Nature of Obsessions & Compulsions Among Children
Obsessions run the gamut– they can be thoughts, urges, or mental images. Whatever form they take, they are intrusive and involuntary.
Constantly creeping back, they are repetitive and persistent, but most of all unwanted. Your child gets no pleasure from these obsessions, and so cause a tremendous amount of distress and anxiety.
Some of the more common obsessions that we see in children and adolescents include the following:
- Contamination fears
- Fear of harming (oneself or others)
On the other hand, compulsions serve to relieve the stress and anxiety brought about by these obsessions. They are ritualistic, typically repetitive behavior, and can both be physical or mental acts.
The child with OCD feels driven to perform these compulsions, usually to neutralize or “fix” their state of distress, repeating as necessary until things are “perfect” or “just right”.
- Excessive washing or cleaning
- Excessive reassurance seeking
How Would I Know if my Child Has OCD?
One of the foremost experts on OCD among children is Dr. Martin Franklin, co-author of “Treating OCD in Children and Adolescents: A Cognitive Behavioral Approach”. Dr. Franklin himself has been researching this topic for more than 25 years.
One of the challenges in recognizing OCD is that while children typically have worries and questions, when does it start crossing the line from a quirk to a major concern towards the realm of obsessive compulsive disorder? What sort of signs and symptoms should parents actually be looking for?
According to Dr. Franklin, when your child starts describing or expressing what they worry constantly, and you start seeing a lot of repetitive behavior, we might be looking at OCD.
A child might ask you six, seven, or more times, “Are things OK?” or “Am I going to be OK?” or something along the lines of “Is it OK for me to drink this, because I’m not sure whether somebody else touched it.”
“I think when you start to see it cross over from being a little bit of a quirk or minor concern to affecting the functioning then that’s where we start to get parents to pay attention,” says Dr. Franklin.
Dr. Denise Dutchak, a child psychiatrist with Lee Health, says these obsessions and compulsions will noticeably interfere with a child’s daily routine eventually.
“Some of the compulsive behaviors might be the need for symmetry, having things lined up just so, or in an even fashion. They might engage in certain ritualistic behaviors that they have to do in a certain order a certain number of times before they can move on to the next activity,” says Dr. Dutchak.
Kids can be unnecessarily checking their homework repeatedly or won’t hand in a paper or a project because it’s not “perfect.” Parents would then see that these behaviors start affecting the child’s functioning or daily routine. This is when they now start paying attention and getting worried.
Taking our online OCD Test for your child might give you a good indication of whether you should be worried or not. Consulting with a proper medical professional specializing in OCD is also a prudent course of action.
Is There A Cure for OCD?
The short answer is: no, there is no cure for OCD, but OCD can be treated quite well.
While obsessive-compulsive disorder can be life long, with adequate treatment, children can be taught to better deal with it and manage it, causing major reductions in stress and anxiety.
Thanks to many years of clinical research, and advancements in modern science, children with OCD can undergo treatment protocols that, if properly implemented and followed through, will allow them to live relatively unhindered, growing up to have fulfilling relationships, worthy achievements, and otherwise normal lives.
If a child starts treatment for OCD, it’s important for the treatment to be consistent throughout both at home and at school.
Psychopharmacological options are also available for more severe or advanced cases of OCD.
The Gold Standard Treatment for OCD
Just as the Yale-Brown Obsessive-Compulsive Test/Scale or Y-BOCS is considered the gold standard when it comes to OCD tests and detecting OCD, there is also a treatment available that is widely recognized for its efficacy among OCD health professionals.
For mild to severe OCD, the gold standard treatment is cognitive behavioral therapy (CBT) with exposure and response prevention (ERP).
ERP is considered to be an effective first-line psychological treatment for children with OCD. Exposure involves the gradual, systematic confrontation of situations triggering the OCD that the child has identified within the treatment.
“Basically to put it in an in a straightforward way, you teach somebody to confront the situations that provoke their anxiety, and you get them to reduce and eliminate compulsions they have associated with it,” explains Dr. Marty Franklin.
This might be akin to “facing your fears”, but it’s important for all involved that exposure is constantly supervised and monitored, starting with things that are minimally or mildly challenging, and working up towards more challenging triggers as the child has gained mastery over the lesser challenges.
“So if I have somebody, for example, who’s afraid of touching things I would have them touch the desk and then not wipe their hands or not wash their hands. I have them tolerate the discomfort because after a couple of minutes customarily or maybe a little longer you’ll see that the anxiety starts to go down. And then the kid learned something from that and say, “wait a minute, this is not as bad as I thought,” explains Dr. Martin
Another vital part of exposure is the child’s effort to utilize skills to resist engaging in the compulsions that reinforce the OCD.
“And then I can gradually move them up a hierarchy– a ladder– to go from things that were a little bit anxiety-provoking to somewhat (anxiety-provoking) to a lot,” continues Dr. Martin. The goal is to “get the kid, and the parents of course, to collaborate in teaching…to lean into their fear instead of away. That’s what we’re trying to do.”
Through this process, the child will understand the dynamic between the obsessions and the compulsions– becoming better at withstanding the ritual behaviors and at tolerating distress and discomfort.
What Can I Do to Help My Child’s OCD Treatments Using ERP?
At a discussion on how can parents get treatment for their child’s obsessive compulsive disorder, Dr. Monica Wu and Dr. Diana Santacrose of the UCLA CARES Center (The Center for Child Anxiety Resilience Education and Support) stresses the importance of family in the child’s treatment.
“When families first start ERP, the first thing that we do is always provide a lot of psychoeducation,” explains Dr. Wu.
“So basically clarifying any misconceptions or myths about OCD…everybody kind of gets on the same page and understand the kind of inner workings of OCD– why is the child is doing what they’re doing and then talking about things that may be helpful or unhelpful for parents in terms of how they respond to the OCD symptoms.”
The meat-and-potatoes of the treatment is of course, the properly supervised exposures and the response prevention techniques, and a lot of these will definitely require the involvement of family and other primary caregivers.
“We definitely want to incorporate the families into the treatment,” says Dr. Wu.”The parents or the caregivers who are working with the child are basically the therapist or the coach at home so whatever you learn in treatment we always want to assign homework because we want to make sure it generalizes and they learn how to do these in all these different situations.”
Dr. Santacrose points out that parents acting as coaches helps much in shaping some of the patterns and responses learned by the child. “So much more progress can happen when family is involved and really helps the child towards the progress that they’re looking for.”
Other Frequently Asked Questions
Dr. Rebecca Berry recently hosted a webinar for NYU Langone, discussing how OCD affects a family. Her discussions provided a lot of practical tools and information to cope with symptoms, practice compassionate limit setting, and help children work toward healthy functioning and satisfying relationships.
It also tackled a good number of questions relating to the topic of treating OCD in children:
What does a medical professional do differently in terms of OCD treatment when symptoms appear on a younger child of around four or five years old?
Note that a child at a tender young age of, say, 4 or 5 years old might not have the insight or ability to understand the importance and the rationale behind treatment plans and assignments.
For this reason, when a relatively younger child presents with symptoms of OCD, the child’s primary caregiver (or caregivers) must be involved for the majority of the allotted treatment sessions. This family-based approach relies on the parents and other family members to facilitate these treatment plans at home.
Can a child ever outgrow OCD if treated consistently? Can this be cured completely?
The fact of the matter is we don’t have any evidence that says OCD can be “cured”.
Obsessive compulsive disorder is a chronic condition, and this typically means that many individuals who experience OCD early on a childhood oftentimes do still experience some of the symptoms throughout their life.
With an appropriate course of treatment, however, many report better outcomes when they receive that treatment early on in childhood.
In many adult cases of OCD– about 80% have experienced OCD in childhood but did not get treatment for it. These cases tend to have a more advanced case of OCD, and so it’s a bit more challenging to move forward compared to those that have received CBT and ERP earlier on.
What type of professional is best to seek out for teens with OCD: psychologists, social workers, or psychiatrists?
While all these professionals can be very helpful to teenagers with OCD, what parents might want to consider instead is to choose a professional that specializes in cognitive behavior therapy (CBT) with exposure response prevention (ERP),
OCD, particularly so in children and teenagers, responds well to CBT-ERP. There’s a certain way of administering this approach properly, and the specialization in treating OCD greatly comes into play when you want to see gains appropriately over time.
If a parent keeps trying to force a child out of his OCD comfort zone, will this break the child free of his OCD or create more anxiety?
There is a reason why CBT and ERP are done the way they are when treating OCD in a child or teenager. And there’s also a reason why parents (or primary caregivers) are tasked to administer treatment consistently even at home or at school.
A child going through the exposure and response prevention process must have some level of insight that it is the OCD that causes all the unwanted thoughts and compulsive behaviors. Being able to confront the fear and anxiety is all part of the plan to manage the obsessions and control the compulsions, and ultimately reduce the distress in the long term.
The exposures in a child’s ERP program are designed to be completed gradually and systematically. The child gains mastery over skills that would allow for a greater degree of toleration for increasingly higher levels of distress, while keeping anxiety down to a more manageable level.
Forcing a child to face levels of stress he or she is not adequately prepared for not only undermines the treatment procedure, but it can also cause tension and conflict between you two, creating a rift in the parent-child dynamic that can greatly hamper progress.
When this happens, your child might lose motivation or trust, or even outright refuse participation. More than a setback to progress, being overly aggressive when it comes to treatment can harm your relationship as well.
Stick to the plan. Look after your child’s mastery over skills that would allow for a steady, sustainable progression. You must also make sure that the professionals you’re working with have a similar outlook when it comes to overseeing treatment for your child.
OCD’s two components, obsessions and compulsions, are not just unwanted and uncontrollable for those who suffer from it, they’re also the source of much anxiety and distress.
Your child gains no joy nor pleasure from the thoughts or actions brought about by OCD, and as parents, we must pay close attention to those little habits, especially if they are suspected to fall within the possibility of obsessive compulsive disorder.
There are online tests for your child to help you determine if what you see are merely quirks or actually patterns of behavior that might be OCD.
The next step is consulting with a medical professional, therapist, or OCD specialist to get an official diagnosis if what your child actually has is obsessive compulsive disorder.
If your child does have OCD, then getting treatment as early as possible is your best recommended course of action. Adults with OCD have experienced OCD when they were much younger, but never had the opportunity to get treatment.
While OCD is a lifelong condition, proper treatment will allow a child to be better equipped to deal with OCD, mastering skills needed to better manage the obsessions and control the compulsions, giving the child a better chance at a more well-adjusted and relatively normal life growing up.