Understanding OCD In Children

It's no secret that kids can display odd behaviors, but much of that can be attributed to a kid just being a kid. But what if such behaviors become problematic and cause immense strain on the child and the rest of the family?

Childhood OCD,¹ or obsessive-compulsive disorder,  is a condition characterized by a child's need to perform actions repeatedly to avoid a perceived negative consequence or having uncontrollable impulses or thoughts that lead to stress.

Learn more about OCD and the treatment options available to your child if they have it.

Symptoms of OCD in children

OCD² is a mental health disorder that can impact people of all ages and backgrounds. Many people claim to have OCD when they like to clean or be in an area free from clutter, but true OCD creates numerous difficulties in everyday life. OCD is marked by obsessions, which are upsetting thoughts that your child may be unable to control.

These obsessions can also lead to compulsive behaviors or rituals, generating thoughts and actions that lead to more stress. There are many possible OCD symptoms in children, including:

• Worrying constantly about bad things happening to themselves or others

• Being afraid of injuries, illnesses, and germs

• Feeling stressed when objects are not arranged in a particular way

• Repeating words or phrases over and over

• Tapping or touching things repeatedly

• Cleaning objects or surroundings more than needed

• Having difficulties with making choices

• Feeling anxious, frustrated, or upset many times throughout the day

OCD can negatively impact a child's ability to pay attention in school, forge friendships, sleep at night, and engage in relaxing activities. Although some of these symptoms may be easy enough for guardians to spot, many children will hide their feelings or rituals because they are ashamed and afraid of what will happen if they tell somebody.

What causes OCD in children?

When a child is diagnosed with OCD, many parents wonder if their actions or parenting style caused it. Rest assured, OCD is not caused by parenting style or abilities, discipline measures, divorce, or other stressful events in a child's life. Still, stress can make OCD worse in children that are already likely to have the condition.

Experts³ aren't exactly sure what causes OCD. Still, evidence⁴ shows that it is likely related to how certain areas of the brain communicate with one another and imbalances in brain chemicals like serotonin and dopamine

 OCD could also have a genetic link, as people with a first-degree relative with OCD are more likely to develop it themselves. Even still, the prevalence of OCD is approximately 2% of the population, and having a first-degree relative with OCD doesn't guarantee that another family member will have it too.

Interestingly, some parents have reported that some children seem completely fine and suddenly show OCD symptoms without any explanation. OCD that seems to come out of nowhere is called Pediatric Acute Neuropsychiatric Syndrome⁵ (PANS). It can be distressing to see these changes in your child, but some experts think such behaviors may come from infections and other inflammatory reactions in the body.

How is OCD diagnosed?

If your child exhibits some or all of the signs above that are consistent with OCD, it may be helpful to make an appointment to talk with your child's doctor or mental health provider.

A child psychologist or therapist may run some evaluations and tests on your child to determine whether their compulsive behaviors are consistent with an official OCD diagnosis. They can provide education to help you better understand what is going on with your child.

OCD is most commonly diagnosed in children between ages 7 and 12,⁶ but people of almost any age can be diagnosed. Receiving an official diagnosis from a qualified healthcare professional is important. It opens up the potential for your child to receive the treatment they need to feel better and manage their condition. 

Treatment options for children with OCD

If your child receives an OCD diagnosis, a few treatment options may be warranted, depending on your family's unique situation. Some common OCD treatments include:

Cognitive behavioral therapy

Cognitive behavioral therapy,⁷ or CBT, is a treatment option that involves working with a therapist or psychologist. It focuses on helping your child notice disruptive thought patterns and actions and developing better-coping strategies to deal with them.

CBT for OCD may also involve exposure and response prevention, or ERP, which involves a therapist introducing various triggers slowly to help your child overcome their obsessive thoughts and compulsions.

Children can learn strategies in CBT, including positive self-talk, redirection, and letting disturbing thoughts pass by without the need to perform compulsive behaviors. CBT is the first line of treatment for OCD, and it is highly effective at helping to reduce symptoms of OCD over time.

It can take weeks or months to start seeing positive changes from CBT, and it can be a frustrating process for children and their families. 

Medication

Although many parents may be hesitant to put their child on medication for OCD, medications can be immensely helpful for children struggling with it. This is especially true when medication is paired with therapy.

However, medication can be used at first to bring anxiety levels down enough to begin CBT if it is too much for your child to handle at the beginning.

To treat the anxiety aspect of OCD, some doctors may prescribe your child an SSRI or a selective serotonin reuptake inhibitor. These include medications like escitalopram, paroxetine, and citalopram, and they can also be used to treat depression.

Of these SSRIs, four have been approved by the FDA to treat OCD in children:

• Fluoxetine

• Fluvoxamine

• Clomipramine

• Sertraline

It can take 10 to 12 weeks for an SSRI to take effect, but it can take several tries to find the right medication at the right dose to help your child's symptoms. These medications can also have side effects, but it's helpful to talk with your child about how they are feeling and contact your doctor if you notice any concerning side effects.

Your child's doctor will likely start your child on a low dose and increase it gradually. Smaller doses tend to work for depression and anxiety in children, but OCD usually requires higher doses.

If none of the above FDA-approved medications for OCD in children seem to work for your child, your doctor can also prescribe other SSRIs.

Support groups

OCD is a challenging condition, and it can often leave a child feeling like they are alone. Your child's doctor or therapist may be able to refer you to an OCD support group for your child or teen, which allows them to talk to other kids their age about the challenges they face because of OCD.

There are also support groups available for families with loved ones who have OCD, and these can give parents and other loved ones a chance to connect with others who have had similar experiences. 

Many mental health centers also offer outpatient treatment groups or day programs for children with OCD, which can give them more opportunities to get therapy and work through the challenges of their condition.

Some facilities even offer summer camps for children and teens with OCD, which can help your child build lasting friendships and learn more coping strategies to help them overcome the difficulties OCD can bring.

How to help your child with OCD

A parent's most common question when they discover their child has OCD is, "How can I help them?" OCD can be difficult for other family members, as the child may exhibit extreme anxiety about the uncertainty that can come with everyday life, including going to parks or restaurants, taking vacations, and forming friendships with others.

To keep the anxiety to a minimum, many parents try to create safe spaces and accommodate the OCD by changing family routines and household dynamics to keep the child comfortable. 

While this may seem to curb anxiety and OCD symptoms at the moment, it may cause the OCD to worsen. Constantly avoiding your child's sources of anxiety can keep anxiety and OCD symptoms more prominent, while confronting fears slowly and gradually can help to mitigate them eventually.

It isn't necessarily beneficial to use "tough love" and force your child with OCD to confront their fears in an extreme way. Upending your family's life to avoid all sources of anxiety can prevent your child from gaining independence.

If your child is working with a therapist on exposure therapy for their OCD, it can be helpful to practice facing their fears as they might with their therapist at home. It may also be helpful to talk with other relatives, such as grandparents, siblings, aunts, and uncles, about helping your child overcome fears in a controlled way instead of curbing the anxiety any time it arises.

For parents trying to help their child manage OCD symptoms, the process can become more difficult when other relatives accommodate their child's fears while the parents are absent. 

Above all, staying patient with your child as they struggle with OCD is important. Your child may ask numerous questions like, "Will everything be okay?" and "Will I get sick if I do this?" which can be frustrating to hear if you have already answered their question many times.

It's also important to remember that each child will get better at a different rate, and rushing the process may be counterproductive.

The lowdown

Having a child with OCD can be difficult for the child and the rest of the family. Still, treatment options available can help your child unwind from their anxieties and eventually overcome their fears. While it might be easy to get frustrated with a child struggling with OCD, it's helpful for the family to view the OCD as the problem, not the child.

This can help other children in the family better support their siblings, and it can help parents and other adults in the child's life assist the child with building and using healthy coping mechanisms when their symptoms show.

If you believe your child may have OCD, it might be helpful to speak with their doctor about their symptoms to get a proper diagnosis. From there, you and your child can begin to work on overcoming the challenges that OCD presents.