Hoarding in Children and Teenagers

Many of us have seen the television shows depicting homes filled from floor to ceiling with newspapers, garbage, and ‘things’. The images of rotten food, dead vermin, and insect infestations fill many of us with shock, horror, confusion, and sadness. How did this happen? Why won’t the person part with all the ‘stuff’? Typically, we associate hoarding with adults, but did you know that children and teenagers also hoard, and if we do not implement appropriate interventions now, this hoarding behaviour will continue to escalate and continue into adulthood?

Hoarding disorder has only recently been added to the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) and is classified under Obsessive Compulsive and Related Disorders category. Hoarding is defined “as the acquisition of and failure to discard possessions of little use or value” (Frost & Gross, 1993, p.367). Approximately two to six percent of children/teenagers hoard. The typical age of onset of compulsive hoarding begins around the age of 11 to 15 years old, however, children as young as 6 to 7 years old can be hoarders.

Hoarding can be thought of as a type of anxiety disorder which typically occurs with OCD (obsessive compulsive disorder). Hoarding rarely occurs on its own. Storch et al., (2016) demonstrated that hoarding symptoms/behaviours are both common and clinically significant in children and teenagers with ASD (autism spectrum disorder) and Hacker et al (2016) reported a high prevalence of hoarding in children with ADHD. Hoarding behaviour is also common in children/teenagers with developmental disabilities, major depressive disorder and anxiety disorders.

Messy rooms in kids are common, but kids who hoard tend to acquire or hold onto objects that most of us consider garbage or useless, and struggle when asked to part with or discard them. Children and teenagers who hoard develop overpowering emotional attachments to their possessions resulting in cluttered rooms. Kids who hoard appear to lack awareness that their behaviours are problematic and are so worried about their possessions that it interferes with daily life (Child Mind Institute, 2019). They may become angry, anxious, distressed if their ‘things’ are taken away. Over time, these kids may experience bullying, social isolation, peer rejection and be thought of as ‘weird’ or ‘crazy’ as friends and family struggle to understand the hoarding behaviours.

It is thought that the core features of hoarding partially arise from observed deficits in executive functioning e.g. organization, sustained attention, long-term planning. Risk factors include:

  • Family history
  • Stressful event (ACEs). It is estimated that 50 percent of hoarding behaviour is preceded by a traumatic event e.g. death of loved one, divorce, move to new school/home, house fire
  • Pre-existing mental disorder: anxiety (25 percent) OCD (20 percent) depression (70 percent)
  • ADHD (30 percent)

Signs A Child/Teenager May Have a Hoarding Disorder

  • Bed is used for storage with no area to sleep
  • Desk is covered with ‘stuff’
  • Bedroom floor full of clutter
  • Closet and drawers are filled with ‘stuff’
  • Overfilled toy box, shelves, containers in bedroom

Treatment
Treatment of a hoarding disorder depends on the age of the child/teenager. For young children (8 years and younger) psychologists typically work with the parent(s) to set up a behavioural plan to stop the child from acquiring more things, and to use incentives to work on gradually getting rid of hoarded items. For older children/teenagers, experts agree that CBT (cognitive behavioural therapy) is effective. This therapy helps the child/teenager understand why he/she feels compelled to hoard. The psychologist works with the child/teenager and teaches him/her to decide which items are worth keeping and what can be discarded or donated. Medications, namely antidepressant (SSRIs) may also be given if the child/teenager has a co-existing mental disorder and/or the hoarding behaviour is extreme.

What Can Parents Do?

  • Restrict space for hoarding e.g. bed and desk must be clear at all times
  • Use one in one out method e.g. donation bin
  • Reward appropriate behaviour e.g. discards item of no value. Reward should not be a new toy or tangible item
  • Be patient and show love
  • Be an active participant in treatment program
  • Talk with siblings, other family about strategies to help child/teenager
  • Talk with child/teenager about his/her ‘collection/things’ listen, be supportive, non-judgemental, do not invalidate, punish, or humiliate
  • Encourage child/teenager to put extra special treasured items in a memory box
  • Arrange a day and time when backpack, bedroom, toy box is checked for useless items, hoarded food
  • Set aside one on one time to do fun activities with child/teenager

References
Child Mind Institute – https://childmind.org
Frost, R.O., and Gross, R.C. (1993). The Hoarding of Possessions. Behaviour Research and Therapy, 31 (4):367-81.
Hacker, L.E., Park, J.M., Timpano, K.R., Cavitt, M.A., Alvaro, J.L., Lewing, A.B., et al. (2016). Hoarding in Children with ADHD. Journal of Attention Disorders, 20(7): 617-26.
Storch, E.A., Nadeau, J.M., Johnco, C., Timpano, K., McBride, N., Jane Mutch, P., et al. (2016). Hoarding in youth with autism spectrum disorders and anxiety: incidence, clinical correlates and behavioural treatment response. Journal of Autism Dev Disord, 46(5):1602-12.

In my next Blog#31
I Will Discuss Sleep and Mental Illness

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