OCD in Children

Both children and adults are susceptible to OCD. OCD in children is usually hereditary, while OCD that shows up in adulthood is not thought to have genetic causes. At present, the exact causes of OCD are unknown.

Obsessive-Compulsive Disorder, or OCD, is a cognitive disorder characterized by a person's thoughts being stuck on one particular idea, creating a need to do tasks repeatedly to relieve the fixation. OCD stems from a problem in brain pattern communication that causes thoughts to repeat continuously.

This obsessive thought pattern is distressing to the individual, as he recognizes the thought as being unreasonable but is unable to stop it from repeating. He develops a series of compulsive behaviors that he believes will control the obsessive thoughts. These behaviors may include counting, repeated hand washing, repeated time-consuming rituals or an extreme need for order.

Signs of OCD in Children
Children are learning to make sense of the world, and feel secure with routine. Some routines are normal and help a child feel comfortable. An example of this is bedtime rituals. A child without OCD may need his door open, his night-light on, the music playing, a hug, kiss and drink of water (in that order) and a bedtime song in order to feel ready to go to sleep. This is not cause for alarm.

Contrast this with a child who is afraid of leaving the house before washing her hands for 15 minutes, or who needs to check that her teddy bear is in her bed many times before she is able to leave. Not doing the ritual causes great distress, tantrums, rage, crying or extreme anxiety. When parents attempt to control compulsive behavior, the child exhibits extreme emotional reactions.

Obsessive-compulsive rituals take time, often making a child late for bed, late for school or other functions, and interfering with daily life. Children with OCD often recognize that they are different, and try to hide their compulsions from their peers. Peers often react negatively toward a child with compulsive behavior, making it hard to keep friends. These kids worry that they may be "crazy" and don't want to have their problem, but they don't know how to stop it. This causes anxiety and anger and sometimes depression. It can also affect appetite and sleep, as many OCD issues revolve around food or the need for long repeated rituals before bedtime.

When a child's rituals are persistent, interfering with normal functioning in daily life, serve no purpose and interfere with the ability to sustain friendships, a parent should take the child to be evaluated for OCD. Delaying treatment can cause the child to develop further complications caused by dealing with the stress of OCD, including depression and anxiety related disorders.

OCD Diagnosis
It may be difficult to get OCD properly diagnosed. OCD is often found in combination with other disorders, including Tourettes Syndrome, ADHD, oppositional defiance or other disruptive behavior disorders, anxiety disorders, hair pulling or Body Dysmorphic Disorder (imagined ugliness). OCD symptoms are more difficult to single out when other symptoms are present.

There are a small number of medical professionals trained in recognizing and treating OCD. Misdiagnosis is common, leading to delays in treatment. Some other disorders require medication, which would need to be taken along with any needed OCD medication. When treating children, a careful balance of the lowest dose needed to work effectively should be found.

Treatment Options
There is currently no cure for OCD. There are, however, therapies that can help control symptoms.

Medical treatment
There are four FDA-approved medicines for treating OCD. They are all serotonin inhibitors, which redirect serotonin and keep it from returning to the brain cells, preventing the obsessive thought. These medications are prescribed based on the individual child's medical history, possible side effects and potential interactions with any other medications the child may be taking. Since the medical treatment only manages symptoms and is not considered a cure, a year-long course of treatment is generally prescribed, with gradual reductions to see if less is needed.

Behavioral therapy
This helps control compulsive behaviors and reduces the fear of germs, disorder or other stimuli that cause extreme anxiety. The techniques involved in behavior therapy for OCD may involve exposure and response prevention. This involves exposing the child to the source of a fear and helping him control his compulsive response to the trigger. For example, a therapist will have the child touch something that he believes has germs, and then delay washing his hands to attempt to teach him to control his fear and respond in a more realistic manner.

Medication alone is not considered effective. With a combination of medical and behavioral therapy, OCD can be effectively managed, and may eventually become manageable with less medication.

Choosing a Therapist
Ask for referrals from your pediatrician and plan to interview therapists before setting up an appointment. During your interview, come prepared with specific questions related to OCD treatment. Ask yourself how you feel about the way in which the doctor answers your questions, as well as the answers themselves. A therapist must have the right demeanor and experience to help your child open up. This person will be asking your child to confront her fears and placing her in situations that trigger her anxiety. She will only be willing to do so with a person she trusts completely. Personality and mannerisms are equally as important as education and philosophies.

Questions for interviewing the child therapist:

• What technique do you use to treat OCD?
• What training have you had in treating OCD?
• What is your success rate for treating patients with OCD?
• How do you connect with a child during a session?
• Are you willing to leave your office to go to an optimal place for treating OCD if necessary?
• What is your attitude toward medication?

Treating OCD takes time and can be stressful. Remember that it is in your child's best interests to continue treatment, and it will help your child ultimately live a normal life, with increased focus, social skills and greater chances for success.