Obsessive Compulsive Disorder in Children and Teenagers

Imagine waking up every day and having to wash your hands 50 times before you eat breakfast, or check the door handle 40 times before you leave for school, or redoing a school assignment every time you made an error. Does this make you feel stressed and anxious and confused? Welcome to the day in the life of a child/teenager living with OCD. Obsessive Compulsive Disorder, or OCD is a serious mental illness/disorder that causes children/teenagers to have unwanted thoughts, feelings and fears. These thoughts are called obsessions and to try and relieve the anxiety and fear caused by the obsessive thoughts, kids do behaviours or rituals, called compulsions. OCD affects approximately one in fifty adults and one in one hundred children/teenagers. It is the fourth most common mental disorder in kids and children as young as three years old have been diagnosed with OCD. Unfortunately, OCD usually does not exist in isolation and children/teenagers frequently have other mental health problems such as ADHD, anxiety disorder, Tourette’s syndrome, major depressive disorder.

There is no single, definitive cause of OCD, however researchers believe biological factors plus family history, genetics, and past strep infection may all play a role. For example, 20 percent of all children/teens with OCD have a family member with the disorder. OCD can also be triggered by a stressful live event such as death of a loved one, divorce, illness, birth of sibling, transition to new school or new class or move to a new home.

Living with OCD is very difficult and stressful. Many kids feel embarrassed or confused and try to hide their fears and the rituals they do. Eventually the patterns of behaviour interfere with daily life and the more tired and stressed they become, the more obvious their rituals become and sadly, many kids with OCD are subjected to taunts, threats and bullying behaviour when at school.

What are Obsessions?
Obsessions are persistent, disturbing worries, fears, or doubts that kids cannot stop thinking about. Even if they know that the thoughts don’t make sense, they still feel anxious and continue to perseverate and fixate on the obsessions. Obsessive thoughts/fears may include:

  • They or someone else will get sick, or die
  • They have said a bad word, had a bad thought or made a mistake
  • Something or someone is dirty, has germs
  • They have broken a rule, sinned, been bad
  • Something is unlucky or lucky, good or bad, safe or harmful
  • Something is straight, even, or placed in an exact way

What are Compulsions?
Compulsions are the rituals or repeated behaviours that kids with OCD do to make sure things are clean, safe, even, in order. They believe that these rituals have the power to prevent bad things from happening and doing the ritual/compulsion is the only way they feel everything is okay. Ritualistic behaviours include:

  • Washing, cleaning
  • Repeating a word or phrase
  • Going in and out of a doorway multiple times
  • Having things in a specific order
  • Erasing things, re writing, redoing, rereading
  • Checking a door is locked, a light is off, checking and rechecking homework
  • Touching, tapping a certain number of times or a set way
  • Counting to a ‘good’ number, avoiding unlucky numbers

Signs and Symptoms

  • Trouble concentrating at school, enjoying activities
  • Trouble making mind up
  • Becomes easily upset, frustrated, irritable, anxious, sad
  • Seems unsure if things are ‘okay’
  • Takes much longer to do everyday tasks e.g. dressing, bathing
  • Often late for school, activities, completing homework assignments
  • Insist that a parent say or do something in an exact way e.g. set the table, load the dishwasher
  • Becomes easily agitated and angry if they can’t make something perfect or something is out of place

Diagnosis
A doctor’s assessment and psychiatric assessment is required for an accurate diagnosis of OCD. One of the most effective assessment tools to help diagnose OCD is the Yale-Brown OC Scale (Y-Bocs) for children https://www.iocdf.org

Treatment

  • Cognitive Behavioural Therapy (CBT) – kids learn about OCD, ways to face their fears, cope with them and develop skills to help stop the obsessions and compulsions
  • Family Therapy – parents are taught how to respond appropriately to OCD situations and how to support child/teenager without relying on compulsions/rituals
  • Exposure Response Prevention (ERP) – repeated exposure to the source of the fear without using compulsions. This is a very specialized therapy and requires a trusted and supportive relationship between child/teen and therapist. Of those who complete ERP up to 80 percent experience a significant reduction in OCD symptoms
  • Medications – antidepressants namely SSRIs have been found to be helpful

What Can Parents Do?

  • Talk with child/teenager, be supportive, offer reassurance, listen, show love
  • Be patient
  • Be an active participant in therapy and treatment plan
  • Encourage child/teenager, work together to deal with the obsessions
  • Adopt holistic lifestyle: healthy diet, exercise, family time, activities, mindfulness, relaxation exercises
  • Spend one on one time with child/teenager, do fun activity
  • Follow up with school
  • Talk with siblings, family, friends
  • OCD is very sensitive to stress and a stressful event may exacerbate symptoms, ability to cope.
  • Consider teaching relaxation and deep breathing exercises, strategize plan to deal with stress, encourage child/teen to express feelings in art, music, poetry, etc.

Check out the Obsessive-Compulsive Foundation of Metropolitan Chicago at www.ocfchicago.org
for some great tips

In my next Blog #30
I Will Discuss Hoarding in Children and Teenagers

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