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Obsessive-compulsive disorder (OCD) is a mental health condition that significantly impacts a child's daily life. Early detection and intervention are crucial when it comes to managing OCD, so caregivers need to understand the symptoms of OCD in order to take appropriate action. This article provides an overview of OCD in children, along with signs to watch for.

What is OCD?

Obsessive-compulsive disorder (OCD) is a condition characterized by recurring intrusive thoughts, known as obsessions, and repetitive behaviors or mental acts, known as compulsions. These obsessions often follow specific themes, such as fear of harm coming to oneself or loved ones. For instance, a child might constantly worry about germs or that something terrible will happen to their family.

Compulsions, the repetitive behaviors or mental acts, can be overt (observable) or covert (not observable). Overt compulsions include actions like excessive hand washing or checking locks repeatedly, while covert compulsions involve mental rituals, such as silently counting or praying. To meet the diagnostic criteria for OCD, these obsessions and compulsions must take up at least an hour of a person’s day and cause significant distress and/or impairment in functioning.

Common Signs and Symptoms

Age-Inappropriate Requests:

Children with OCD may ask their parents to perform tasks that are not appropriate for their age. For example, an older child might ask a parent to tie their shoes or repeatedly check their homework for mistakes, even if they are capable of doing these tasks themselves.

Requests for Reassurance:

A common symptom of OCD is the need for constant reassurance. Children may ask the same question repeatedly or in different ways to alleviate their anxiety temporarily. This can manifest as questions like, "Are you sure the door is locked?" or "Did I wash my hands properly?" The relief is usually short-lived, leading to a cycle of persistent questioning.

Accommodations:

Parents often unknowingly accommodate their child’s OCD behaviors to reduce anxiety in the moment. However, this can end up exacerbating the problem. Accommodations might include performing rituals for the child or answering repeated questions. Such actions reinforce the child's obsessive thoughts and compulsive behaviors, perpetuating the cycle of OCD.

The cycle of OCD typically involves four parts: intrusive thoughts (obsessions), anxiety or distress, compulsive behaviors, and temporary relief. Any form of accommodation or compulsion reinforces the belief that the obsessive thought is worth responding to, thereby intensifying the cycle. The fourth part of the cycle, temporary relief, is what causes long-term discomfort. Avoiding accommodations, however, can be considered temporary discomfort that leads to long-term relief.

Observable and Non-Observable Compulsions:

Widely recognized compulsions include excessive hand washing, checking, and arranging objects in a specific order. However, non-observable compulsions, such as mental rituals or rumination (continuously thinking about the same worry), are also common. These can involve repetitive "what if" questions or prolonged contemplation of certain fears.

OCD Symptoms by Age

OCD symptoms can vary significantly depending on the child's age. Understanding these age-specific manifestations can help parents and caregivers identify the disorder early.

Preschool-Age Children:

In preschoolers, OCD symptoms might be harder to identify because young children often have difficulty articulating their fears. However, persistent and distressing rituals, such as needing toys arranged in a particular way or insisting on specific bedtime routines, can be signs. Insight into the core fear behind these behaviors is usually limited at this age.

School-Age Children:

For school-age children, OCD may manifest as excessive hand washing, repeatedly seeking reassurance from parents or teachers, or needing things to be "just right." These children might also display more insight into their fears, recognizing that their behaviors are irrational but feeling powerless to stop them.

Teenagers:

Teenagers with OCD might engage in more complex rituals and may become more secretive about their symptoms. They could experience intrusive thoughts related to harm, morality, or contamination and might perform mental rituals to help them cope. It's important for parents to watch for signs such as declining academic performance, social withdrawal, or increased irritability.

Red Flags for Parents

Parents should be vigilant for specific warning signs that may indicate OCD in their child. These include:

• Persistent, distressing rituals or routines that interfere with daily activities.

• Excessive time spent on grooming or cleaning.

• Repeatedly seeking reassurance from parents, teachers, or peers.

• Difficulty completing tasks or making decisions due to fears of making a mistake.

• Increased anxiety or irritability when rituals are disrupted.

• The child has been in therapy for anxiety but is not showing improvement.

Trust your instincts and seek professional help if you suspect your child may have OCD.

Differential Diagnosis

OCD can often be confused with other childhood behaviors or conditions, such as ADHD, anxiety disorders, and tic disorders. Understanding these differences is important for accurate diagnosis and treatment.

• ADHD: Children with ADHD may display impulsive behaviors and difficulty concentrating, but these are not driven by obsessive thoughts.

• Anxiety Disorders: While anxiety is a component of OCD, it typically does not involve the compulsive rituals seen in OCD.

• Tic Disorders: These involve sudden, repetitive movements or sounds, but are not performed in response to obsessions.

Conditions like tic disorders, trichotillomania (hair-pulling disorder), and excoriation disorder (skin-picking) are related to OCD, but have distinct characteristics. The function of the behavior (e.g., reducing anxiety vs. sensory pleasure) helps differentiate these conditions.

The Importance of Early Intervention

Early identification and intervention are vital in managing OCD symptoms effectively. Untreated OCD can negatively impact a child's emotional well-being, academic performance, and social relationships.

Addressing OCD early allows families to implement strategies to reduce accommodations and compulsions. Consistent daily practices, such as exposure exercises and accommodation reduction plans, are essential. Keep in mind that everyone in the family must be committed to these strategies for them to be effective.

Seeking Support

Initiating conversations with your child about OCD can be challenging, but it is important. Use simple, reassuring language and emphasize that seeking help is a positive step. Resources for finding qualified mental health professionals include:

• International OCD Foundation: Provides information and resources for parents and children.

• NOCD: Specializes in OCD treatment for children and adults, offering virtual support.

Supporting Children with OCD

Caregivers can support a child with OCD by creating a supportive and understanding environment. Some tips to do this include:

• Encourage your child to work through uncertainty rather than seeking immediate relief from anxiety.

• Avoid accommodating OCD behaviors; instead, gently guide your child through exposure exercises.

• Work with your child's school to make sure they receive appropriate support and accommodations as needed.

• Educate yourself about OCD to better understand your child's experiences and challenges.

Recognizing the signs and symptoms of OCD in children is the first step in providing effective support. Keep in mind that the best gift you can give your child is the ability to tolerate uncertainty and resist the urge to escape or avoid their anxiety. Recovery from OCD involves learning that having a distressing thought doesn’t necessitate a response.

If you suspect your child may have OCD, trust your instincts and seek professional help. By joining Little Otter, you can access a range of resources and professional support for managing your child's mental health. Get started at the link below.

This article was written with support from Little Otter therapist, Amy Adams, and Little Otter’s Director of Clinical Research and Programs, Alison Stoner, PhD.