To receive one training credit, please read the article below and answer the following questions.

What is Childhood Obsessive Compulsive Disorder?

Childhood Obsessive Compulsive Disorder (OCD) is a very complex disorder, because it does not have a specific set of symptoms. A person can have OCD and have totally different symptoms from another person with the disorder. OCD is listed under the category of anxiety disorders and is described as obsessions and compulsions. A person can have either obsessions or compulsions or both. With these come marked stress and interference in one's life.

One third to one half of adults suffering from OCD had onset of the illness during childhood and adolescence. A child can be diagnosed with OCD as young as two. It has been shown that more boys have OCD than girls. There is a significant increase in the incidence of OCD in puberty. But the good news is that usually there is a gradual decrease as patients approach late adolescence. Some studies have suggested several causes for OCD, including brain injury, strep throat, and it can be inherited. Children born to parents with OCD usually have totally different symptoms from those of their parents. There is no evidence to believe that OCD is a consequence of trauma.

In the past, OCD was considered to be very rare in children, but recent studies have shown this to be untrue. It has been estimated that over one million children in the US suffer from OCD.

OCD is called the “secret disorder” because children are very secretive about this illness. The symptoms are strange and weird to children. The child does not usually understand what is happening and will try to hide the symptoms as much as possible. He or she is afraid of being seen as crazy or weird by others.


Obsessions

Obsessions are described as thoughts, impulses and images that are intrusive and recurrent because of anxiety and stress. An example is a child sitting in class listening to the teacher. Suddenly, a bad thought pops up in her head, over and over and over again, and this thought creates stress and anxiety.

Obsessions are not simply excessive worries about a real problem. An important aspect of obsession is the attempt to suppress and neutralize the obsession with other thoughts and actions. An example is: I have a thought, let's say, my mom is going to die if I don't say certain words like “It's not going to happen”. It's very common for me then to keep repeating “It's not going to happen” over and over. Another example is children who can't even go through doorways because if they have a bad thought, they have to go back in the room they were in before and then go through the doorway again. People usually recognize that OCD is a product of their own mind, not that their thoughts are being controlled by someone else.


Compulsions

Compulsions are repetitive behaviors or mental acts performed in response to obsessions or according to rigid rules. They are sometimes referred to as habits. Here's an example. A compulsion in response to an obsession would be, “I touched something that I think is contaminated. I have to go to the bathroom and wash my hands until I think they are clean.” It can involve washing 5, 20, or 100 times. The thought creates a high anxiety level and a behavior the child is performing to decrease the anxiety.


Common Symptoms of OCD

Educating a child about OCD is very important. It helps them understand that their behaviors are a normal response to their compulsions or obsessions. With OCD comes a feeling of incompleteness. A child must perform a behavior a certain number of times to get it just right. The number progresses more and more as the symptom worsens. An example is the need to wash their hands five times to get it right, but the number later increases to twenty or fifty times (which takes a longer amount of time). You may find the child spending longer amounts of time in the bathroom.

Some children will have rigid rules to do certain things; they have to do things in a specific order. For example, every Monday, the child has to eat Cheerios for breakfast. She cannot eat anything other than Cheerios and has to dress a certain way every day. The goal of the compulsion or the behavior is to reduce stress or prevent something from happening. Often children have habits or compulsions to prevent harm to themselves or others. An example is they are afraid that if they don't touch something in a certain way, their cat is going to be killed. Sometimes children do not know their behaviors are obsessive and unrealistic. Sometimes they have been doing this for such a long time; it's just part of what they know.

Another important symptom of OCD is doubting. An example is when the child answers “I don't know” to everything you ask him; “Did you brush your teeth today or did you watch your favorite TV program? He may answer “I don't know”. It's not because he doesn't know the answer, it's just because he's afraid of not saying the right thing.

An important aspect of doubting is the use of “what ifs”. It is a very common pattern of thinking and verbal behavior for OCD people. They go through all different possibilities of what could happen. If you tell a child, “Go to that room and pick up a chair”, she will ask, “What if I get there and the chair is not there?” They look at every detail, every possibility and they start doubting. This can lead to repeating questions over and over to seek reassurance. Sometimes this can be frustrating for their parents and teachers, because they think the child cannot make a decision.

The most common symptom presented by children in terms of obsessions is contamination. Contamination is a feeling that you are going to get germs or illnesses by touching something and being contaminated. This is most often displayed by washing, which usually involves washing hands. They may also spend unusual amounts of time in the shower, being careful to wash themselves in a specific order.

Another very common obsession relates to aggression. A child may have very aggressive intrusive thoughts such as harming someone or themselves. They must keep checking to see if someone is following them, who might hurt them. They may worry that if they hug you too tight, they may kill you. They are afraid that if someone comes towards them to give them a hug, they may bite the person or hurt him.

Somatic concerns also come into play with OCD. This is a fear that a child feels he is sick. They often complain of headaches or stomach aches. They worry the entire day that they may get ill.

Checking is another symptom of OCD. It is well known because it's shown a lot in the movies. Examples are that you have to check to make sure you locked the door a certain way or that the stove or iron is turned off so there is no harm to anyone in the house. Most times, the checking has to be done repeatedly, because the person doubts for sure if they did lock the door or turn off the iron and has to keep checking. Checking is very impairing, because it's usually very time consuming.

Another very common compulsion is ordering, in which one has to have everything in a certain order. It could be ordering daily activities in a specific way. A person could order his clothing. A shirt has to be worn two days and a jacket the other two days. A person can order objects - where things have to be placed in a specific place or order. Making lists is a common way of ordering. Children have to make lists of their homework or activities they have to perform that day. These lists are often very cumbersome, detailed and rigid, including everything to be done down to the minute detail.

Counting is also a very common compulsion. If a child with OCD is in the room, they might be counting every square in the floor or ceiling. Sometimes children with this behavior count up to their lucky number and then start over. Everything must be done in numbers. For example, a child must touch the table four times, then touch her face three times, or walk four steps and stop.

Grooming is another interesting symptom. A child may spend hours in front of the mirror trying to brush their hair. He feels his hair doesn't look perfect, that it is uneven. He may not be able to play sports, because he feels it may mess up his hair. OCD children are always matching. Grooming takes a long time and produces much anxiety.

Hoarding is a symptom and compulsion where people cannot throw thing away, even things in the garbage. They collect, but it is a very dysfunctional type of collecting. Things collected may be considered junk by others; tissue paper, candy bar wrappers, and very old magazines are examples.

Self-mutilation is another symptom of OCD. Common behaviors are scab picking, skin picking, severe nail biting, biting the insides of their mouths, and skin burning.

OCD has some secondary characteristics. The child may be withdrawn, irritable, inattentive, fearful, avoid social situations, be depressed, have phobias, or have tantrums. School is often very difficult situation for children with OCD. They find it difficult to complete homework assignments because they have to keep going over and over the answers. They may doubt and keep rechecking their work. They may keep erasing the answers and rewriting them. In school, OCD children have a hard time socially, because they often feel their behavior is viewed by others as weird. They tend to avoid others when possible. Sometimes, OCD children have trouble leaving their locker, because they feel something bad will happen.

According to the literature, the most effective treatment for childhood OCD is behavior therapy. There have also been improvements made in behavior when medication is prescribed. However, medication needs to be closely monitored, because the side effects are not as well tolerated as in adults. It is important to note that if the medication is stopped, the behaviors usually continue. Family involvement and knowledge of OCD can greatly impact the treatment outcome.