Obsessive-Compulsive Disorder in Children and Adolescents - Symptoms, Diagnosis and Treatment of OCD in Children

Written by Carol E. Watkins, MD

There are now several SSRI medications. They include Fluoxetine (brand name Prozac) Fluvoxamine (brand name Luvox) Paroxetine (brand name Paxil) and Sertraline (brand name Zoloft). All seem to be effective at reducing the symptoms of OCD, but different ones may be best for individual patients. Fluoxetine has the advantage of being available in liquid form. Using the liquid, one can start at very small doses and titrate the dose gradually. Common side effects include headache, GI complaints, tremor, agitation, drowsiness and insomnia. These medications may affect how other drugs are broken down in the liver. One must use caution when mixing medications. If a child taking an SSRI, it is a good idea to consult one's physician or pharmacist before taking other prescription or even non-prescription medications. Many children take a long time to achieve a good response to medication. 10 to 12 weeks is not uncommon. Some children will respond to one medication but not to another.

Dealing with Recurrences

Education about OCD often an early part of the therapy. Both parents and child are included. It is important for them to continue the education process. A good understanding of the disorder can help the child and family feel a greater sense of mastery and control.

The process of education should extend on after the end of the therapy. It can occur through reading age-appropriate books, attending support groups or having group therapy with peers. I have listed some recommended books and support groups at the end of the article. Secrecy and shame are common in individuals with OCD. Education and the support of others can help the individual keep the disorder in perspective.

Children and families should be aware that OCD can be chronic and that symptoms may return months or years later. Some children will schedule "check up" sessions every six months or each year. If symptoms reoccur, they may return to therapy for a shortened version of their previous treatment.

Suggested readings and Internet Links

Brain Lock: Free Yourself from Obsessive-Compulsive Behavior by Jeffrey M. Schwartz 1996, Regan Books. This book is primarily aimed at adults. However, I have found it useful for adolescents and for relatives of the child or adolescent with OCD. Dr. Schwartz discusses both the causes and symptoms of OCD. He then suggests a four-step self-help approach to help the individual deal with the symptoms of OCD. For those who do not want to read the entire book, he provides a summary of the basics of the four steps near the end of the book. Some individuals may be able to use the book to deal with the OCD by themselves. I prefer to use it with patients as an adjunct to therapy and as a reminder between sessions.

Blink, Blink, Clop, Clop: Why Do We Do Things We Can't Stop? by Moritz and Jablonsky, ChildsWork, ChildsPlay (1998) This illustrated book explains OCD to elementary-aged children. It uses the metaphor of farm animals who are tormented by "O.C.Flea." It can be a useful story early on in the child's therapy. This book is probably best read with or to a child. Some of the concepts and vocabulary are more advanced and should be explained.

OCD in Children and Adolescents: A Cognitive-Behavioral Manual by John March and Karen Muller, 1998, The Guilford Press. This book is fairly technical and is aimed at psychiatrists and other mental health professionals. This book contains the excellent cognitive-behavioral protocol that Dr. March has been using successfully with children and adolescents with OCD. The book also discusses in more depth special considerations in treating OCD as it occurs in children.

AACAP, (1998) Practice Parameters for the Assessment and Treatment of Children and Adolescents with Obsessive-Compulsive Disorder, Journal of the American Academy of Child & Adolescent Psychiatry, 37:10;27s-45s.

American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders, 4^th Edition (DSM-IV) Washington, D.C. American Psychiatric Association.

About the author: Carol E. Watkins, MD is Board-Certified in Child, Adolescent and Adult Psychiatry and is in private practice in Baltimore, MD.

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