Childhood OCD

Obsessive compulsive disorder (OCD) is a type of anxiety mental health disorder in which people have obsessive thoughts which compel them to perform certain activities or display certain behaviors (compulsions). The compulsions are carried out to relieve the obsessions but often provide no or only temporary relief. Obsessive compulsive disorder is common in adults and most cases begin at adolescence or early adulthood.  However, it is not uncommon for OCD to begin in childhood.

Childhood OCD often presents itself differently than adult OCD.  The first major difference is that children do not always realize that their obsessions are irrational or excessive – one of the diagnostic criteria for OCD in adults.  With children, the obsessions may be unknown and only compulsions are apparent. It is common for the compulsive behaviors to occur before obsessive thoughts develop.

The obsessions and compulsions in children are often the same as those found in adults.  However, childhood obsessive compulsive disorder often presents itself in a very different ways than with adults. Children are more likely to include others in the compulsions, such as asking a parent to repeatedly perform a compulsion (like washing their clothes repeatedly).  Compulsions in children are often very extreme and frequently occurring which is not always the case with adults.

Another major difference between childhood and adult OCD is that children are much more likely to have a comorbid condition, particularly tic disorders, ADHD, mood disorders or abnormal development problems. When treated for OCD, children are less likely to respond to first-line treatments such as antidepressants.

How Common is Childhood OCD?

Obsessive compulsive disorder is one of the most common childhood conditions.  In the United States, about 1 million children and teens have OCD.  The rates of OCD in children are just under the numbers diagnosed with ADHD and about 10 times greater than children diagnosed with diabetes.

In adulthood, OCD is equally prevalent amongst men and women.  In children though, OCD is more common in boys than girls.

Symptoms of Childhood OCD

The symptoms of childhood OCD depend on the nature of the obsession and compulsions that a child is experiencing.  For example, if a child has a germ obsession which compels him/her to constantly wash, then the child may have chapped hands from the repeated washing.

There are some widely-occurring symptoms of OCD in children such as constant tardiness, making repeated requests (such as to wash the laundry again), spending a long time in preparation for simple tasks, troubles leaving home, persistent fears, and unusual habits which display patterns.

Common Obsessions and Compulsions in Children

Obsessions and compulsions are similar in children and adults.  However, children are likely to only have compulsions and not obsessions.  Some studies show that most children with OCD will have 4-5 compulsions and/or obsessions. The younger the child with OCD is, the more unusual or bizarre the obsessions and compulsions are likely to be.

Childhood obsessions are usually focused on a fear of harm to oneself or others, contamination, bodily fears, and also self doubt. The most common compulsions in children are washing, repetition, organizing, and checking things. 

What Causes Childhood OCD?

While an exact cause of obsessive compulsive disorder is still unconfirmed, experts believe that it is caused by brain abnormalities. Imbalances of neurotransmitters such as serotonin are thought to have a role in causing OCD.  In brain imaging scans, people with OCD show abnormal activity in the brain including in the orbital cortex, striatum, Basal Ganglia, and thalamus.  Researchers thus believe that these parts of the brain may have malfunctioned and caused OCD.

There is strong evidence that some cases of obsessive compulsive disorder may be suddenly caused by the streptococcal bacteria.  There have been cases in which children suddenly experienced symptoms of OCD or tic disorder after having strep throat – an infection common in children. The way that strep could cause OCD is not clear but it is possible that the bacteria causes the body to mistake healthy cells with those of the infected cells.  The immune system would then attack the healthy cells and could result in damage.  If the damage occurs in the brain, then the parts of the brain which are linked with OCD could be damaged. Children with OCD should be screened for streptococcal (PANDAS) infections.

How is Childhood OCD Treated?

If a child with OCD tests positive for a strep infection, then the infection should immediately be treated as this could cure the condition.  However, only rare cases of childhood OCD seem to be caused by the strep infection thus other treatment methods are deemed necessary.

OCD is often a lifelong, unremitting disorder.  Thus, the goal of treatment for OCD (in both adults and children) is to manage the symptoms of the disorder.  Antidepressants are typically prescribed as a first-line method of treatment for OCD in children.  These medications have shown very effective in managing the symptoms of the disorder but they are not always effective in children.  Further, there are risks and side effects associated with antidepressant use in children including an increased risk of suicide in adolescents.

Cognitive behavioral therapy has shown to be a very effective treatment for OCD in children and adults. For OCD treatment, experts typically use a method called exposure therapy and ritual breakdown.  During exposure therapy, patients are gradually introduced to their obsession in a controlled environment.  Then, they have their reaction to the obsession controlled as part of ritual breakdown.  A classic example of these methods of cognitive behavioral therapy includes a patient who has a contamination obsession which compels him to repeatedly wash.  He would be required first to look at something “dirty” like pictures of a bathroom sink.  The patient would gradually have his exposure increased to the sink and then be required to touch it.  After the exposure, the patient would be forbidden to wash for a certain period of time which increasingly gets longer until the compulsion becomes unnecessary.

References:

American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (Revised 4th ed.). Washington, DC: Author.

Eddy, Mark F., Ph.D, and Gordon S. Walbroehl, MD. “Recognition and Treatment of Obsessive-Compulsive Disorder.” American Family Physician, 1 April 1998. Web.

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