Obsessive-Compulsive Disorder in Children and Teens

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KEY POINTS

• Obsessive-compulsive disorder (OCD) is a condition in which your child constantly thinks about something (obsessions) that causes anxiety. Your child may do certain actions over and over (compulsions) to help control the anxiety.
• Treatment may include exposure and response prevention therapy, medicines, and learning ways to relax.

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What is obsessive compulsive disorder?

Obsessive-compulsive disorder (OCD) is a condition that affects your thoughts and actions. If your child has OCD, he has constant unwanted thoughts about something that causes anxiety. Your child may do certain actions over and over to help control the anxiety. For example, if he constantly worries about germs or getting sick, he may wash his hands every hour. The constant thoughts are called obsessions. The actions are called compulsions. Your child may spend hours each day doing certain actions over and over. These are called rituals. Your child may have only obsessions, only compulsions, or both

Your child may always have this disorder, but treatment can help him recognize and manage the symptoms. OCD may last for weeks or months and then disappear or reduce dramatically. It may reappear during the adult years. Advances in therapy and new medicines are helping many people with OCD.

What is the cause?

The exact cause of this disorder is not known. What is known is that:

• The brain makes chemicals that affect thoughts, emotions, and actions. Without the right balance of these chemicals, there may be problems with the way your child thinks, feels, or acts. A child with this disorder may have too little or too much of some of these chemicals.
• OCD tends to run in families.
• Childhood physical or sexual abuse increases the risk for OCD.
• People with this disorder may have differences in certain parts of their brains. These differences may mean that some parts of your child’s brain are more active or less active than in other people.
• OCD may develop or get worse after a strep infection.
• OCD often occurs along with mood disorders such as other anxiety disorders, depression, and bipolar disorder.
• Children who have been diagnosed with Tourette syndrome are more likely to develop OCD. Children with Tourette syndrome may have repeated, brief movements of the face, hands, or legs that they can’t control. They may also say words or make other sounds that they can’t control.

Children may show signs of OCD as early as the preschool years, but it is most commonly diagnosed when children are between the ages of 10 and 15.

What are the symptoms?

Children with OCD may have just obsessions or just compulsions, but most often they have both. Many children with OCD know that their thoughts and actions are not normal.

The kinds of obsessions and compulsions children have depend on their age. The obsessions and compulsions may change as the child gets older. Children with OCD may have symptoms such as:

• Cleaning: Children often wash their hands or brush their teeth many times a day. They may refuse to touch things with their hands, using a barrier (tissue or shirt cuff) to touch things. They may develop odd routines like turning things on and off with their feet.
• Repeating: They may put the lid on the toothpaste 20 times before they feel sure it's secure. Or they may turn the light switch on and off a set number of times before they are sure it is off.
• Checking: Children may want to return to their room over and over to see if video games are turned off. You may need to reassure them over and over to keep them from going to their room.
• Ordering: Children may get very anxious if things are out of place or not in the order that feels right to them.

Along with the main symptoms, children with OCD may:

• Arrange their desk top or place at the kitchen table until it is just so
• Be on guard all the time or startle easily
• Constantly think that something bad is going to happen
• Feel low self-esteem over not being able to control symptoms
• Have trouble completing homework and papers as they focus on getting things perfect
• Have rituals related to food and eating, eat poorly, or be a very picky eater
• Have trouble concentrating due to worry about OCD symptoms

Symptoms may happen only in certain places, for example, at home but not at school. They may also happen at a certain time, such as bedtime or when children are getting ready for school.

A child with OCD may want to change what family members do. For instance, the child may insist that laundry be washed multiple times, demand that parents check their homework repeatedly, or get angry if household items are not in order.

Along with OCD, children and teens may have other problems such as:

• General anxiety much of the time
• Depression or thoughts of suicide
• Eating disorders
• Post-traumatic stress disorder
• Drug and alcohol abuse problems, including using marijuana, alcohol, or sedatives to try to control or avoid their symptoms

How is it diagnosed?

Your child's healthcare provider or a mental health therapist will ask about the child's symptoms, medical and family history, and any medicines the child is taking. He will make sure that your child does not have a medical illness or drug or alcohol problem that could cause the symptoms.

It is important to have an experienced professional working with your child or teen. Your child's therapist will need to check your child's symptoms and medicines often.

How is it treated?

Therapy

There are several cognitive behavioral treatments that help teach children to control or stop their obsessive thoughts and compulsive acts.

Exposure and response prevention therapy is one kind of CBT that has provided relief for many children with OCD. It consists of having your child confront his fears by gradually increasing his exposure to them. For example, if a child washes their hands all the time because they are afraid of being dirty, the therapist might have the child touch something dirty. Then the two of them might stand at the sink without washing hands until the anxiety goes away. This therapy takes time, and much of the work is done at home as well as with the therapist. Children learn ways to control their body's response to anxiety, like breathing exercises. With practice, obsessive thoughts don't make them as anxious, and they can prevent compulsive behaviors for longer periods of time.

Other cognitive behavior therapies (CBT) help children learn about what thoughts go with their urges to act and how to control them. CBT also teaches skills for managing anxiety about symptoms.

Family therapy may also be helpful. Family therapy treats the whole family rather than just the child. Children often feel very supported when parents and siblings attend therapy with them and work as a group.

Medicines

If a child has severe symptoms, both CBT may be best. Several types of medicines can help treat OCD. Your child’s healthcare provider will work with you and your child to select the best medicine. Your child may need to take more than one type of medicine. Your child needs to take medicine for as long as prescribed, even if he feels better. If your child stops taking the medicine too soon, OCD symptoms will come back.

N-acetylcysteine may be helpful as an add-on treatment for OCD. Supplements are not tested or standardized and may vary in strength and effects. They may have side effects and are not always safe. Talk with your child’s provider before you try herbs or dietary supplements to treat your child’s OCD.

How can I help my child?

You may find yourself frequently washing or not touching things, or doing things a certain way, to relieve the distress of the person with OCD. Talk with your child's therapist to help decide whether family members should continue to participate in the child's symptoms and learn how to best help your child.

• Support your child. Let your child talk about the scary feelings if he feels ready to do that. Do not force the issue if your child does not feel like sharing his thoughts. Do not criticize your child for his symptoms or for acting younger than his age. Let your child know that he is safe and protected. The support and understanding that you provide can help children deal with scary emotions.

  Stay in touch with teachers, babysitters, and other people who care for your child to share information about symptoms your child may be having.

• Help your child learn to manage stress. Teach children and teens to practice deep breathing or other relaxation techniques when feeling stressed. Help your child find ways to relax. For example take up a hobby, listen to music, play, watch movies, or take walks.
• Take care of your child’s physical health. Make sure your child eats a healthy diet and gets enough sleep and exercise every day. Teach children and teens to avoid alcohol, caffeine, nicotine, and drugs.
• Check your child’s medicines. To help prevent problems, tell your healthcare provider and pharmacist about all the medicines, natural remedies, vitamins, and other supplements that your child takes. If your child has been prescribed medicine for OCD, make sure he takes it as directed.
• Learn about your child’s condition. Knowing how OCD affects your child helps you better understand how treatments, medicines, and lifestyle changes can help. Know what symptoms you should call your healthcare provider or therapist about.
• Contact your healthcare provider or therapist if you have any questions or your child’s symptoms seem to be getting worse.

Get emergency care if your child or teenager has ideas of suicide, harming himself, or harming others.

For more information, contact:

• The Obsessive-Compulsive Foundation, Inc.
  203-878-5669
  https://iocdf.org/
• National Alliance on Mental Illness (NAMI)
  800-950-NAMI
  https://www.nami.org
• Mental Health America
  800-969-6642
  http://www.mentalhealthamerica.net/