Obsessive-compulsive disorder (OCD) is a psychological health condition characterized by intrusive thoughts (obsessions) and repetitive activities (compulsions). OCD in children may make them feel compelled to perform certain acts (compulsions) to cope with the tension caused by obsessive thoughts. These actions could potentially disrupt a child’s education and social ties. Unwanted and recurring ideas, pictures, doubts, or impulses are examples of obsessive thinking. Most children with OCD require cognitive-behavioral therapy to control their obsessions and compulsions. Read this post to learn more about the causes, symptoms, diagnosis, therapy, and techniques to manage a child with OCD at home and school.
Causes And Risks Factors For OCD
The exact cause of OCD is not yet known. However, the following factors may play a role in the development of OCD in children (1).
Some researchers suggest that it can be due to lower serotonin levels than others.
Children with a positive family history of OCD and related disorders have a higher risk of developing OCD. This may indicate a genetic basis for the disease.
Some children may have an acute onset of severe forms of OCD with distressing and confusing symptoms. The sudden onset of OCD in children is called pediatric acute-onset neuropsychiatric syndrome (PANS). Infectious diseases, such as mononucleosis, Lyme disease, flu (H1N1), and mycoplasma (causes walking pneumonia), are common PANS triggers.
If the acute onset of OCD is related to a strep infection, it’s called PANDAS (pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections). These conditions can be recurrent and often increase in severity with each recurrence. There are specialist who are learning more about PANDAS and its appropriate treatment.
OCD may be related to mental health disorders, such as body dysmorphic disorders, hoarding disorders, skin picking, trichotillomania, and tic disorders, in some children
Symptoms And Signs Of OCD In Children
Most children may not show any apparent signs and symptoms of obsessive-compulsive disorder since it has a gradual onset. Children may become obsessed with fears and worries of getting harmed or injured. They may fear injuring others or themselves or contracting a disease. These fears may compel them to do certain things to balance or neutralize its effects repeatedly. Some children are aware that the obsessions and compulsions are abnormal and try to hide them. However, many may perceive it as valid. The following behaviors are seen in children with OCD (2). Children may become distressed and anxious if they cannot carry out their compulsions or are restrained from doing them.
Diagnosis Of OCD
Symptoms may indicate OCD in children. Children could also share their symptoms since many children with OCD are aware of their unusual behavior. Multiple counseling sessions are often required for children to share their obsessions and compulsions with the pediatric counselors. Knowing the reasons for their compulsions and obsessions is necessary to diagnose OCD since the same symptoms can be seen in other disorders due to various reasons. The obsessions and compulsions are analyzed based on the DSM-5 OCD diagnostic criteria (3). Obsessions and compulsion may interfere with the child’s abilities and often result in distress. If an infection, such as PANDAS or PANS, is involved in developing OCD, doctors may refer to the concerned specialists for diagnosis and treatment of it.
Treatment For OCD In Children
The following treatments are usually given for children with OCD (4).
Cognitive-behavioral therapy is the most effective OCD treatment for children, and other treatment options are given with it. Cognitive therapy helps the child to manage obsessive thoughts without resorting to compulsive behaviors. A trainer may teach alternative methods to manage obsessions and compulsions. Other forms of cognitive-behavioral therapy involve repeated exposure and response prevention (ERP). Continuous exposure may help to overcome the fear during ERP therapies.
Medications, such as the antidepressants called selective serotonin reuptake inhibitors (SSRI), are often prescribed in some cases. Clomipramine (another type of antidepressant) is given if the SSRIs are not effective. Medications may cause side effects and may not be sufficient alone to control OCD symptoms. So doctors may suggest cognitive therapies along with medication.
Family therapy may help the family members to understand and deal with the OCD issues of the child.
Group therapy can be beneficial for older children. This involves interactions with OCD sufferers and often helps to reduce the feeling of isolation.
Antibiotic treatment is generally recommended for OCD due to PANDAS and PANS depending on the current state of infection.
If the training sessions and medical treatments are not effective in managing OCD, children may require inpatient treatment in special centers with intensive behavioral therapies.
Prevention Of OCD In Children
OCD cannot be prevented in most children since the biological factors may cause it (5). However, early diagnosis and appropriate treatment may prevent the worsening of the condition. If the child has first-degree relatives with hoarding or cleaning symptoms, seeking early medical care for obsessive behavior is recommended. Preventing infections can be beneficial if the OCD is related to streptococcal or other infections (PANDAS and PANS). Treating strep throat and other infections on time with prescription medications may reduce the incidence of neuropsychiatric complications such as OCD in some cases.
How To Help A Child With OCD At Home?
The following tips may help to manage a child with OCD at home (6).
Consistently set limits for behaviors. A child may display an outburst or meltdown in the beginning, but gradually they feel less anxious.
Ensure that the caregivers and other family members are not allowing the child to fulfill their compulsions.
Never accommodate your child’s OCD. Accommodating OCD means other family members change their habits according to the child’s wish or participate in certain activities and rituals suggested by the child. However, awareness and consideration are needed to help alleviate some of the symptoms.
Reassure the child about dealing with their compulsions and obsessions. However, do not give excessive reassurances that are a part of the child’s obsessive-compulsive behavior.
Reward and praise the child when they display voluntary efforts to curtail their obsessions and compulsions.
Parents and caregivers should understand and actively participate in child’s behavioral therapies.
Accommodating isolated OCD symptoms may eventually result in disorder. Thus, parents should take a firm stand and set limits to control OCD symptoms from its beginning.
How To Help A Child With OCD In School?
OCD children may face challenges while completing school work. They may have disputes between other students and teachers due to compulsions and obsessions. The following tips may help an OCD child cope with the curriculum and school environment (7).
Give more time to complete school works and tests since they may take more time due to extensive corrections for perfection.
Let the child use the laptop to take notes or to do assignments instead of writing. Rewriting and erasing can be problematic compared to typing and changing.
Allow fostering friendship or a buddy system to prompt them to do tasks. A peer coach who sits next to them can be helpful for many children with OCD.
Let them give tests in a private room since researchers suggest that children have more control of their thoughts and behavior in a quiet environment.
Spare reading loud tasks since children with OCD tend to reread sentences for perfection, and reading tasks can be a nightmare for them.
Listening to audiobooks can be helpful for children with OCD who take more time to read books.
Break homework into smaller sections since lots together can cause anxiety, and they may start worrying about making mistakes.
Give an escape plan from the OCD thoughts and compulsions. Let the child signal the teacher and leave the classroom if they have OCD symptoms coming in. Frequently asking permission and interrupting the class can be embarrassing and often result in bullying from other children.
Give advance notice of things since children with OCD can become more anxious and irritable due to changes in routine.
Let the child sit in a place where they can concentrate on their work better. Children with OCD may find it challenging to pay attention if they are sitting at certain places, such as near the door or window.
Peer awareness of OCD and how to behave with them can be helpful.
Awareness programs for teachers by psychologists can help them learn about common mental health disorders in children and provide appropriate facilities or permissions at school. Forcing an OCD child to be like their peers in school can be distressing and harmful for them. You may ensure to provide them special care to reach academic goals.
