Your child clings desperately to a particular piece of clothing or a rundown toy. He/she is stuck on one game, one type of food, one way of going through his/her daily routine. He/she has little Rituals he goes through that make no sense to anyone but him/her. Could he/she have obsessive-compulsive disorder (OCD)?

What exactly is OCD?

OCD is a type of anxiety disorder. All kids have worries and doubts. But kids with obsessive-compulsive disorder (OCD) often can’t stop worrying, no matter how much they want to. And those worries frequently compel them to behave in certain ways over and over again. These kids become preoccupied with whether something could be harmful, dangerous, wrong, or dirty — or with Thoughts that bad stuff could happen. With OCD, upsetting or scary thoughts or images, called obsessions, pop into a person’s mind and are hard to shake. Kids with OCD also might worry about things not being “in order” or “just right.” They may worry about losing things, sometimes feeling the need to collect these items, even though they may seem useless to other people. Someone with OCD feels strong urges to do certain things repeatedly — called rituals or compulsions — in order to banish the scary thoughts, ward off something dreaded, or make extra sure that things are safe, clean, or right in some way.

Children may have a difficult time explaining a reason for their rituals and say they do them “just because.” But in general, by doing a ritual, someone with OCD is trying to relieve anxiety. They may want to feel absolutely certain that something bad won’t happen or to feel “just right.” Think of OCD as an “overactive alarm system.” The increase in anxiety or worry is so strong that a child feels like he/she must perform the task or dwell on the thought, over and over again, to the point where it interferes with everyday life. Most kids with OCD realize that they really don’t have to repeat the behaviours over and over again, but the anxiety can be so great that they feel that repetition is “required” to neutralize the uncomfortable feeling. And often the behavior does decrease the anxiety — but only temporarily. In the long run, the rituals may worsen OCD severity and prompt the obsessions to return.

What is causing OCD?

Doctors and scientists don’t know exactly what causes OCD. Experts however believe OCD is related to levels of a neurotransmitter called serotonin. Neurotransmitters are chemicals that carry signals in the brain. When the flow of serotonin is blocked, the brain’s “alarm system” overreacts and misinterprets information. These “false alarms” mistakenly trigger danger messages. Instead of the brain filtering out these messages, the mind dwells on them — and the person experiences unrealistic fear and doubt. Evidence is strong that OCD tends to run in families. Many people with OCD have one or more family members who also have it or other anxiety disorders influenced by the brain’s serotonin levels. Because of this, scientists have come to believe that the tendency (or predisposition) for someone to develop a serotonin imbalance that causes OCD can be inherited.

Having the genetic tendency for OCD doesn’t mean that someone will develop OCD, but it does mean there’s a stronger chance that he or she might. Sometimes an illness or some other stress-causing event may trigger the symptoms of OCD in a person who is genetically prone to develop it. It’s important to understand that the obsessive-compulsive behavior is not something that a child can stop by trying harder. OCD is a disorder, just like any physical disorder such as diabetes or asthma, and is not something kids can control or have caused themselves. OCD is also not something that parents have caused, although life events (such as starting school or the death of a loved one) might worsen or trigger the onset of OCD in kids who are prone to develop it.

Common OCD behaviours in kids:

OCD can make daily life difficult for the kids that it affects and their families. The behaviours often take up a great deal of time and energy, making it more difficult to complete tasks, such as homework or chores, or to enjoy life. In addition to feeling frustrated or guilty for not being able to control their own thoughts or actions, kids with OCD also may suffer from low self esteem or from shame or embarrassment about what they’re thinking or feeling (since they often realize that their fears are unrealistic, or that their rituals are not realistically going to prevent their feared events). They also may feel pressured because they don’t have enough time to do everything. A child might become irritable because he or she feels compelled to stay awake late into the night or miss an activity or outing to complete the compulsive rituals. Kids might have difficulties with attention or concentration because of the intrusive thoughts.

Diagnosing OCD

OCD is more common than many other childhood disorders or illnesses, but it often remains undiagnosed. Kids might keep the symptoms hidden from their families, friends, and teachers because they’re embarrassed. Even when symptoms are present, a parent or health care provider might not recognize that they are part of a mental health disorder and may attribute them to a child’s quirkiness or even bad behavior.

Doctors consider OCD to be a pattern of obsessive thinking and rituals that does one or more of the following:

• takes up more than an hour each day
• causes distress
• interferes with daily activities

OCD in kids is usually diagnosed between the ages of 7 and 12.

If I had a world of my own, everything would be nonsense, nothing would be what it is because everything would be what it isn’t, and contrary wise; what it is it wouldn’t be, and what it wouldn’t be, it would, you see? ~ Alice in Wonderland

In screening for OCD, the doctor or a mental health professional will ask your child about obsessions and compulsions in language that kids will understand, such as:

• Do you have worries, thoughts, images, feelings, or ideas that bother you?
• Do you have to check things over and over again?
• Do you have to wash your hands a lot, more than most kids?
• Do you count to a certain number or do things a certain number of times?
• Do you collect things that others might throw away (like hair or fingernail clippings)?
• Do things have to be “just so”?
• Are there things you have to do before you go to bed?

Because it might be normal for a child who doesn’t have OCD to answer yes to any of these questions, the doctor also will ask about how often and how severe the behaviours are, about your family’s history of OCD, Tourette syndrome and other motor or vocal tic disorders, or other problems that sometimes occur with OCD. OCD is common in people with Tourette syndrome. Other disorders that often occur with OCD include other anxiety disorders, depression, disruptive behavior disorders, attention deficit hyperactivity disorder (ADHD), learning disorders, and trichotillomania (compulsive hair pulling). PANS, a rare condition that stands for Pediatric Acute-onset Neuropsychiatric Syndrome, also has been associated with having OCD.

Remember That No One’s at Fault!

You must know and believe that your child is not trying to aggravate you with obsessive-compulsive behaviour, no matter how annoying it may be. He or she can’t help it — OCD is a biochemical brain glitch, not a psychological condition, and the behaviours most likely annoy your child even more than they annoy you. OCD has nothing to do with your parenting skills, your neurosis, or anyone’s neurosis, any more than the chickenpox or the flu. And although this is especially difficult for parents, whose instincts tell them to do all they can to ease their child’s pain, understand that you are not helping your child by participating in his or her obsessive-compulsive rituals. The best thing you can do is help your child learn to stop.

Symptoms of Obsessive Compulsive Disorder in Children:

The following true/false questionnaire can be used as a screening tool to help describe OCD symptoms in children:

1. Child leaves the restroom a mess including toilet paper on floor, wet sink surface and toilet not flushed.
2. Child expresses need to conquer, defeat or have victory over a sibling.
3. Child avoids looking at a sibling who is seeking parental attention.
4. Child often lines up dolls, cars, or other objects during play.
5. Child often craves white sugar treats such as cookies, candy and cake.
6. Child often craves white flour carbohydrates including crackers, macaroni and cheese and pizza.
7. Child’s daily separation from parent involves a ritual.
8. Child’s preparations for bed involve a rigid ritual.
9. Child reads well but has low comprehension.
10. Child tends to get “stuck” more when sleep hours are reduced.
11. Child must have a parent beside her to fall asleep.
12. Child has difficulty knowing if she completed something or just thinks that she did.
13. Child awakes during night if parent leaves the sleeping perimeter.
14. Child often gets stuck on any minor interpersonal disagreement that is long over for others involved.
15. Child fusses over clothing that “doesn’t feel right”.
16. Child does not like to place trash in a public trash can.
17. Child makes hateful statements such as “I hope you die” then follows with being loving soon thereafter.
18. Child gets upset when an object goes out of sight i.e. airplane, toilet water, bath water, etc.
19. Child requests that things be said a certain way i.e. baby doll vs. doll baby.
20. Child repeats parts of a prayer until they “feel” right.
21. Child repeats certain movements such as touching and retouching a chair or light switch.
22. Child repeatedly goes through a doorway until he passes through just right.
23. Child does not want her room, cloths or toys touched or moved by others.
24. Child asks, “Is it OK?” repeatedly.
25. Child wants someone else to do things for her that she can easily do for herself.
26. Child avoids certain numbers such as “6” and loves certain numbers like “4” or “7”.
27. Child requires a certain comfort item such as her blanket and a substantial meltdown will occur if this item is misplaced.
28. Child asks the name of a substance or the cause of every stain she sees.
29. Child avoids touching items with stains on them.
30. Child avoids touching public chairs, desks, bleachers etc. out of fear for the hygiene of the previous user.
31. Child asks “what if” questions that others would not, ie. “What if that dust falls off that fan onto my head?”
32. Child requires the exact same routines of others.
33. Child limits food choices to less than 10.
34. Child has more “stuck” moments at home than at school or at a friend’s home.
35. Child has to fully explain minor situations thoroughly and believe that you have understood.
36. Child requires that she be washed more than one time in shower/bath.
37. Child is very difficult to “move along” when she must get ready to leave.
38. Child may use words like “kill”, “hate” or “die” inappropriately in an effort to “conquer” some thought.
39. Child uses cuss words when stuck, and this is not his normal daily language.
40. Child picks skin irregularities, especially if a bite, bump or cut exists.
41. Child needs to do something much worse and often unreasonable to another who has slighted her.
42. Child has written parts of cuss words on expensive items.
43. Child may state that brushing hair “hurts” and may resist this activity.
44. Child often “retaliates” at a parent for saying “no” to something he is set on.
45. Child requires that everything be done a certain way, yet personal belongings are preferred to be in disarray.
46. Child moves about room with excessive energy, often making repetitive sounds.
47. After the child understands death, she seeks reassurance of being heaven-bound.
48. Child fears nearby use of products containing bleach or ammonia.
49. Child may fear individuals whose hygiene appears compromised.
50. Child is very quick to announce his feeling about smells, and is upset if the scent of the air isn’t desirable.
51. Child worries that someone may die if she does not do certain rituals.
52. Child may become disturbed by hair that looks greasy or dirty.
53. Child fears that his parents may die in a car accident.
54. Child fears contracting AIDS or some serious unknown illness from casual contact with a person, gum, or saliva.
55. Child excessively texts, calls or checks on a friend or loved one.
56. Child repeatedly asks questions about tornados, storms, tsunami’s, volcanoes or other news stories.
57. Child is preoccupied with getting cancer, when no known medical validation exists.

This completes the SLOCC Checklist, which is designed to help identify symptoms of Obsessive Compulsive disorder in children. Please take this with when visiting your pediatrician or treating doctor.

Treating OCD:

The most successful treatments for kids with OCD are behavioral therapy and medication. Behavioral therapy, also known as cognitive-behavioral psychotherapy (CBT), helps kids learn to change thoughts and feelings by first changing behavior. Behavioral therapy involves gradually exposing kids to their fears, with the agreement that they will not perform rituals, to help them recognize that their anxiety will eventually decrease and that no disastrous outcome will occur. For example, kids who are afraid of dirt might be exposed to something dirty, starting with something mildly
bothersome and ending with something that might be really dirty. For exposure to be successful, it must be combined with response prevention, in which the child’s rituals or avoidance behaviours are blocked. For example, a child who fears dirt must not only stay in contact with the dirty object, but also must not be allowed to wash repeatedly. Some treatment plans involve having the child “bossing back” the OCD, giving it a nasty nickname, and visualizing it as something he or she can control. Over time, the anxiety provoked by dirt and the urge to perform washing
rituals gradually disappear. The child also gains confidence that he or she can “fight” OCD.

OCD can sometimes worsen if it’s not treated in a consistent, logical, and supportive manner. So it’s important to find a therapist who has training and experience in treating OCD. Just talking about the rituals and fears have not been shown to help OCD, and may actually make it worse by reinforcing the fears and prompting extra rituals. Family support and cooperation also go a long way toward helping a child cope with OCD. Many kids can do well with behavioral therapy alone while others will need a combination of behavioral therapy and medication. Therapy can help your child and family learn strategies to manage the ebb and flow of OCD symptoms, while medication, such as selective serotonin reuptake inhibitors (SSRIs), often can reduce the impulse to perform
rituals.

Helping Kids With OCD:

It’s important to understand that OCD is never a child’s fault. Once a child is in treatment, it’s important for parents to participate, to learn more about OCD, and to modify expectations and be supportive. Kids with OCD get better at different rates, so try to avoid any day-to-day comparisons and recognize and praise any small improvements. Keep in mind that it’s the OCD that is causing the problem, not the child. The more that personal criticism can be avoided, the better!

The Sensory Integration Difference

We know now that the course of OCD is unknown, but a genetic connection is suspected. Children who have one parent with the disorder are as much as 8% more likely to be diagnosed with it.
Urges or tics seen in individuals with OCD may be due to a sensory processing disorder. If your child is hypersensitive to information coming in through his/her senses — that is, he/she perceives a threat from a touch or sight or sound that others would find harmless — he/she may set up routines and defences for herself that could be mistaken for OCD.

Additionally, if he/she has problems with planning out how to do a particular activity, he/she may become strongly attached to the one way of doing it that he/she has already worked out, or he/she may stick stubbornly to activities that are much simpler. In both cases, though, he/she will likely be open to other alternatives that achieve the same effect. He/she may be willing to change routines if you very patiently teach her how to do it differently. A child with OCD is obsessed with things that aren’t real and develops compulsions to deal with them, whereas a child with sensory integration disorder is bothered by real things in his/her environment and develops routines and defences to deal with them. If you can change those real things, you can most likely change the behaviours.

I have got this obsessive compulsive disorder where I have to have everything in a straight line, or everything has to be in pairs. ~ David Beckham

Bronnelys / Resourses:

1. Google: Obsessive compulsive disorder — info-ocfoundation.org
2. OCD — helpguide.org
3. Obseessive compulsive disorder—Wikipedia—the free Encyclopedia
4. Google: quotes on OCD
5. OCD—anxiety BC
6. OCD—kidshealth
7. Google: YBOC—symptom—checklist
8. Notes on sensory integration from previous courses