Helping Children With Obsessive Compulsive Disorder
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Obsessive compulsive disorder is a complex condition that involves two separate but related components: The private inner world of thoughts, urges, ideas or images (obsessions) and external behaviors and symptoms (compulsions). The compulsive behaviors associated with OCD are not always perceivable to others, as they may be intentionally hidden or carried out privately. Furthermore, compulsive symptoms can come and go, or can be more prominent in one setting and nonexistent in another.
While environmental factors can affect the severity or prominence of the condition, OCD is primarily a biological and often hereditary condition that affects roughly 1-2 percent of children in the U.S.
Diagnosing OCD in Children
Diagnosing OCD in children can be a complicated process. The presence of compulsive, rigid or repetitive behaviors does not necessarily indicate a biological case of OCD. A diagnosis may be determined over time and should include observations across settings, input from parents, caregivers and educators, and an in-depth evaluation from a qualified mental health professional.
Obsessions are fixations of the mind on thoughts, urges, ideas or images. Obsessions are often persistent or recurrent and are unpleasant or distressing, sometimes even frightening. Examples include:
- Fears of contamination (dirt, germs or illnesses).
- Desires to hoard or save items (resulting in the collection of items in case they are needed in the future).
- Fears of aggression or violence (of harming oneself or others, that something bad will happen to oneself or others, or of blurting out inappropriate comments or obscenities).
- Magical thoughts (lucky or unlucky words, numbers or colors, or avoiding places or activities associated with certain attributes).
Compulsions are a means to ease or reduce the fear or anxiety caused by obsessive thoughts or ideas, and are behaviors or rituals that one feels compelled to do, even if one has the knowledge or awareness that the behavior is not logical. The prevalence of these behaviors, or symptoms, may wax and wane. Under more stress or in certain settings, the symptoms may become more prominent, while they may be more easily hidden or even nonexistent during periods of less stress or in different settings. Children with OCD are sometimes able to keep their compulsions under control in a setting such as school, but are unable to do the same in their home environment. Examples include:
- Excessive or ritualized handwashing, showering or cleaning of items.
- Excessive checking (including locks, plugs/outlets, seatbelts or placement of items such as toys or other belongings).
- Excessive checking for mistakes, of one’s health, or that one did not or will not harm oneself or others.
- Repetition (re-reading, erasing or rewriting excessively).
- Routine activities (going up and down stairs or in and out of doorways a specific number of times).
- Arranging (excessively organizing or ordering items and showing signs of distress if the order is disrupted).
- Counting (steps or words, for example, or completing activities in specific number sets).
- Saving, hoarding or collecting items that do not have apparent significance (such as pieces of string, paper or wrappers).
- Superstition (such as touching an object a certain number of times, usually as a way to avoid or prevent something bad from happening, or avoiding floors or days/months associated with a certain number).
- Tics (blinking, throat-clearing or tapping, for example, for usually a specific number of times), which can also be a symptom of Tourette syndrome.
- Rituals that involve other people (for children, this is most often a parent), such as seeking reassurance, checking or doing something a certain number of times (fastening a seat belt three times before it is OK to go, for example).
When to Seek Help
Parents concerned about the possibility of their child having OCD should seek help from a qualified mental health professional. Attempts to alleviate a child’s discomfort may not be the best way to help. It’s equally important that treatment includes support for parents. OCD is a complex condition, especially when obsessions and compulsions interfere with a child’s well-being and ability to comfortably take part in usual childhood activities.
The Lucy Daniels Center is a nonprofit agency in Cary that promotes the emotional health and well-being of children and families. Visit lucydanielscenter.org to learn more.