Building Awareness: OCD and Children
Think for a second about the words Obsession Compulsion Disorder, what type of picture pops into your mind?
Someone wiping down the same surface over and over again?
A person shutting a door three times before they leave their house?
An adult feeling uncomfortable with shaking another person's hand?
Movies and TV Shows love to stereotype OCD as either an all out cleaning obsession or fixation about numbers. However the picture is much bigger, less comical, and more hidden, than you may see on a screen. Additionally, there is a huge population that most media tends to leave out when it comes to showing OCD on the screen: Children.
Obsession Compulsion Disorder is one of the most misunderstood mental health disorders. Think about it, how times have you known someone to say, "I'm just a neat freak, I must have OCD!". Not only are comments like these in poor taste, they de-minimize a disorder that affects many people, children included. The general public associates OCD with cleaning, counting, being particular about organizing; yet they know very little beyond these stereotypes. It is important to discover the truth behind OCD and how it impacts the lives of children.
The week of October 11th to 17th is Obsession Compulsion Disorder Awareness Week. I welcome you to come along with me as I explore and expand more awareness towards how OCD affects children, learn what are some true facts about OCD, and how therapy and parental intervention can be helpful with OCD.
As in writing about any mental health disorder, I can not speak directly for those who are suffering, or who's loved ones are suffering, from any particular disorder. I only seek to provide knowledge from creditable sources, awareness of facts, and hopefully comfort to the general public about mental health topics.
Let's Get Basic: What really is Obsession Compulsion Disorder?
Obsession Compulsion Disorder, in both adults and children, is essentially divided into two major parts, obsessions and compulsions. The two play a part in influencing one another.
Obsessions are intrusive or repeated thoughts that cause a child distress, fear, or anxiety surrounding thinking about the thought. Although the thought may not make complete sense to the child, it is still painful to think about. There are many different fear categories that obsessions can fall in.
1) The fear of harm, that someone will get hurt or sick, and that the child may be responsible for the harm.
2) The fear of contamination, that something is dirty, germy, or related to coming in contact with bodily fluids that aren't one's own.
3) The fear of violating the rules, religious rules, saying a bad word, or doing a bad thing, therefore being thought of as a bad person.
4) Obsessions can also be related for the need for things to be symmetrical or perfect. These can be known as the fear of things not placed in a particular way, or things will go bad if not executed perfectly.
Obsessions can either come in the form of ideas or images. They also can not just 'go away'; a child having these thoughts does not ask for them nor want to have them. Children may have specific obsessions relating to family members, such as a fear that a parent may be harmed and that the child may be at fault for the harm.
The goal of compulsions are to ease the mind of anxiety caused by the obsessions. Compulsions are rituals performed by the child, which could be done mentally, or physically, and are done repeated until the obsession is "made right" and the threat is no longer a possibility of happening. Usually the compulsion matches the obsession in terms of category and level of intensity. Common compulsion behaviors include checking, washing, cleaning, going in and out of a certain space, repeating a word or phase, re-doing things, re-writing words, arranging items, hoarding items, and seeking reassurance for doing things right. Compulsions can be one ritual, or a combination of different rituals.
Obsession Compulsion Disorder affects around 1% of school age children, with the earliest age being around five years old, and the average age of onset around ten years old. Younger child, due to a lack of developed insight, have a more difficult time recognizing exaggerated thoughts or behaviors, therefore have a more difficult time identifying OCD thoughts. Many older children and teenagers tend to hide and suppress their OCD thoughts and behaviors at school and in public, in order to fit in, and then engage in their routines in the comfort of their home for hours.
Like, any mental health diagnosis, an officially diagnosis from a medical doctor, psychologist, or psychiatrist, is needed. It is uncertain of what directly causes OCD in children. An interview process and simple screenings are typically used to diagnosis OCD, as there is no lab tests for OCD. There is no one size fits all blueprint for OCD, every child has their own unique obsessions and compulsions.
Closer Look: Typical OCD Behaviors in Children
A lot of time, Obsession Compulsion Disorder behaviors are easily hidden and hard for parents to see in their children. Remember, only a medical doctor, psychologists, or psychiatrists can truly diagnosis OCD. However there are some signs to be aware of possible OCD , if a child is exhibiting these certain behaviors on a daily basis. Getting distressed or angry if something isn't perfect, taking more time than needed typically to do everyday tasks like getting dressed or showering, have a difficult time choosing between choices, always asking if things are okay, or insisting that adults not say certain things, or say certain things in an exact way, may all be signs of OCD.
There are only a few differences between adults and children with OCD. As stated more, children may have more family or parent related obsessions, while adults may have a larger pool of obsessions. Children tend to not have sexual related obsessions, as some adults may have. Compulsions in children may included more reassuring questions, questions about the future, or hoarding. Boys tends to develop OCD symptoms before puberty, while girls tend to show more symptoms during or after puberty. ADHD and tic disorders are also common co-morbid diagnoses with childhood-onset OCD.
How can we tell if behaviors are developmentally appropriate for children, or may be considered more fitting into OCD Behaviors? Typically, the behavior being either distressful for the child to perform, or must be done precisely to prevent adverse consequences, makes a behavior fall more into the OCD realm of behaviors. Compulsions are not fun tasks for the child, and they cause the child to go out of their normal routine to complete them. Compulsions tend to increase over time and become more demanding of a child's time. A normal task or routine would change as a child losses interest in the routine, or finds a new hobby.
The Next Step: What Parents Can Do To Help
Treatment for Obsession Compulsion Disorder is a combination of medication and therapy. Cognitive Behavioral Therapy, CBT, and Exposure and Response Prevention, ERP, are the two types of therapies with the best results in treating OCD in children. Cognitive Behavior Therapy focuses on modifying thoughts and behaviors and developing alternate coping strategies. Exposure and Response Prevention helps children externalize the OCD symptoms and gradually increase their tolerance towards the anxiety that OCD produces. Medications for OCD typically include SSRI's, Selective Serotonin Reuptake Inhibitors, which help reduce anxiety. Children who received the combination of both medication and therapy showed better results than children who just went the medication route. Parents being proactive in their child's treatment is one of the major contributors to successful treatment. Family therapy may be an option for families who want to increase their support and communication for their children diagnosed with OCD.
As parental support in treatment is so important in helping with Obsession Compulsion Disorder, at home intervention and support is as equally important. Turning Point Psychological Services has outlined some great tips on how parents can work with and support their child at home. Here are some key summarized points for parents to consider while helping their child.
Normalize It. Many children believe that they are the only one with obsessions and compulsions and therefore hide it from others because it is embarrassing. Explain to your child that may children have similar thoughts and rituals, and what they are thinking and doing is part of normal OCD. Tell your child that you are there to help them fight the obsessions and compulsions. However, do not find yourself just telling your child that everything will be okay, or help them complete rituals as that will only temporary ease the anxiety.
Externalize It. Explain to your child that OCD is like a 'Bully', and that the obsessions are a separate part of who they truly are. By labeling OCD as a separate part, it allows your child to fight back against it, without feeling like they have to fight against themselves. The Bully will try to knock them down with obsessions. However talking back to the Bully, and not following through with compulsions, will help make your child stronger, while decreasing the power of the Bully.
Challenge It. Encourage your child to not give into the 'Bully' for any long rituals, as that will just give the bully more power. Explain to your child that if they don't listen to the Bully, that the fear will eventually pass, and that you are there to help them sit and talk through it. Try alternative coping strategies with your child when they express thoughts of obsessions. Learning alternative coping strategies could gradually decrease the time spent on rituals.
Education Yourself As a Parent. Learn more about OCD from your child's doctor or therapist, and ask for more activities you can do at home with them. NEVER yell at or punish your child for expressing obsessions and compulsions. Be on the lookout for new rituals and help challenge them. Encourage your child when they spends less time on a ritual and show them that you've noticed them working hard.
Remember, Obsession Compulsion Disorder, although a very stereotyped disorder, is very real to the individuals who have been diagnosed with it. Although you may not be a parent or family member who is helping their child conquer OCD, you can help too by stopping the stigma beyond mental health disorders and conditions. Point out to friends and colleagues when they make a generalization, or joke, about mental health disorders that it is very insensitive. Bring up facts and knowledge you know about mental health disorders to educate others on things that may be misrepresented on social media or TV. Above all, be supportive of the mental health community and be aware of any future mental health related awareness days, weeks, or even months.
ADAA. (2020). Information for Parents: Behaviors That Could Be Symptoms of OCD. Retrieved October 15, 2020, from https://adaa.org/understanding-anxiety/obsessive-compulsive-disorder-ocd/symptoms/info-for-parents
Chansky, T. (2000). Obsessive Compulsive Disorder vs. Normal Child Behaviors. Retrieved October 15, 2020, from https://www.upmc.com/services/behavioral-health/ocd/symptoms/ocd-versus-normal
Child Mind Institute. (2020, July 30). Obsessive-Compulsive Disorder Basics. Retrieved October 15, 2020, from https://childmind.org/guide/obsessive-compulsive-disorders/
Hasan, S. (Ed.). (2017, June). Obsessive-Compulsive Disorder (for Parents) - Nemours KidsHealth. Retrieved October 15, 2020, from https://kidshealth.org/en/parents/ocd.html
Jerry Bubrick, P. (2020, August 17). Why Behavioral Therapy Is the Best Way to Treat OCD in Kids. Retrieved October 15, 2020, from https://childmind.org/article/behavioral-therapy-treat-ocd-in-kids/
Owen Kelly, P. (2020, January 23). OCD in Children Differs From Adults. Retrieved October 15, 2020, from https://www.verywellmind.com/ocd-in-children-2510658
Prudovski, A. (2019, December 03). Don't Argue With a Brain Glitch. (10 Do's and 5 Don'ts for Parents of Kids with OCD). Retrieved October 15, 2020, from https://www.turningpointpsychology.ca/blog/children-with-ocd-guidelines-for-parents