Everything you need to know about OCD in Children

According to OCD UK, three-quarters of a million people are living with OCD and it affects around 1.2% of the population, including young children. The problems caused by OCD begin having more of an impact for males in late adolescence and for females in their early 20s.

Though the typical age of onset is wide, children as young as six have been known to develop the disorder. Around one-quarter of all cases of OCD are apparent before age 14. It is unusual for people to develop OCD after 35 years of age. In this article, we’ll tell you everything you need to know about OCD and its occurrence in children.

What is OCD?

OCD stands for obsessive-compulsive disorder. It is a common mental health condition that is characterised by compulsive behaviours and obsessive thoughts. It can affect both men and women. Though most people begin having symptoms in early adulthood, some people develop them earlier, with many beginning to notice symptoms around puberty.

The condition is often distressing and interferes significantly with people’s lives. However, there is treatment to help manage the condition.

What causes OCD in children?

Lots of children will have occasional thoughts that concern them and they might feel as though they need to do something about them, even if the actions don’t really make sense. For some children, their thoughts and urges to do specific actions will persist, even if they attempt to make them disappear or ignore them.

Children might be diagnosed with obsessive-compulsive disorder when they have thoughts that bother them and make them perform certain behaviours or rituals frequently. A diagnosis is likely if the rituals take up lots of time, make them upset, or interfere with their activities.

The thoughts a person with OCD has are the ‘obsessions’, while the behaviours they might perform as a part of a routine or ritual are the ‘compulsions’.

It isn’t known why some children get OCD. There are likely to be neurological and biological components. Some children who have OCD also have tic disorders like Tourette syndrome. Some people believe that health problems during a pregnancy or birth make obsessive-compulsive disorder more likely to occur. It’s also believed that OCD that begins in childhood might be different from OCD that begins in adulthood.

Brain dysfunction

One presumed cause is that there is a likelihood of some degree of brain dysfunction. This is believed to be linked to the neurotransmitter serotonin.

Brain scans on people with OCD have highlighted brain abnormalities in the part of the brain called the orbital cortex, which is located above the eyes, as well as the thalamus and basal ganglia. This suggests that these parts of the brain are not communicating as they should. As such, when someone with OCD feels anxious, there are inappropriate circuits of responses between these parts of the brain.

Essentially, the primitive parts of the brain are misinterpreting messages and the person perceives the danger and threat to be real. For this reason, it’s not possible for the person to think reasonably. People with OCD often refer to this part of their brain as a huge two-year-old child as this is how irrational and primitive the part of the brain is that causes the issues.

Genetics

There seem to be some genetic links between people who suffer from OCD and other similar disorders like hypochondriasis, body dysmorphic disorder, trichotillomania and binge eating. There are suggestions that as many as one-third of adolescents with OCD have a family member with the condition or a similar condition.

Infections

There are theories that ‘strep throat’, an infection common in children, can be a causal factor in OCD in children. In these cases, the symptoms will come on quickly within a matter of a week or two.

Depression

People who suffer from depression can sometimes develop obsessive-compulsive symptoms. Equally, people with OCD can also develop depression.

Environmental influences

This includes things like general health, home life, living conditions, significant changes, exposure to abuse or other trauma, and how well supported they are in general.

Symptoms of OCD in children.

Studies have shown that children and adolescents typically have around four or five obsessions and compulsions. However, experiencing compulsions without obsessions is more common the younger the person is. The age of onset or gender doesn’t seem to affect the number, severity or type of OCD symptoms.

As for obsessions, younger children usually focus on a fearful family event like a parent dying. They might also experience feeling contaminated or have fears about doing the right thing. Quite often, the younger the child is, the more bizarre or unusual their symptoms might be.

Concerning compulsions, these are usually putting things into order, checking things, repeating activities, and washing. As is expected, children frequently involve their caregivers in their compulsions and obsessions.

With childhood OCD, the symptoms often fluctuate. With younger children, it can be difficult to distinguish between normal children’s fears as a stage of development or ones that could mean OCD is present.

Things caregivers might notice at home

Parents are the most likely to notice OCD. At home it can manifest itself in a number of ways.

A child might be unusually distressed by:

• Whether a person will become ill, get hurt or die.
• Injury, harm, illness, dirt or germs.
• Things being out of place or seeming ‘wrong’.
• Whether a bad thought could come true.
• Things not being straight or arranged in the right way.

In terms of compulsions or rituals, parents often notice children:

• Touching things, tapping things, or stepping in an unusual way.
• Arranging and rearranging things.
• Repeating questions, words or phrases.
• Having doubts and not being able to make choices.
• Cleaning or washing themselves more than is necessary.
• Taking an excessive amount of time to do something like shower, get dressed, do homework or eat.

Children also involve their parents in their compulsions. They might insist that a parent does things in a particular way, for instance, or might request reassurance again and again.

Common ways OCD symptoms manifest at school

At school, symptoms of OCD can often go unnoticed as they might not necessarily be obvious.

Some ways you might notice OCD in a child at school include:

• School absences or tardiness.
• Tantrums, meltdowns or disruptive behaviour.
• Finding it difficult to complete work or asking repetitive questions.
• Frequent reassurance seeking.
• Throwing paper out, excessive erasing, rewriting and rereading of work.
• Being unable to complete work and procrastinating.
• Frequent bathroom trips.
• Avoiding particular objects, situations, people or places.
• Making frequent adjustments to personal belongings.
• Doing actions repeatedly by a particular number or until it feels right.
• Being unable to transition between two tasks, including leaving or entering a classroom.

How does OCD affect children?

The majority of research tends to support the idea that people who have childhood OCD will often have other problems that interfere with their development. This could be anxiety disorders, behaviour disorders or depressive issues.

OCD can affect children’s behaviour in that they can be easily annoyed, argumentative, seem defiant and hostile and show aggression. Some children will be indifferent to social rules and have a lack of remorse for their actions.

Another way in which young people with OCD are affected is in their self-esteem. They often have perfectionist tendencies with schoolwork and struggle to live up to their own standards.

How to diagnose OCD in children

There are no tests that diagnose OCD. Instead, a psychiatrist or psychologist will interview the child and their parents to understand the situation and try to get to the bottom of what’s going on. Depending on their age, the child might complete questionnaires and checklists to help the specialist diagnose them.

To a certain extent, OCD-like symptoms are probably experienced by all people at some point, particularly in stressful times. However, with OCD, there is a devastating, huge impact on the child’s whole life. The difference between someone claiming to be “a bit OCD” and a person having a clinical diagnosis is that the obsessions and compulsions significantly affect everyday functioning.

A child might be asked questions like:

• Do you check things lots of times?
• Do things take you a long time to complete?
• Do you feel that you need to put things in a specific place or order?
• Do you get very upset if there is a mess?
• Do you have a particular thought that upsets you and you can’t get rid of?
• Does all of this trouble you?

A diagnostician will look at all of the symptoms and evidence to determine whether or not a child is suffering from OCD or something else, or whether the concerns raised by parents are within normal parameters.

How to help a child with OCD

If a parent believes that their child has OCD there are a number of things they can do to help. Firstly, they should talk to their child about what they have noticed. This should be in a supportive and caring way. They could, for example, say something like “I’ve noticed you spend a long time fixing your bed covers to be a certain way. Getting it perfect causes you to feel stressed.”

By stating it like this, parents aren’t asking their child anything and the child doesn’t need to respond. This can be followed up by explaining about OCD as a possibility and how a doctor might be able to see if this is what is happening. A child knowing that things can improve and that you want to help them is important.

Secondly, a parent should seek an appointment with their GP who can refer the child to a psychologist or psychiatrist to diagnose the condition.

When a child has a diagnosis, the parents should follow advice from professionals on how they deal with the condition at home and how they can help their child. This might involve being a part of their therapy. It also might mean exercising a lot of patience as there is no quick fix for OCD.

At school

In school, teachers can do a lot to help their pupils with OCD. Things like helping them to find a safe place in the classroom to be in can help. Making work and homework more manageable is also important.

If there is a fear of contamination, the student could be supplied with their own equipment that won’t be used by others. If reading and writing are affected, alternative methods can be offered. This might mean typing work if handwriting is causing anxiety or listening to audiobooks if students are struggling with the urge to reread passages.

It’s also important to set limits and boundaries while still acknowledging their fears. If the person has a bathroom obsession, for example, limiting the number of visits allowed per day can help them to control their compulsions.

Finally, it’s important for everyone not to use the phrase ‘OCD’ lightly by making jokes about it. It has become common for people to say they are “OCD about X, Y or Z” but to a real sufferer of OCD, this is not appropriate.

How to treat OCD in children

One of the most frequently recommended treatments for OCD in children is cognitive behavioural therapy (CBT). This is a special type of psychotherapy that teaches people who have OCD that they are in charge and not their OCD.

The therapy works through the children being able to face their fears in achievable steps so that they learn that their fears aren’t justified because they don’t come true. With CBT, children also learn how to get used to their feelings just like they can get used to other unpleasant sensations like getting into a swimming pool and feeling cold.

For children whose symptoms are severe, a type of antidepressant medication called SSRIs, or serotonin reuptake inhibitors, has been shown to have good outcomes. Given that OCD is believed to be linked to serotonin, these medicines work to target the areas of the brain that use this neurotransmitter.

Final thoughts

OCD, though challenging, is manageable and can be treated. In children, it can be difficult to diagnose and sometimes a ‘wait and see’ approach is needed to determine if the obsessions are part of normal childhood developmental fears. Once diagnosed, there are many ways in which children and their parents can get help.