Obsessive-Compulsive Disorder (OCD) in Children

Children may have OCD when their obsessions and compulsions happen frequently, take up a lot of time (more than an hour a day), interfere with daily activities or make them feel very distressed. As a result, kids and teenagers with OCD can get trapped in a vicious cycle of these thoughts, anxiety, and rituals.

What Signs or Symptoms of OCD Might Parents Notice?

Ψ Obsessions

• A child with OCD doesn’t want to think about these things, but they often feel like they can’t control nor stop these thoughts. These persistent obsessions often make the child feel anxious or distressed.Parents may notice obsessions as intense fear or worries.

• Kids with OCD may be unusually upset about:

  • Things that are not straight, even or arranged in the “right” manner

  • Things that appear out of place

  • Whether someone could get sick, hurt or die

  • Germs, dirt, illness, harm, or injuries

  • Whether bad thoughts might come true
    

Ψ Compulsions (Rituals)

• Behaviours that a child with OCD will do to feel better and reduce the anxiety associated with obsessions. To the child, these behaviours seem like the “solution” to stop those obsessions and prevent bad things from happening.

• ·However, these behaviours are not typically connected to the actual danger of something bad happening, and they can be very extreme, such as washing hands multiple times per hour.

• As parents, you might notice that kids with OCD:

  • Need to think about or say something repeatedly (for instance, counting, or repeating phrases or words over and over silently or aloud).

  • Having to do something repeatedly (for instance, arranging items in a specific order, or checking the same things over and over, like whether a door is locked).

  • Having to do something repeatedly according to rigid rules that must be followed exactly to make an obsession go away such as putting on clothes in the same order each day. Children with OCD may get upset if the order becomes disrupted.

  • Touch, tap or step in unusual ways

  • Have many doubts, and trouble making choices.

  • Wash or clean more than needed.

  • Take an unusually long time to do things – like to get dressed, eat, shower and do homework.

• Kids may also involve parents in their rituals. At first, you may not realise that something is a ritual. For example, a child with OCD might ask you for reassurance repeatedly. Alternatively, a child may insist you say or do something a certain number of times, or in a certain manner.
  

Ψ Feelings

• OCD symptoms are hard on kids. As the frequency of rituals increase, they start to take more time and energy. As a result, kids have little time and energy for things they enjoy. OCD can also make it hard to focus in school, have fun with friends, sleep or relax.

• Kids may seem:

  • Anxious, worried

  • Frustrated. Irritable

  • Sad, tired

  • Upset when they can’t do a ritual

  • Need constant reassurance from a parent that things are going to be OK.

Kids and teenagers with OCD can have obsessions, compulsions, or both.

What causes OCD?

Unfortunately, the exact cause of OCD is not yet determined. However, genetics, brain abnormalities and the environment are thought to play a role. Children and teenagers with OCD may have internal stressors such as worries about school, friendships and self-esteem. Difficult relationships with peers, parents and teachers can also cause anxiety. Likewise, they might also have external stressors, i.e., changes in family relationships, traumatic losses or conflicts with friends that may promote anxiety and obsessions.

Other anxiety problems, depression, or eating disorders may be comorbid with OCD. Additionally, OCD affects both genders equally, and it can run in families.

Seek Early Intervention

OCD typically does not disappear on its own and requires intervention to reduce its severity. Early intervention for kids with OCD helps tame the obsessions and compulsions with professional help. The earlier the intervention, the better the intervention outcome for your kids!

How is OCD typically addressed?

Intervention typically involves medication and psychotherapies.

Ψ Cognitive Behavioural Therapy (CBT)

Cognitive Behavioural Therapy (CBT) helps the child learn and respond differently to their triggers, reducing the frequency of compulsions and the intensity of obsessions. CBT consists of two evidence-based techniques: Exposure and Response Prevention (ERP) therapy and Cognitive Therapy (CT)

ERP:

• it involves gradually exposing children to their fears in a safe setting, without allowing them to respond with compulsions or rituals to decrease their anxieties.

• This helps them learn that bad things do not really occur when they do not engage in their compulsions, which eventually decreases their anxiety (habituation). It also teaches them that they can tolerate uncomfortable feelings.

• Specifically, the therapist will work with you and your child to create a “fear hierarchy” in which we collaboratively identify all the feared situations, rate them on a scale of 0 to 10, and tackle them one by one.

For instance, a child who fears getting contaminated with germs will repeatedly confront “contaminated” situations and objects until their fear subsides and they can tolerate the exposure without performing compulsions. Your child will start with a low-level anxiety item, such as touching clean towels, before moving on to more difficult items such as holding half-eaten food from the trash.

CT:

• This helps the child change negative thoughts that cause anxiety and distress into more positive, effective ways of thinking, leading to more effective behaviours. They will learn to confront their obsessions by responding to them in new ways.

• For instance, a child who believes “I’ll get germs and fall sick from touching clay” may be taught to reframe his or her thinking, changing their belief into: “Lots of kids my age play with clay, yet they are perfectly fine!”

Ψ Positive Family Interaction Therapy

• May be used in conjunction with Cognitive Behavioural Therapy

• Usually involves regular sessions of family therapy aimed at improving OCD-related emotion regulation and problem solving.

• Can reduce functional impairment, symptom accommodation, and family conflict, while improving family cohesion.

Psychotherapy alone can be effective, but some children are provided a combination of therapy and medication. Families and schools can help children by being part of the therapeutic process and learning how to respond supportively without accidentally reinforcing the child’s symptoms.

Here at Annabelle Kids, our child psychologists will work together with you and your child to develop a personalised management plan that will respect and value your child’s unique preferences and needs.

How can I help my child as a parent or caregiver?

Ψ Practice at Home

Often, psychotherapy involves practice outside of sessions, requiring parents to participate in the intervention plan. Children will be assigned “homework” and asked to continue practicing their fears in multiple settings beyond the clinic. Since exposure and response prevention evokes anxiety and requires considerable follow-up, family involvement and support are essential.

Ψ Help Kids Face Their Fears Instead of Accommodating Them

As OCD can be a crippling disorder for children, they may seek constant reassurance from family members to manage their fears and many parents would often provide it, even if excessive, to make them feel better in the moment.

Reassurance-seeking is one of the many forms of “family accommodation”, which refers to how family members may participate in the rituals the child uses to manage their anxieties, and how family members might modify personal and family routines to accommodate them.

Unfortunately, many children with OCD are unable to tolerate uncertainty, hence they often ask their parents to provide them with definitive answers. For instance, an anxious child might ask “Am I going to get sick from eating this?” or “Is everything going to be okay?” repeatedly although you might have answered the same question before.

It is understandable to feel frustrated as a parent, since it feels like no matter how many times you have answered your child’s questions, they are never satisfied. Answering their questions can then become an endless cycle, and the children may never learn that they can tolerate the uncertainty.

By accommodating their fears, OCD can become very overwhelming to families and interfere with how families normally function. Further, it can reinforce their symptoms, maintaining the anxiety through avoidance.

Instead of family accommodation, family members can learn to help the children face their fears instead of avoiding them. Rather than excessively reassuring the child, you can help remind them of the skills they have developed during therapy and to use them in the moments they experience those anxieties or obsessions. You can also acknowledge what they are feeling and provide positive affirmations that they have the strength to fight the OCD.

Ψ Name the Child’s OCD

Naming the OCD is one way to reduce the stigma associated with it, and make the child feel like the anxiety does not define who they are. For instance, the child may name their OCD “The bully” or “The witch”. Divorcing the OCD as separate from the child may enable the family to have a “common, identifiable enemy” to fight against.

Ψ Help Them Build Coping Skills

Working together with the therapist, parents can learn new strategies to respond when their children get “stuck” and to encourage them to rely on coping skills to tackle the obsessions, instead of relying on their parents to help them through it.

With built-in coping skills, the child will learn to be more independent and feel more empowered in tackling their OCD.

Since grandparents and siblings can be involved in family accommodation, it is recommended that they also be involved in the child’s intervention plan, so they don’t undermine it.

Overcoming OCD is a process. There is no way to predict exactly how long it will take for your child to regain control over their symptoms. Nonetheless, it is important to praise their efforts and show them how proud you feel about their progress. Remind them that OCD is not their fault.

Sometimes, children may have upsetting thoughts which make them feel like they must do something about these thoughts, even if their actions don’t make sense. For instance, they might worry about having bad luck if they don’t wear a particular piece of clothing, or that something bad might happen if they don’t wash their hands.

What is obsessive compulsive disorder, or OCD?

OCD causes upsetting, unwanted thoughts called obsessions, which in turn, causes the urge to engage in behaviours called compulsions (also known as rituals) to try to reduce the obsessions.