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Obsessive-compulsive disorder (OCD) is an anxiety disorder in which people cope with obsessive thoughts or worries with compulsive, repetitive behavior. It can manifest in children as well as adults, becoming so severe, that they affect the child's everyday living. The most well-known OCD symptom is a fear of germs that results in frequent hand washing.
While the onset of OCD usually occurs during the teen years, about half of the cases occur in childhood. Unlike other anxiety disorders that affect females more, OCD affects boys and girls equally, although boys outnumber girls in childhood onset.
How Kids Develop OCD
OCD is a brain disorder, not an environmental one, which indicates parents cannot cause, nor necessarily, prevent it. People with OCD may have a serotonin deficiency, and research suggests that OCD may also develop or worsen in children after suffering from a streptococcal infection. The National Institute of Mental Health reports that the bacteria may act on a brain enzyme, resulting in OCD or tic disorders in children. OCD might also run in families, suggesting a genetic component--although a parent with OCD will not necessarily have a child with the disorder, nor does it mean a parent without OCD should expect their child not to suffer from the disorder.
Short of preventing a streptococcal infection in children, there are no real preventive strategies. Parenting and other environmental influences don't cause OCD in children. The good news is that OCD is manageable, particularly with early diagnosis and intervention.
Symptoms of OCD
Recognizing OCD in children can be a challenge, as many parents, teacher and doctors dismiss the behaviors as excess worry or oppositional behavior. Symptoms can evolve over time or change depending on the level of stress the child is feeling. And symptoms don't appear in all areas of a child's life. For example, a child might be able to resist the obsessive thoughts and compulsions at school, but not at home. Common symptoms of OCD include:
- Excessive worry about unrealistic fears
- Repeated or ritualistic behaviors to prevent fears from manifesting, such as hand washing to avoid germs
- Behavior to avoid fears, such as not touching other people to prevent germs
- Tantrums or distress when compulsions or rituals cannot be performed
- Inability to articulate worries or compulsions
- Hiding obsessions and compulsions
- Resistance to stopping the behavior
- Worrying about being "crazy"
The results of these behaviors are that children are often socially isolated and suffer from low self-esteem. Their schoolwork may suffer from poor concentration because of obsessive thoughts. Some children may exhibit behavioral problems such as fighting.
With early detection and intervention, the prognosis for OCD in children is good with early detection and intervention. Several treatment strategies range from counseling to medication:
Exposure response prevention (ERP) is a behavioral therapy specifically used with people suffering from anxiety. It focuses on the misinterpretation of fear and teaches the child to interpret fear more appropriately and to avoid ritualistic behaviors as a coping mechanism. Often CBT and ERP are used together.
Parent training can help parents cope with and manage their child's illness.
Family therapy can help when the child's illness impacts the entire family. It can ensure that the family supports the child, instead of inadvertently sabotaging the child's progress.
School counseling can provide the child support at school, help him make friends, and manage academic demands.
Medication is usually a last resort if other interventions don't work, and oftentimes they are used in conjunction with therapy. Anafranil, Luvox, Prozac, and Zoloft are FDA approved for use with children. Research suggests that use of antidepressant medication may lead to increased thoughts of suicide, so children should be closely monitored if they are taking such medication. Further, along with the effect on mood, medication can have physical side effects. Thus, parents and doctors need to monitor children's mood and physical health regularly.
While parents cannot prevent OCD from developing, they don't need to fear that the disorder will stop their child from living a full and normal life. With early intervention, children can learn the skills they need to manage and cope with their fears.