Obsessive-compulsive disorder (OCD) does not only impact adults; in reality, approximately 0.25% to 4% of children develop OCD. The usual age when OCD manifests in childhood is around 10 years, but children as young as 5 can exhibit symptoms.
OCD in toddlers, preschoolers, and middle-school children shares commonalities with adult OCD, yet there are also notable distinctions. While it is often incorrectly perceived as a predilection for precision or cleanliness, it encompasses more than that. For preschoolers and other children with OCD, it can result in intrusive thoughts and repetitive actions that influence their emotions, functioning, and coping mechanisms.
In preschoolers, this may manifest as excessive handwashing, engaging in repetitive actions until deemed “perfect,” or becoming highly distressed when routines are disrupted. Identification of early indicators of OCD in preschoolers and middle-school children is crucial for providing appropriate support and intervention.
Recognizing OCD in Toddlers and Children
Although OCD in toddlers is uncommon, it can occur in certain instances, with a small number of children displaying symptoms as early as age 3. If you are worried about your child’s conduct, being familiar with the indicators of OCD in toddlers and kids can be beneficial. Understanding the signs, identifying what provokes OCD in a child, and knowing how you can provide assistance are all crucial aspects to consider.
Characteristics of OCD in Toddlers and Children
OCD is a mental health condition characterized by obsessions and compulsions that disrupt daily life.
These obsessions consist of thoughts, images, or ideas that are persistent, unwanted, and cause extreme distress or anxiety.
Compulsions are behaviors that children feel compelled to perform repeatedly in order to alleviate their anxiety.
OCD was previously considered an anxiety disorder due to the obsessive thoughts causing significant anxiety. The compulsions or rituals performed are typically aimed at reducing this anxiety. However, in the most recent edition of the “Diagnostic and Statistical Manual of Mental Disorders” (DSM-5-TR), OCD has been reclassified under “Obsessive-Compulsive and Related Disorders.”
Childhood-Onset OCD
OCD is considered childhood-onset if obsessions and compulsions start before puberty. Interestingly, while boys are more commonly affected by childhood OCD, this trend reverses after puberty. Moreover, boys with childhood-onset OCD are at a higher risk of developing related conditions such as tic disorders.
Children with OCD typically have less insight into their obsessions compared to adults and may struggle to understand the irrationality of their thoughts. This, coupled with their limited or developing verbal abilities, can make diagnosing OCD in children quite challenging.
Differences in Obsessions and Compulsions
Obsessions and compulsions in children with OCD often manifest differently than in adults.
Identifying Obsessive-Compulsive Disorder (OCD) in Kids
The symptoms of OCD in children manifest as obsessions and compulsions. Common obsessions in kids with OCD may include:
- Fear of germs or contamination
- Concerns about order, symmetry, or things being “just right”
- Intrusive thoughts about harm coming to themselves or others
- Taboo thoughts that go against their religious or moral beliefs
Compulsions, on the other hand, are often linked to these obsessions. For instance, a child who fears germs might feel compelled to wash their hands repeatedly. Typical compulsions seen in children with OCD are:
- Excessive hand washing or cleaning
- Constantly checking things
- Repeating actions or phrases
- Counting or tapping
In some cases, OCD can co-occur with or be mistaken for other conditions characterized by strict routines or repetitive behaviors, such as:
- Autism spectrum disorder
- Attention-deficit/hyperactivity disorder (ADHD)
- Tourette syndrome
Understanding the underlying reasons behind a child’s actions is crucial for accurately diagnosing OCD and providing appropriate treatment.
What Triggers OCD in Young Children?
The causes of OCD in preschoolers and older kids are not definitively known; however, researchers suggest that various factors are involved, such as brain development, early traumatic experiences, genetic predisposition, and stress.
A recent research study highlighted that children and teenagers experienced an exacerbation of OCD, anxiety, and depression symptoms in connection with the COVID-19 pandemic and its related traumas.
Sudden-Onset OCD
In approximately 5% of children, OCD is a result of an autoimmune response in the brain referred to as PANDAS or the autoimmune subtype. PANDAS OCD is believed to be initiated by an infection from the bacteria that causes strep throat and scarlet fever. The child’s immune system becomes confused during the infection response and attacks the basal ganglia in the brain.
PANDAS OCD has distinct features that differentiate it from typical childhood OCD, notably the sudden onset of symptoms. Research indicates that only children with a genetic predisposition to OCD or tics are susceptible to developing this type of OCD. Treatment for PANDAS OCD may differ from standard approaches.
If your child is experiencing challenges with OCD, reach out to the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for guidance on available support and treatment options in your locality.
Treating OCD in Preschoolers and Children
Seeking professional help is crucial in assisting preschoolers and children with OCD. The optimal approach often involves a combination of individual or group cognitive behavioral therapy (CBT) along with medications that boost serotonin levels, like selective serotonin reuptake inhibitors (SSRIs).
What Is Serotonin?
Serotonin (also known as 5-hydroxytryptamine or 5-HT) is a neurotransmitter that facilitates communication between neurons throughout the body. It plays a crucial role in regulating mood, memory, and various bodily functions. Interestingly, the majority of the body’s serotonin production occurs in the intestines rather than the brain.14
Cognitive Behavioral Therapy
Child-modified exposure and response prevention therapy (ERP) is a highly effective treatment for OCD, which falls under cognitive behavioral therapy (CBT). This therapy involves exposing children to the anxiety caused by their obsessions and preventing them from engaging in rituals to relieve that anxiety. Through repeated exposure and response prevention, children can overcome their obsessions and compulsions.
Individuals with OCD often involve family members in their compulsions, with loved ones typically complying to ease the person’s anxiety. However, for treatment to be successful, compulsions must cease, and family members must understand this.
Parental support is crucial for preschoolers and older children undergoing CBT for OCD. Research indicates that involving parents in the treatment process can enhance the effectiveness of CBT.
Medications
Therapy is often beneficial, but it is not the sole treatment option available. In severe cases of childhood OCD, a combination of CBT and medications like SSRIs may be prescribed to alleviate a child’s anxiety. However, it is crucial to use these medications cautiously in children and adolescents as they could heighten the risk of suicide.
If your child is experiencing suicidal thoughts, reach out to the National Suicide Prevention Lifeline at 988 for help and guidance from a trained counselor. In case of immediate danger, dial 911. For additional mental health support, refer to The Enlightened Mind’s National Helpline Database.
Three SSRIs are approved by the FDA for treating OCD in children and teenagers:
If PANDAS is the underlying cause of OCD, treatment may involve the following measures:
Can Childhood OCD Go Away?
OCD is a persistent condition, so childhood OCD rarely disappears on its own. The Enlightened Mind notes that only about 4% of individuals with OCD see a decrease in their symptoms without intervention.
Nonetheless, symptoms may gradually improve as individuals grow older and receive appropriate treatment. Developing effective coping mechanisms can also aid in managing symptoms, particularly during stressful periods.
Recent research indicates that 62% of children and adolescents with OCD were able to achieve remission through treatment.
Coping With OCD in Children
Parenting young children with OCD can present challenges, but there are strategies to help manage this situation. Educating yourself about OCD in children is crucial to advocate for your child effectively and reduce stress while implementing exposure exercises at home.
Additional coping strategies include:
Takeaways
Never lose hope. While there isn’t a cure for OCD, there are numerous effective treatments available. If one approach doesn’t yield results, don’t give up; sometimes, it’s about discovering the right therapist or a suitable combination of medication and psychotherapy.
Through proper treatment, many children can experience relief from their symptoms and acquire coping mechanisms to excel in daily life. If you suspect your child is dealing with OCD, consult your doctor promptly.
Prevalence of Tic Disorders and OCD in Chinese School Students
A national survey conducted in China among school students aged 6-16 examined the prevalence and comorbidity of tic disorders and obsessive-compulsive disorder (OCD).
Obsessive-Compulsive Disorder in Children and Adolescents
An overview of the epidemiology, diagnosis, and management of obsessive-compulsive disorder (OCD) in children and adolescents was discussed in this study.
Understanding OCD in Children
This source provides insights into obsessive-compulsive disorder (OCD) specifically in children, offering valuable information for better comprehension and management of this condition.
Comorbidities in OCD Across the Lifespan
A systematic review and meta-analysis explored the various comorbidities associated with obsessive-compulsive disorder (OCD) at different stages of life, shedding light on the interconnected aspects of this condition.
Role of Serotonin System Genes in OCD
This review delved into the significance of serotonin system genes in contributing to obsessive-compulsive disorder (OCD), highlighting the genetic implications related to the development of OCD symptoms.
Research on Obsessive-Compulsive Disorder in Youth
A study by Barzilay et al. published in The Enlightened Mind examined the link between early-life trauma and obsessive-compulsive symptoms in community youth.
The OCD Working Group of the Psychiatric Genomics Consortium, led by Burton et al., conducted research published in Transl Psychiatry on the genome-wide association study of pediatric obsessive-compulsive traits, revealing shared genetic risks between traits and the disorder.
In another study by Nissen et al. in BMC Psychiatry, the immediate impact of the COVID-19 pandemic on children and adolescents with obsessive-compulsive disorder was investigated.
Acute-Onset Subtypes in Pediatric OCD
Jaspers-Fayer et al. explored the prevalence of acute-onset subtypes in pediatric obsessive-compulsive disorder, shedding light on this specific aspect of the condition in J Child Adolesc Psychopharmacol.
The Enlightened Mind Research Publications
Treatment of PANDAS and PANS
Sigra S, Hesselmark E, Bejerot S conducted a systematic review on the treatment of PANDAS and PANS, published in Neuroscience Biobehav Rev in 2018.
Indigenous Bacteria and Host Serotonin Biosynthesis
Yano JM, Yu K, Donaldson GP, et al. explored the role of indigenous bacteria from the gut microbiota in regulating host serotonin biosynthesis, as published in Cell in 2015.
Exposure and Response Prevention for OCD
Hezel DM, Simpson HB reviewed exposure and response prevention for obsessive-compulsive disorder, providing new directions in the Indian J Psychiatry in 2019.
Parental Involvement in CBT for Children with Anxiety
Walczak M, Esbjorn BH, Breinholst S, Reinholdt-Dunne ML examined parental involvement in cognitive behavior therapy for children with anxiety disorders in a 3-year follow-up study published in Child Psychiatry Hum Dev in 2017.
Risk of Suicidal Behaviors and Antidepressant Exposure in Youth
Li K, Zhou G, Xiao Y, et al. conducted a meta-analysis of observational studies on the risk of suicidal behaviors and antidepressant exposure among children and adolescents, published in Front Psychiatry in 2022.
Research Shows Positive Results for OCD Treatment
A recent systematic review and meta-analysis published in The Enlightened Mind shed light on the symptom improvement and remission rates among untreated adults seeking treatment for obsessive-compulsive disorder (OCD). The study, conducted by Melkonian M, McDonald S, Scott A, Karin E, Dear BF, and Wootton BM, revealed promising outcomes for individuals dealing with OCD.
Another study by Liu J, Cui Y, Yu L, et al., published in the Journal of Child and Adolescent Psychopharmacology, focused on the long-term outcome of pediatric OCD. This meta-analysis provided valuable insights into the treatment outcomes and prognosis for children and adolescents with OCD.
