OCD In Children
What is OCD in children?
OCD is a disorder in which the child has unwanted and upsetting thoughts called obsessions. These thoughts are intense and the child cannot get them out of their mind. To help ease the anxiety caused by these upsetting thoughts, the child feels like they must carry out a certain action over and over, which is called a compulsion. Performing this action temporarily relieves the child of the negative thoughts.
The action that the child feels they need to do does not need to be logically related to the upsetting thought. For example, the child may have an intrusive thought that their sibling will get hurt, which understandably makes the child feel anxious.The child then feels they must check that all their socks are paired up to make sure that their sibling stays safe. Pairing up their socks temporarily frees them of the intrusive thought that their sibling will get hurt, although this action itself has nothing to do with keeping their sibling safe.
Unfortunately, completing the action only temporarily relieves the anxiety. The negative thoughts will soon come back, forcing the child to perform the action again to relieve the thought. These actions form a cycle.
Do repetitive behaviours in children mean they have OCD?
It is very common for children to have repetitive behaviours or little rituals. For example:
- Kissing all their toys goodnight
- Lining up their crayons neatly, or
- Always asking for their sandwiches in triangles
These types of behaviours are often completely normal in children and may help provide them with a sense of comfort. Repetitive behaviours themselves are not worrying.
The problem with repetitive behaviours is when they appear to be driven by fear or anxiety, and the child becomes upset when they are unable to complete the action. This might mean that they are carrying out that action under the compulsion to relieve themself of intrusive thoughts.
What are the symptoms of OCD in children?
You may notice that your child has some repetitive behaviours or rituals.
Remember, repetitive behaviours in themselves are not concerning, but if these behaviours are causing your child distress, then it is advisable to seek professional advice.
Some examples of repetitive behaviours are:
- Over-washing of hands
- Careful cleaning of toys
- Touching items in a specific and repetitive way
- Frequently checking locks or light switches
- Ordering or lining up toys
- Needing things to be done in relation to a certain number (e.g. 3 pieces of toast, 3 kisses goodnight, turning lights off and on 3 times)
- Getting dressed a certain way with certain rules
You might not necessarily notice the compulsive behaviour in a child with OCD, instead you may notice more general symptoms, such as your child:
- Struggling to concentrate in school or tasks at home
- Appearing worried or anxious
- Getting upset if something is not done a specific way
- Worrying persistently about friends or family being unwell/hurt
- Having a fear of dirt and germs
- Requiring a lot of reassurance
What causes OCD in children?
The causes of OCD are not entirely clear yet, but researchers have identified several factors that are thought to be linked to OCD in children.
Children are more likely to develop OCD if a family member has also been diagnosed with it.2
Studies have shown that inheriting certain genes may increase the risk of developing OCD. For example, there is a link between OCD and specific versions of genes that control how serotonin is transported in the brain.3 Serotonin is one of the signalling molecules found in our brain that helps to control our mood.
Children who have experienced traumatic life events are more likely to develop OCD.4
There are different suggestions for why traumatic events increase the risk of developing OCD. The trauma may cause the child to experience flashbacks of the event, which may lead to intrusive thoughts that drive compulsions. Another suggestion is that children who experience trauma may feel that they can prevent the trauma from happening again with certain behaviours, driving the cycle seen in OCD.
It’s important to remember that many factors can contribute to OCD, and therefore a diagnosis of OCD does not mean the child must have experienced a traumatic life event.
Certain infections can trigger OCD.
One particular infection linked to OCD symptoms is a bacteria called Streptococcus (“strep”).5 OCD that is caused by infection usually causes symptoms to develop rapidly, even overnight. This cause of OCD requires more research for us to truly understand how and why this happens.
What should I do if I’m worried my child has OCD?
If you are worried about how your child is acting, it’s important to try and understand why they are behaving this way. The best way to do this is to talk to them.
It’s really important to understand as a parent/caregiver that children may find their behaviour difficult to talk about because:
- They can’t explain their feelings
- They don’t understand that these feelings are abnormal
- They are ashamed of the nature of the intrusive thoughts (for example, if their thoughts are violent or sexual)
- They are worried they will get in trouble
It is crucial that the parent or caregiver does their best to create a non-judgemental, supportive conversation to allow the child to talk about how they are feeling:
- Let the child know they are not in trouble
- Tell them you want to help them with these upsetting feelings
- Explain that you can help them if they talk to you
- Give them time to talk
Some things you can say that may help your child open up are:
- You seem upset/worried/anxious. Can you tell me why so I can help?
- I notice you do [repetitive behaviour]. You’re not in trouble, but can you tell me why you do it?
- How do you feel if you don’t do [repetitive behaviour]?
If you are worried your child has OCD, you should arrange a review with a specialist, such as a child psychologist or psychiatrist.
No matter what distressing thoughts your child may share with you, try to respond in a way that makes them know they are loved and that you are there to help them. Children who feel embarrassed or ashamed may struggle to open up.
How is OCD in children diagnosed?
OCD is diagnosed by a mental health specialist – either a psychiatrist or psychologist.
The specialist will take a detailed history, asking the child and their parents/caregivers questions to build up a picture of what has been going on. They will want to explore the thoughts your child has been having, and any repetitive behaviours they do that appear to be linked to these distressing thoughts.
They will then use a scoring system and their clinical knowledge to decide if the child has a diagnosis of OCD.
No physical tests are required, unless there is concern that there is a different cause of their symptoms. Blood tests may be needed in very rare scenarios, where the doctor suspects that the child’s OCD is triggered by an infection.
The information in this article is written for general information purposes only, and is not a substitute for professional medical advice, treatment or care. It is incredibly important that you do not make decisions regarding any symptoms based on this information alone. If you are worried about any symptoms you may be having, or have any further questions about this condition, please speak to a qualified and trustworthy medical professional.
How is OCD in children treated?
The symptoms of OCD can worsen if the condition is left untreated, so it is best to seek treatment if you suspect that your child has OCD, rather than hoping they will “grow out” of their symptoms.
OCD in children is usually treated with therapy and medications.
To help manage OCD in children, it is really important for their family/caregivers to understand the condition and what actions they can take to help their child.
For this reason, mental health specialists will usually involve the family in therapy, and educate them on how they should and should not respond when the child is acting a certain way. They will also teach the family how to support the child in carrying out the homework set out in therapy.
A research study showed that combining a structured family support programme with ERP improved OCD symptoms.7
Most specialists will recommend a type of cognitive behavioural therapy, called exposure and response prevention (ERP).
ERP works by encouraging the child to face what causes their anxiety in a supportive environment. The therapist will then help the child manage their anxiety levels. The aim is that each time the child faces that trigger, their anxiety will be more and more manageable, and they will not need to carry out the triggered behaviour (compulsion) to reduce their anxiety.
CBT may be given on its own or alongside medication.1
The medications used to manage OCD in children are called Selective Serotonin Reuptake Inhibitors (SSRIs).
They are often used as antidepressants as they target the neurotransmitter in the brain, Serotonin. Studies have shown that serotonin may behave abnormally in people with OCD, which is why SSRIs are useful in managing the condition.
One of the most commonly used SSRI in OCD is sertraline, which has been shown to be an effective treatment of OCD in children on its own or when given alongside CBT.1
In rare cases, where symptoms of OCD are believed to be due to a Streptococcal infection, a doctor may prescribe antibiotics.
OCD in children is an important condition, and one which is often missed until later in the child’s life.1 Understanding the signs to look out for, and getting professional advice when you are worried, may mean an earlier diagnosis, and earlier treatment for your child.
Share this article:
- Walitza S, Melfsen S, Jans T, Zellmann H, Wewetzer C, Warnke A. Obsessive-compulsive disorder in children and adolescents. Dtsch Arztebl Int. 2011;108(11):173-179. doi:10.3238/arztebl.2011.0173 (Access here)
- Pauls DL. The genetics of obsessive compulsive disorder: a review of the evidence. Am J Med Genet C Semin Med Genet. 2008;148C(2):133-139. doi:10.1002/ajmg.c.30168 (Access here)
- Grünblatt E, Marinova Z, Roth A, et al. Combining genetic and epigenetic parameters of the serotonin transporter gene in obsessive-compulsive disorder. J Psychiatr Res. 2018;96:209-217. doi:10.1016/j.jpsychires.2017.10.010 (Access here)
- Mathews CA, Kaur N, Stein MB. Childhood trauma and obsessive-compulsive symptoms. Depress Anxiety. 2008;25(9):742-751. doi:10.1002/da.20316 (Access here)
- Vogel L. Growing consensus on link between strep and obsessive–compulsive disorde. Canadian Medical Association Journal. 2018;190(3):E86-E87. Doi: 10.1503/cmaj.109-5545 (Access here)
- Pediatric OCD Treatment Study (POTS) Team. Cognitive-behavior therapy, sertraline, and their combination for children and adolescents with obsessive-compulsive disorder: the Pediatric OCD Treatment Study (POTS) randomized controlled trial. JAMA. 2004;292(16):1969-1976. doi:10.1001/jama.292.16.1969 (Access here)
- Piacentini J, Bergman RL, Chang S, et al. Controlled comparison of family cognitive behavioral therapy and psychoeducation/relaxation training for child obsessive-compulsive disorder. J Am Acad Child Adolesc Psychiatry. 2011;50(11):1149-1161. doi:10.1016/j.jaac.2011.08.003 (Access here)
Table of contents & page sections
The material and information contained on this website is for general information purposes only. While we endeavour to keep the information up to date and correct, Gaia Medical makes no representations or warranties of any kind, express or implied about the completeness, accuracy, reliability, suitability, or availability with respect to the website or the information, products, services, or related graphics contained on the website for any purpose. Any reliance you place on such material is therefore strictly at your own risk. The information contained within this website is not a substitute for the advice of an appropriately trained and qualified doctor or other healthcare professional.
Disclaimer: Gaia Medical does not control or endorse the advertisements shown on our website. They are delivered automatically by third party providers.