Obsessive Compulsive Disorder in Children

Through the clinical interview process, OCD is diagnosed by a mental health professional. During intake, the clinician is trained to assess whether obsessive or compulsive behaviors are present as well as their impact on that child's or individual's life and functioning.  An OCD specialist will use the diagnostic and statistical manual to see if a child meets the clinical criteria for a diagnosis. 

For diagnosis, these behaviors have to have a significant impact on daily functioning, occupy a lot of time (typically more than one hour per day), and cause distress. No specific psychological or laboratory OCD test exists which often causes frustration.

Can my Child Outgrow OCD?

Children don't outgrow OCD; rather, they learn to overcome it through the use of therapy and a variety of treatments. Symptoms can increase during periods of stress, as well as hormone and developmental change. 

There can also be a waxing and waning of symptoms, which can confuse parents but it often is part of the disorder. Getting support early in a child's life is key to successfully managing obsessions and compulsions.

Are OCD and Autism Related?

A high rate of individuals with Autism also have OCD. According to a Danish study of more than 850,000 people, compared with their typical peers, people with Autism are twice as likely to receive a diagnosis of OCD and people with OCD are four times as likely also to have Autism.

The Danish study also found that there is a connection between OCD and Autism at the genetic level. They found that when at least one parent had OCD, their offspring had a higher risk of Autism.

Similarities between OCD and Autism include reliance on repetitive behaviors to calm anxiety, which suggests a genetic overlap.  For example, autistics display stimming behaviors (hand flapping) and children with OCD display rituals and compulsions which both fulfill the same emotional need. However, as children with Autism always have social issues and social communication issues, children with OCD do not always have these, differentiating the two diagnoses.

What is OCD Treatment?

OCD is treated using a variety of traditional and holistic therapies. Some people benefit from medication, and others don't. A consistently proven effective treatment for OCD is Cognitive Behavioral Therapy (CBT) and Exposure Therapy (and more specifically Response and Prevention Therapy (E/RP).

Holistic therapies, such as Neurofeedback, Biofeedback, Reiki, EFT/Tapping, and massage can also be good adjunctive therapies to help align the nervous system. Before a person can fully move forward in clinical therapy, they need to get the Central Nervous System (CNS) regulated.  

How Does CBT and Exposure (ERP) Therapy Help OCD?

Cognitive Behavioral Therapy (CBT) is a type of psychotherapy that works at the conscious level. CBT presumes that how individuals perceive a situation is more connected to their reaction than to the situation itself thus working through those misperceptions brings relief. CBT combines talk and behavioral therapy to reframe negative thinking patterns into positive thoughts.  Research has found CBT to be more effective than medication in reducing symptoms (59.9 % vs. 33.4%) and widely considered to be the first line of treatment in OCD.

Exposure Therapy, a type of CBT, specifically called Response and Prevention Therapy (ER/P), exposes the person to their trigger so they learn how to be uncomfortable to the point where they can ignore their trigger. 

First, the person identifies all the triggers. Next, the therapist exposes the person to the situations that trigger his or her obsessions and compulsions (sometimes starting gradually and other times addressing more moderate triggers).

The therapy emphasizes learning how to deal with the uncomfortableness rather than avoiding it, as the latter leads to negative reinforcement. Patients learn that with exposure, their anxiety increases, but it also decreases.

Over time, through psychoeducation and cognitive behavioral therapy, the person's response to triggers changes, leading to a decrease in the frequency of compulsions and the intensity of obsessions. OCD treatment and anxiety expert, Kimberly Morrow, LCSW explains “We have to teach clients that they are “feeding the dog” with negative thinking and they have to understand that OCD is a bully that they can overcome”.

Therapeutic exposures repeated over time decrease associated anxiety because the individual learns that nothing bad happens when they stop performing rituals. They can stop OCD from bullying them. 

Cognitive restructuring is part of the process, so they learn to evaluate perceived threats associated with each obsession and then test limits. Upon completion of ER/P therapy, the OCD symptoms often diminish or disappear.

How is Pediatric OCD Treatment Different From Adult OCD Treatment? 

Treatment for children and adolescents with OCD isn't that different from adult OCD treatment. What is different is that the brain of an adult with OCD has habituated much longer than that of child. That means that there is a stronger subconscious behavioral component for adults simply because the behavior has been there longer. 

That doesn't mean that the obsessions and compulsions found in adults vs children are any less treatable, rather, it means that they are habits that will take longer and more effort to break. With OCD, it is all about talking back to that OCD and showing it who is boss.

Kids are more willing and open to getting rid of their “habit” (the negative reinforcement cycle) because it hasn't been there as ong. In addition, kids are more willing to push themselves in new learning areas because they do that everyday at school.

How Does OCD Impact School?

Obsessions and compulsions can interfere with learning and processing in a variety of ways. Typically, these children display slow processing and perfectionistic tendencies. They also can display difficulties with focus because they are often performing mental rituals. Finally, children may display OCD as increased emotionality or rigidity. 

Although signs and symptoms may be obvious, most are more subtle and misinterpreted as a focus, behavioral or processing problem. For those with sudden onset of OCD due to PANS/PANDAS, their behavior can change overnight and come on with such a frightening intensity. These children need immediate medical care from a PANS/PANDAS specialist.

How Can I Help My Child or Teen With OCD?

The best thing you can do is to get help early. Obsessions and compulsions often appear between ages  7 and 12 and shouldn’t be ignored because childhood-onset OCD isn’t a mental health disorder that just goes away. The longer they occur, the more behaviorally ingrained they become and therefore harder to break the “habit.” 

Children can become habituated toward obsessive and compulsive behaviors as a way to cope with stress. Breaking those behaviors before they become ingrained can lessen the severity and, in some cases, stop the progression of OCD.

Even when treatment has not begun until obsessions and compulsions have become more ingrained and debilitating, forms of treatments, including exposure therapy (ERP), PEMF, and neurofeedback can help. You have to calm the brain and treat the behaviors and that is exactly with we do in our program

Parent psychoeducation and participation in the ERP therapy sessions and process is critical for supporting a child with OCD. Parents need to help with the exposure process by not allowing a child to suppress the obsessions and compulsions and instead learn to tolerate them. This process helps to lessen, if not extinguish, obsessions and compulsions.

Calling a therapist who is trained to do ERP is an important step to getting your child help. You can find a therapist through the International OCD Foundation (IOCDF) or apply to work with us at www.drroseann.com/apply