OCD in Children

Obsessive-compulsive disorder in children, also called 'paediatric OCD' or 'early onset OCD', is diagnosed less in the UK than the USA. But in the last two years we have seen big leaps in how we understand and diagnose OCD in adults. Does that mean the conversation about OCD in kids will grow here also?

OCD revolves around just what it says-- obsessions and compulsions.

Obsessions are distressful and repetitive thinking patterns that come in the form of ideas, images, or impulses. You can’t stop having them, try as you might.

Compulsions are repetitive behaviours or rituals you can’t stop doing because you believe that by carrying out the compulsion you will save yourself or someone else from danger. If you don’t carry out the behaviour you feel so anxious or uneasy you eventually given in to the urge.

It’s now understood that while most forms of OCD involve both obsessions and compulsions, sometimes someone can be mostly just caught up in obsessions, or mostly just caught up in compulsions.

In America there is a belief is that OCD can start in very young children, with the International OCD Foundation even suggesting it can start as early as preschool.

In the UK, the National Institute for Health and Care Excellence (NICE) currently only recommends diagnosing and treating OCD in children from the age of eight onwards.

The first line of treatment for in the UK for kids with OCD is cognitive behavioural therapy (CBT) that uses 'exposure and response prevention' (ERP) and includes the involvement of the family and carers. SSRI medication is only considered in the case that this does not work and is carefully monitored.

A classic example here is a child who believes that if that their parents will die if they don't carefully avoid all cracks in sidewalks.

Otherwise, obsessions in children can look like:

• being very upset and scared of germs, dirt, or sickness
• fear of being unwanted
• worries something bad will happen like a fire
• scared their parents will die
• violent thoughts or thinking of taboo behaviours
• religious worries such as feeling God will punish them or they will go to hell.

And compulsions can look like:

• wanting parents to constantly check doors and windows are locked
• being obsessed with touching things a certain number of times
• lining up toys, food, etc. in an exact way or needing symmetry
• repetitively checking things like homework or erasing and redoing things
• repeatedly asking for the same reassurance from adults
• repeating numbers, words, a bible verse, a rhyme
• getting upset if a parent won’t say an exact word for them or do an exact thing
• wanting to wear the exact same outfit
• needing an exact bedtime ritual or having an eating ritual
• having a certain religious ritual.

OCD was previously thought to be an anxiety, stress-related, neurotic, or psychosomatic disorder, and was seen as a sub category of such bigger categories.

But now it’s seen as more of a brain issue, possibly linked to not enough serotonin in the brain, with a genetic influence. And brain scans show intriguing differences in places like the orbitalfrontal cortex which affects decision-making (although how to interpret such results is debated).

This understanding means that the way it is classified in diagnostic manuals has changed. In both America’s manual the ‘DSM’, and the WHO’s internationally used manual the ‘ICD’, OCD now is its own category, called “OCRD”, obsessive compulsive and related disorders.

Some researchers and international experts are going so far as to now call OCD an ‘early onset brain disorder’. Which means we might see new research into just how early that onset is.

Do we need more research? Yes. When it comes to previous research around the onset age for OCD, a lot of it is heavily dated, from as far back as the 1980s and 90s. We know more now about child development and neurodevelopment. So things that were then seen as obsessive-compulsive behaviour now might be more correctly identified as anxiety, autism spectrum disorder, or attention deficit hyperactivity disorder (ADHD).

Very young children often use rituals to self-soothe or feel at ease in a world can that feels overwhelming and that they are learning to live in. It doesn't mean they necessarily have OCD when they are simply going through a neurodevelopmental phase or time of stress.

And it’s important to make sure that your child is not misdiagnosed, as there are other issues with similar symptoms. While things like autism, anxiety, eating issues, and ADHD can occur alongside OCD, they can also be misdiagnosed as OCD.

Before assuming your child has OCD, ask questions such as:

• Has my child recently gone through a major change? New school, divorced parent, lost a family member or pet?
• Are they going through a typical neurodevelopmental stage that is leading to temporary anxiety, such as learning to be independent (walking to school alone, going to sleepovers)?
• Are these symptoms new, might they clear up naturally with time, or is this an entrenched pattern that has been going on for some time?
• Does my child share their worries with me (fear and anxieties) or do they seem to have their own world and fears they are hiding (more likely to be obsessions)?
• Am I myself as a parent very stressed, could they be picking up my own worries and compulsive behaviours?
• Are they going through puberty and could hormones be causing different behaviours?

Being open and available for your child to discuss what is upsetting and worrying them is a helpful starting point.

And note that research repeatedly supports the idea that parenting can increase your child or teen's risk for OCD, notably giving a child overwhelming amounts of responsibility, overprotective parenting and rigid rules, or allowing a child to think they caused a negative life event.

Your child needs to feel safe and secure, to feel they are accepted no matter what their behaviour, and to understand that life can be challenging at times, but that they are not to blame.

If you find it hard to veer away from such unhelpful forms of parenting, or to struggle to deal with your own life stressors and taking them out on your children, then it’s worth looking into therapy for yourself. A therapist will not judge you. They understand parenting can be a real challenge, and will create an unbiased and safe space for you to look at what drives your parenting choices, such as living through a difficult childhood yourself.

And finally, if your child has obsessive thinking or ritualistic behaviours that they refuse to talk about with you, or are leaving them struggling on a daily basis? A child therapist is a great option. They can gently help your child to question their fears and worries and learn new ways of coping.

Need help with parenting? Talk to someone who understands and can help by booking a session with a parenting therapist today.