OCD in Kids
Obsessive-Compulsive Disorder (OCD) is not just a disorder that occurs in adulthood, as it can present in early childhood and adolescence as well. The gold-standard treatment for OCD is exposure and response prevention (ERP). Early detection and treatment is associated with better treatment outcomes, regardless of the age of onset of symptoms.
The core components of OCD, regardless of age of the patient, include obsessions and/or compulsions.
Obsessions are intrusive and unwanted thoughts, images, or urges (e.g., having the worry of: “If I touch that, I’m going to get sick”).
Compulsions are behaviours that one feels they have to engage in, in order to get rid of the obsession (e.g., Washing hands several times, in a specific way, after touching a doorknob). Sometimes, kids believe that engaging in their compulsions prevent something bad from happening (e.g., they have a phrase that they need to say to their parent at bedtime and if they don’t say it, something bad will happen).
Common themes of obsessions in childhood may include:
Contamination, including worries about germs, getting sick, or dying
Intense fear and worry about something bad happening, or doing something wrong
Disturbing or unwanted thoughts or intrusive images of harming others, or disturbing and unwanted thoughts or intrusive images of a sexual nature (more relevant for older children, teens, and adults)
Common compulsions in childhood may include:
Checking behaviors (e.g., the door is locked, the pet is inside the home)
Excessive washing or cleaning, of themselves or their environment
Feeling the need to repeat actions until it feels “just right” (e.g., turning lights on and off until it feels right, tapping each knee until it feels right to stop)
Arranging and ordering toys or objects in a specific and particular order
Mental compulsions (e.g., saying a phrase in their head in order to prevent something bad from happening)
Excessive reassurance seeking (e.g., always asking if something or somebody will be okay, above and beyond what may be considered developmental normal or typical)
Of course, many of these behaviors are normative in some cases, and all behavior exists on a continuum. One important distinction when differentiating normative rigidity from OCD symptoms is the level of distress and impairment that is associated with these symptoms, and more specifically with the inability to complete the compulsions.
Often, those with OCD will be distressed more frequently, more intensely, and for longer periods of time than their peers in similar situations. Further, children with OCD will spend a lot of time caught up in the obsessions and compulsions, which prevents them and their families from completing many other tasks in a timely manner.
For example, it is expected that a young child may become distressed by deviations in their routines or rituals, but they may also be able to move on with the rest of their day after a few moments of dysregulation. Whereas a child with symptoms of OCD will not be able to move on easily- it may take much longer and would include needing to complete the associated compulsions.
If you or your family could benefit from a discussion about normative routines and rituals vs symptoms of OCD in kids, please speak with your psychologist.
