Obsessive Compulsive Disorder in Children

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The Cleanest Kids on Earth:
Obsessive Compulsive Disorder
in Children

January 2002

Step on a crack, break your mother's back; hold your breath while passing a cemetery; touch a screw and lift your legs when going over railroad tracks. These are some of the superstitious games that children play, but do not necessarily take seriously. They are usually outgrown by adolescence, but sometimes live on in the form of harmless superstitions such as knocking on wood, or wearing "lucky" socks when playing softball. These types of behaviors are not indicative of a problem.

By the age of two and a half most children have routines that they like to follow, bedtime rituals, such as being tucked in by daddy, but having mommy turn out the lights, or morning rituals such as brushing teeth and then hair. These routines can be comforting, and because they are repeated every day, they can smooth the course of going to bed and getting ready in the morning. Many adults have routines to which they adhere every day, such as reading the newspaper in a specific order. Who doesn't yearn for some routine and stability in life? It is when a child insists on performing time-consuming and seemingly purposeless rituals, such as washing their hands every time they touch a doorknob, that there may be cause for concern.

Obsessive-Compulsive Disorder (OCD) is an equal opportunity anxiety disorder, it can affect both children and adults. Obsessions are defined as repeated intrusive thoughts that cause distress. Thoughts of catching a disease from touching an object, such as a computer keyboard, or constantly imagining harm coming to family members are examples of common obsessions. These thoughts, ideas and feelings are completely involuntary, unwelcome and have no basis in reality. Compulsions are acts that are repeated again and again in an effort to either reduce the anxiety and distress caused by obsessive thoughts or to actually prevent an event from taking place. Some common compulsions are hand washing, touching surfaces, and counting to a certain number.

The diagnostic criteria for OCD in children are the same as those for adults. According to the diagnostic manual used by mental health professionals (DSM-IV), obsessions and compulsions must take up at least one hour of a person's day and disrupt normal functioning in order for there to be a diagnosis of OCD. An estimated one million children and adolescents in the United States suffer from the disorder.

Although the peak age for diagnosis of OCD in children is ten years old, it can strike children as young as two or three. Boys are twice as likely to develop OCD before puberty, girls tend to develop it during adolescence, when the numbers become even. According to Tamar Chansky, Ph.D., author of Freeing Your Child from Obsessive-Compulsive Disorder, boys' compulsions usually focus around symmetry and evenness and they are more likely than girls to have physical tics. Girls tend to have washing and cleanliness compulsions, although 85% of children with OCD will display a washing compulsion at some point, hand washing being the most common of these. An individual (child or adult) with OCD may spend a few minutes or a few hours washing themselves.

Very young children with obsessions and compulsions may have trouble verbalizing what they feel, but they certainly have others ways of getting their point across. A child who is too young to wash his hands himself may nonetheless get very upset if his hands are dirty, another may insist on lining up items, or may have touch an object a certain number of times. According to Susan Swedo, M.D., of the National Institute of Mental Health, young children tend to have more compulsions than obsessions, she notes that counting and re-reading are very common and can distract children from schoolwork. Children with OCD usually realize that their thoughts and behaviors are extreme, but feel that they have no control over them. Even a four-year-old knows that obsessive thoughts are different from other thoughts, says Dr. Chansky, and a slightly older child may describe the feeling of having compulsions by saying something like, "my brain is very strict with me." Sometimes parents do not recognize that there is a problem until it is full-blown because many children are embarrassed by their compulsions and go to great lengths to hide them, especially at school. Recognition can also be made difficult by the fact that some compulsions are mental - counting, praying, repeating the alphabet, or visualizing a specific image. Compulsions sometimes relate to obsessions, but often they seem completely unrelated, for example a person with an obsession about harming someone may have a compulsion that involves counting.

Children with OCD have the same types of obsessions and compulsions as adolescents and adults with the disorder, but the issues with which they are concerned may differ. A young child may worry about getting sick from touching a doorknob, while a teenager or adult may worry specifically about catching AIDS from touching a doorknob. Dr. Chansky notes that OCD can act as a "magnet to whatever is going on in a person's life and adolescents have different issues than younger children."

There appears to be a strong genetic component to OCD. Approximately 20% of children with the disorder have a relative who is also a sufferer. These adults may have had OCD as children. According to Harold Koplewicz, M.D., founder of New York University's Child Study Center and author of It's Nobody's Fault: New Hope and Help for Difficult Children and their Parents, approximately 50% of adults with OCD had symptoms before they were fifteen. It is not known whether a child with OCD will grow into an adult with OCD, but the number of adults with OCD suggest that many do not.

Treatment of Obsessive Compulsive Disorder in children and adults is effective. It is common to use combination therapies for both (see p. ). Medication, commonly a Selective Serotonin Reuptake Inhibitor (SSRI) often lessens a child's anxiety, giving other forms of treatment a chance to work.

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Behavior therapy has proven to be very effective in the treatment of OCD. A form of behavior therapy found to be particularly effective in dealing with OCD is exposure and response therapy. In this type of therapy the patient is exposed to whatever he fears, and is subsequently encouraged to not engage in his compulsion for a period of time, which is increased by increments with each treatment. With cognitive therapy the goal is to change the irrational belief system of the sufferer, to get them to realize that even though their obsessive thoughts make them very anxious, they can be safely ignored. According to Dr. Swedo, the response rate of children 8-14 years old to the combination therapies of medication and Cognitive Behavioral Therapy is similar to the response rate in adults.

Obsessive Compulsive Disorder is responsive to treatment, although that treatment may be hard work, for both child and parents. In the past few years there has been a considerable increase in the numbers of resources to help parents cope with their child's disorder.

The Cleanest Kids on Earth: Obsessive Compulsive Disorder in Children

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The Cleanest Kids on Earth:
Obsessive Compulsive Disorder
in Children