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OCD (Obsessive Compulsive Disorder) in Children
By Riikka Melartin, Psy.D.
Many people casually use phrases like “I’m really OCD about the dishes,” meaning that they are very meticulous about something. However, in the clinical domain, OCD or Obsessive Compulsive Disorder is a type of anxiety disorder that is relatively common in both children and adults. You likely know people who have it, although many individuals are able to hide their OCD from casual observers or even family, especially if it is relatively mild.
The “obsessive” in OCD refers to thoughts that are intrusive, repetitive, and unwelcome. They are usually frightening or morally unacceptable. For example, someone might have obsessive thoughts of their father dying, fears of hurting their own pet, or sexual images they find disturbing.
“Compulsive” refers to thoughts, behaviors, or acts that the person feels they must do to prevent a feared something from happening. Common examples might be checking that doors are locked or appliances are turned off, having to have objects arranged in a certain way, touching things a specific number of times, or consciously repeating thoughts or phrases.
Given that many people can have mildly obsessive thoughts or compulsive behaviors at times, “disorder” refers to the fact that these obsessions and/or compulsions cause the individual distress, interfere with daily functioning, continue over time, and generally become worse if untreated.
According to American Academy of Pediatrics, about 3% of children and adolescents are diagnosed with OCD. Fewer are diagnosed with OCD-like PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infection) from strep, or with PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) from other types of infections. The International OCD Foundation notes typical onset of OCD occurs between 10-12 years, with symptoms usually beginning gradually. With PANDAS and PANS, symptoms appear suddenly.
For a variety of reasons, children are unlikely to tell adults about their symptoms. They may not realize that what they’re thinking, feeling and doing is atypical, they may fear getting into trouble or being made fun of, or they may be embarrassed and ashamed. Very young children may actually believe (the way they believe in magic) that their behaviors are preventing disaster. If you notice your child performing certain acts over and over, or having to have things a certain way, you might gently ask about it. If they were prevented from doing the behavior, how would they feel? Can they say why they are doing it?
You may notice that your child taking much longer than expected to accomplish tasks. While there are any number of causes for this, one might be that the child is needing to repeat, check, or avoid, thus slowing themselves down. Perhaps your child is getting anxious and upset more often, seemingly out of nowhere. Again, there are many potential reasons for this type of symptom, but it could be that they are upset because they’ve been unable to act on a compulsion that they “need” in order to avoid a bad consequence. Sometimes obsessions and compulsions directly affect academic tasks. For example, a child avoids certain letters, has to have numbers always come out even, or cannot end a sentence except at the end of a line.
If you are at all concerned that your child may be experiencing obsessions or compulsions, talk to your pediatrician and seek a referral with a child psychologist or psychiatrist with experience in OCD and related disorders. The sooner you begin treatment, the better in terms of the distress and negative effects caused by the symptoms. Cognitive behavioral therapy, possible medication, support for the child, and guidance for the family on how to help their child, all can successfully help treat OCD symptoms.
Riikka Melartin, Psy.D. is a licensed psychologist who provides individual therapy, counseling, and consultation for clients who are diverse in age, ethnicity, and sexual orientation. Until recently, she also worked as a school psychologist. Look for her monthly blog post about child & adolescent therapy on www.commpsych.com.
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