"What if I forget to bring my homework to school? Did I remember to feed my
goldfish? I know I turned off the TV, but let me check to make sure."
All children have worries and doubts. But when your child can't stop thinking
about them, they begin to hamper his ability to function. No matter how
stressful the worries are, no matter how silly they may seem, and no matter
how much your child wants them to go away, they do not subside on their
own. In association with this anxiety, your child may begin to perform certain
rituals, behaviors that are performed in a certain way over and over again.
If these behaviors persist, your child may be diagnosed with obsessive
-compulsive disorder (OCD).
It is reported that approximately 1 million children and adolescents in the United
States suffer from OCD. This translates to one in 200 children. OCD is more
prevalent than many other childhood disorders or illnesses, but it is often
hidden because it causes pain and embarrassment to the child.
In the years when most children want to fit in with their peers, the discomfort
and stress brought on by OCD can make them feel scared, out of control,
What can you do to help? Keep reading to learn more about OCD and how you
can help your child.
What Is OCD?
OCD is an anxiety disorder in which the brain gets stuck on a particular thought
or urge and can't let go. OCD manifests itself in obsessive thinking or beliefs that
tell a child: "If you don't do X, then something uncomfortable or even life-threatening
will happen." (In younger children, compulsive behaviors may be evident without
the "if...then" thinking.) The rise in anxiety or worry is so strong that the child must
perform the task or dwell on the thought, over and over again, to the point where
it interferes with everyday life. OCD can become extremely embarrassing and
overwhelming for both the child and his family.
Experts aren't sure how OCD gets started, but it should never be viewed as the
child's fault or something he can stop if he just tries harder. OCD is a disorder, just
do know that OCD tends to run in families, and just like in children, OCD in adults
is often kept private so that most families are not aware of this disorder in their
OCD is best viewed as a "short circuit" in the brain's "worry computer," says John March,
MD, author of OCD in Children and Adolescents: A Cognitive Behavioral Treatment Manual.
This worry computer inappropriately and repeatedly cues the child to fear that something
will happen. These cues are commonly called obsessions.
Obsessions are repeated thoughts or impulses that are out of place - they cause the
child to experience anxiety or distress. They are out of the child's control, and they
are different from normal thoughts. A child with these thoughts usually attempts to
ignore or suppress obsessive thoughts or impulses by neutralizing them with another
thought or action - a compulsion. For example, a child who is plagued with doubts
about having turned off the stove might compulsively check the stove, again and
again, to ensure that it is off.
Compulsions, or rituals, are the deliberate and repeated behaviors a child with OCD
performs to relieve the anxiety caused by the obsessive thoughts. For example, a child
who has a fear of germs may repeatedly wash his hands until the skin becomes raw;
a child who has an obsession with neatness will redo her test paper so many times
that she may tear a hole in it from constant erasing. Other times, compulsions might
seem less clearly related to the obsessive thought.
Common OCD Behaviors in Children
OCD can make daily life difficult for children and families. The behaviors often take up
a great deal of time and energy, making it more difficult to complete tasks such as
homework or chores or enjoy life. In addition to feeling frustrated or guilty for not
being able to control their own thoughts or actions, children with OCD also may suffer
from low self-esteem because the disorder can lead to shame or embarrassment.
Children often involve their parents in their rituals (for example, asking about a potential
illness they think they have), leading to increases in family stress.
Children with OCD may feel pressured because they don't have enough time to do
everything. They might become irritable because they have to stay awake late into
the night or miss an activity or outing to complete their rituals. They might have
difficulties with attention or concentration because of the intrusive thoughts.
In addition, obsessions and compulsions related to food are common. These can lead
to abnormal eating habits (such as eating only one kind of food), thus compromising
Studies of children and adolescents with OCD have revealed that the most common
- fear of dirt or germs
- fear of contamination
- a need for symmetry, order, and precision
- religious obsessions
- preoccupation with body wastes
- lucky and unlucky numbers
- sexual or aggressive thoughts
- fear of illness or harm coming to oneself or relatives
- preoccupation with household items
- intrusive sounds or words
The following compulsions have been identified as the most common in
children and adolescents:
- grooming rituals, including hand washing, showering, and teeth brushing
repeating rituals, including going in and out of doorways,
needing to move through spaces in a special way, checking
to make sure that an appliance is off or a door is locked,
and checking homework
- rituals to undo contact with a "contaminated" person or object
- touching rituals
- rituals to prevent harming self or others
- ordering or arranging objects
- counting rituals
- hoarding and collecting things
- cleaning rituals related to the house or other items
Signs of OCD
Recognizing OCD in children is often difficult because they become adept at hiding
the behaviors. It's not uncommon for a child to engage in ritualistic behavior for
months, or even years, before parents know about it. Also, many children do not
engage in their rituals at school, so parents may think that this is just a phase their
child is going through.
"Kids try to contain their thoughts or behaviors, and this creates anxiety," says
David Sheslow, PhD, a pediatric psychologist. "Children experience embarrassment
and sometimes feel like they are 'going crazy.' They try to keep it quiet and to blend
it into the normal routine of their lives until they can't contain it anymore. This is
when the parents become concerned. Even then, parents typically know of only some
of their child's ritual thoughts and behaviors.
"The child may ask the parent to join him in the ritualistic behavior: first the child has
to do something and then the parent has to do something else. If a child says, 'I didn't
touch something with germs, did I?' the parent might have to respond, 'No, you're
OK,' and the ritual will begin again for a certain number of times," Dr. Sheslow explains.
"Initially, the parents might not notice what is happening. Tantrums, overt signs of
worry, and difficult behaviors are common when parents fail to participate in their
child's rituals. It is often this behavior, as much as the OCD itself, that brings families
Parents can look for the following possible signs of OCD:
- raw, chapped hands from constant washing
- unusually high rate of soap or paper towel usage
- high, unexplained utility bills
- a sudden drop in test grades
- unproductive hours spent doing homework
- holes erased through test papers and homework
requests for family members to repeat strange phrases
or keep answering the same question
- a persistent fear of illness
- a dramatic increase in laundry
- an exceptionally long amount of time spent getting ready for bed
- a continual fear that something terrible will happen to someone
- constant checks of the health of family members
reluctance to leave the house at the same time
as other family members
Environmental and stress factors can signal the onset of OCD. These can include
ordinary developmental transitions (such as starting school) as well as significant
In screening for OCD, your child's doctor or mental health professional will ask about
obsessions and compulsions in language that your child will understand, such as the
- Do you have worries, thoughts, images, feelings, or ideas that bother you?
- Do you have to check things over and over again?
- Do you have to wash your hands a lot, more than most kids?
- Do you count to a certain number or do things a certain number of times?
- Do you collect things that others might throw away (like hair or fingernail clippings)?
- Do things have to be "just so"?
- Are there things you have to do before you go to bed?
Because it can be normal for children to answer yes to any of these questions, your
and other motor or vocal tic disorders. OCD has a genetic component, which means
that children whose family members have had any of these disorders may be more
prone to OCD.
Tic disorders often resemble OCD symptoms: approximately 35% to 50% of people
with Tourette syndrome also have OCD (but only a small percentage of children with
OCD also have Tourette syndrome).
Disorders that frequently occur with OCD include other anxiety disorders, depression,
defiant disorder), learning disorders, trichotillomania (compulsive hair pulling), and
The most successful treatments for children with OCD are behavioral therapy and
medication. Cognitive-behavioral psychotherapy (CBT) helps children learn to change
their thoughts and feelings by first changing their behavior. CBT involves exposure,
or exposing the child to his fears to decrease his anxiety about it. For example, a child
who is afraid of dirt might be exposed to something he considers dirty until he no
longer fears it.
For exposure to be successful, it is often combined with response prevention, in which
the child's rituals or avoidance behaviors are blocked. For example, the child who fears
dirt must not only stay in contact with the dirty object, he also must not be allowed to
wash repeatedly. Some treatment plans involve having the child "bossing back" the
OCD, giving it a nasty nickname, and visualizing it as something the child can control.
Behavioral treatment with children works best when the whole family is involved, according
to Dr. Sheslow. "Treating children from a behavioral perspective requires a high degree
of cooperation," he says. "Without a considerable amount of family support, you won't
have a high rate of success. Because cognitive behavioral treatments often provoke
considerable anxiety, a good deal of support is needed. As well, it is important to find
a therapist who knows about how to treat OCD. OCD can worsen if not treated in a
consistent, logical, and supportive manner."
Medication is often combined with CBT to get more complete and lasting results. Research
shows that selective serotonin reuptake inhibitors (SSRIs) are most effective in children
agree that medication should be used to treat children as a second choice to CBT.
"Medication often can reduce the impulse to engage in ritualistic behavior. Therapy will
help the child and family learn strategies to manage the waxing and waning of OCD
symptoms," Dr. Sheslow says.
"Many children can do well with CBT alone, others will need a combination of behavioral
therapy and medication. It's important to use the treatments appropriately to avoid the
long-term adverse effects of OCD on children's development," Dr. March says.
How Can I Help My Child?
Parents and children should understand that OCD is never the child's fault. Once a child
is in treatment, parents are encouraged to participate, to learn more about OCD, and
modify their expectations and be supportive. You need to realize that kids get better
at different rates and day-to-day comparisons of your child's behaviors should be avoided.
Small improvements should be recognized and praised.
"It is rare to find a child with OCD without finding a family with OCD," Dr. Sheslow says.
Your entire family should be educated and supportive at all times. The more personal
criticism can be avoided, the better. Members of your family should keep in mind that it's
the OCD that is causing the problem, not the child. Family routines should be kept as
normal as possible, family members should learn strategies to approach members with
OCD, and if your child is on medication, the regime should never waver.
It's not surprising that many people keep this disorder hidden. "This is not something
that people want to advertise; there's an embarrassment about it," says Dr. Sheslow,
who explains that OCD is different from other disorders, such as a fear of dogs, for
example. Other disorders are easier for people to talk about than OCD.
Source: KidsHealth www.KidsHealth.com is a project of The Nemours Foundation which is dedicated
to improving the health and spirit of children. Today, as part of its continuing mission, the Foundation
supports the operation of a number of renowned children's health facilities throughout the nation,
including the Alfred I. duPont Hospital for Children in Wilmington, Delaware, and the Nemours Children's
Clinics throughout Florida. Visit The Nemours Foundation to find out more about them and its health
Preview: Obsessive-compulsive disorder is now recognized as one of the most common
causes of disability worldwide. Recent advances in treatment have greatly improved the
prognosis for patients with this disorder, but diagnosis can be elusive. What should the
primary care physician watch for or ask about? What interventions are appropriate? In
this article, Dr Khouzam discusses the definition, causes, epidemiology, diagnostic criteria,
and treatment options for this often puzzling problem.
Obsessive-compulsive disorder is defined as a condition in which a person has repeated
and uncontrollable thoughts (obsessions) that are accompanied by persistent urges to
perform repetitive rituals (compulsions). The rituals serve to counteract the anxiety
precipitated by the obsessions (2).
Although the majority of patients with obsessive-compulsive disorder have both obsessions
and compulsions, some have only one or the other (3). Most patients realize the irrational
nature of their thoughts and rituals but feel helpless and hopeless about controlling them
(4). Obsessive-compulsive disorder can impair all areas of functioning, and despite its
devastating effects on patients and families, it may be unrecognized by primary care
physicians because of the patient's secrecy about this embarrassing disorder (2,4).
The National Alliance for the Mentally Ill (NAMI) is a nonprofit, grassroots,
self-help, support and advocacy organization of consumers, families, and
friends of people with severe mental illnesses, such as schizophrenia,
major depression, bipolar disorder, obsessive-compulsive disorder, and
disorder (PTSD), obsessive-compulsive disorder (OCD), generalized anxiety disorder,
and phobias (social phobia, agoraphobia, and specific phobias). More than 19 million
American adults suffer from an anxiety disorder in a given year, and many people
have more than one anxiety disorder. Anxiety disorders frequently co-occur with
depressive disorders, eating disorders, or substance abuse. Depending on the type
of anxiety disorder(s) someone has, effective treatments can include medication(s),
psychosocial therapies, or a combination of the two.
It includes prevalence among youths, common obsessions in youths, and treatments.
Medications used to treat obsessive compulsive disorder:
benefits, and risks and side effects.