Obsessive-Compulsive Disorder and Kids

OCD can Affect Children and Teens

Deciding whether to talk to a professional about your child and OCD can be daunting. Even if you suspect that something is upsetting your son or daughter, or that they behave differently than other kids, you may feel as to unsure what to do about it. Understanding OCD better and learning about what it looks like in kids is one of the best first steps in making that decision.

What is OCD?

OCD stands for Obsessive-Compulsive Disorder. The defining feature of OCD is experiencing thoughts, mental images, impulses, or actions that are repeated, intrusive, and unwanted. Such thoughts or actions take up a lot of time and energy, affect a person’s day-to-day functioning, and are distressing to the person who has them. They know that they don’t want to think about or do these things over, and over, and over, and over again but can’t seem to help it. Feelings of anxiety and fear often come with these thoughts, even though logically there is no true threat. OCD causes these unrealistic fears or worries to replay in a person’s mind, as if there is no off-switch to the thoughts and feelings.

The average age of onset is 19.5 years but childhood onset is also very common. By late adolescence, OCD has a lifetime prevalence rate of 2-3%, which translates to 1,000,000 afflicted youth ages 10-19. Childhood OCD is associated with high rates of co-occuring disruptive, tic, and developmental disorders, as well as major depressive disorder and separation anxiety.

The worries attached to OCD vary greatly and can be about almost anything. Contamination worries (fear of germs or dirtiness) is a more common type of OCD. Other types include perpetual doubts, religious thoughts, sexual or aggressive thoughts (even in children), worries about symmetry or evenness, hoarding, and bodily obsessions.

What would OCD look like in my child?

Your child may require regular reassurance against their fears.

It is important to know that repetitive or ritualistic behaviors is normal for children between about 1.5-3 yrs old. Repetition is one of the earliest forms of learning, and in this age range kids will often repeat new words, facial expressions, physical movements, or experiences they’ve had or witnessed. This period can last longer in children who have developmental delays or intellectual disabilities.

OCD in childhood usually starts near the onset of puberty (8-12) or the onset of early adulthood (late teens to early twenties), but can start at other ages too. Younger children often try to ignore obsessions, and might say at first that they aren’t bothered by them. Alternatively, they might act out compulsions more quickly as a way to cope with obsessions. Your child may require regular reassurance against their fears.

School-age children and teens can have difficulty socializing with others due to the OCD. They may be bullied by peers for their odd behavior, or spend time hiding their OCD that takes away from normal socialization. Kids of this age are likely to have obsessions or compulsions related to schoolwork, and may turn in work that is incomplete because their obsessions prevented them from finishing it until it was 'just right' or perfect. They often develop fears about what teachers and peers might think of them, or their schoolwork.

Shame and embarrassment are common.

Feelings of shame and embarrassment can plague the lives of people who have OCD. Even younger children often become quickly aware that others don’t have obsessions or compulsions like they do. Their peers are usually too young to understand why they are different, and might bully them or make fun. If that wasn’t enough, kids can also see that their parents and siblings don’t have obsessions or compulsions either and may worry about what their own family thinks of them.

If you’re the parent of a kid with OCD, this challenge is twofold, because sometimes the behaviors your kid engages in are embarrassing and confusing to you! You know that they obsessions and compulsions don’t make sense, and might worry that other people will judge your child.

What can mental health professionals do to help?

One of the best parts of therapy is knowing that you have someone ‘in your corner’ who won’t judge. A therapist can help you and your child deal with feelings of shame, learn more about OCD, and build coping skills for awkward social situations. In this sense, therapy provides quick relief and hope to many parents.

That said, finding a therapist who is well-trained in treating childhood OCD is extremely important. Many therapists are unfamiliar with OCD symptoms and only minimally trained in dealing with them. At the Louisville OCD Clinic, our therapists are trained and supervised in Exposure and Response Prevention Therapy (EX/RP), one of the best therapies for OCD. In EX/RP, a therapist will address thoughts, feelings, and behaviors with your child. It is focused on understanding symptoms, learning to become stronger in the face of anxiety, reducing compulsions, and developing management skills to reduce OCD’s effect on your family life.

Mental health concerns of any kind are a challenge, but they don’t mean your child can’t be successful. We believe success (whether social, school-related, or otherwise) depends more on whether challenges are addressed in productive way. Although OCD symptoms may wax and wane, the disorder tends to get worse over time if left untreated. By getting help for your child now, you reduce the impact the diorder with have on his or her future.

What would treatment look like?

At our clinic and many others, treatment begins with a consultation session. To get one, you will need to call the clinic to schedule the session and give some information so that the office may start a case file for your child. It's advisable to show up early for a first appointment, since you will likely have paperwork to fill out.

In the consultation session, you and your child will meet with a therapist who will listen to your concerns about your child, answer your questions, and ask questions about your child's symptoms to figure out the best course of treatment. The therapist should also tell you about the therapy offered, begin scheduling any necessary psychological tests, and answer any questions about fees and payment you might have.

OCD treatment is most successful when clients start with at least two sessions per week, but at least one session per week is necessary for most people. Depending on the severity of your child’s symptoms, the frequency of sessions might reduce as they start to improve.

During EX/RP therapy, your child’s therapist will identify their specific obsessions and compulsions and talk about thoughts and feelings related to them. The therapist will also create a subjective scale that reflects your child’s unique anxiety levels related to their OCD worries. Then, gradually, the therapist will work with your child to confront situations in which they are exposed to some of their worries. This will help your child manage feelings that come up during exposure, teach them coping skills for dealing with these thoughts and feelings, and help them separate feared outcomes from realistic outcomes. In this way, EX/RP helps your child master a set of skills that can be applied not only to current OCD worries, but also other worries that may develop in the future.

Some parents worry that “exposure” sounds frightening and may be too intense or upsetting for their child, but this is why the therapist works to create the unique anxiety scale. This scale is specific to your child and helps the therapist plan unique exposures that are doable. The idea is for exposures to be challenging but not overwhelming. The intensity of exposures increases gradually, with time for emotional and mental processing in-between.