children have (bedtime rituals, lining up toys), in its severity and the number of areas it touches.

  • Often misdiagnosed or overlooked by both family, medical doctors, and mental health professionals.

  • Distressing, sometimes more to the family than to the child

  • Intrusive. Often, but not always, the thoughts seem separate from the child, and the child does not feel s/he has control or can make them go away when they creep in.

  • Often frightening to both the child and the adult who may hear about it

  • Treatable


Childhood OCD can be distressing, overlooked, intrusive, and frightening. Fortunately, it is also treatable. For more information online, see www.adaa.org, www.ocfoundations.org, www.bpchildresearch.org, http//www.adaa.org/GettingHelp/FocusOn/Children&Adolescents.asp



Marolyn Morford, Ph.D. is a licensed psychologist at the Center for Child & Adult Development, inn State College, PA.




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