OCD in Children and Preteens
OCD can affect children as young as three and four years of age, but OCD symptoms look and sound different in a younger child than they do in the school-age youngster of eight or the prepubescent boy of eleven. For example, a younger child will often reveal more of his obsessive thoughts to his parents, even if he doesn't yet have the words to verbalize what he's thinking or the cognitive skill to understand the contradictions inherent in these thoughts.
A younger child's OCD-related fears can be particularly intense. The desire to cling to you may be strong, making the first day of school very trying. A younger child with OCD would also be more likely to try to enlist you in the performance of her compulsions than an older child might. She may, for example, ask you to clean off the seat of the car repeatedly before she'll sit on it. Or she may demand that you wear gloves before touching her food. Acquiescing to these demands will only reinforce your child's obsessive behaviors and increase their frequency. In later chapters, you'll learn better strategies for handling such situations.
How Does OCD Feel to the Younger Child?
Of course, every child is different, but the unwanted thoughts and compulsions caused by OCD often result from the same triggers and produce the same compulsive behaviors in different children. To a young child with OCD, offensive dirt and germs can dwell anywhere, whether visible or invisible to the naked eye. From mild to extreme, these fears often interfere with the most basic activities of the child's daily life. What follows are statements from children under the age of twelve who are dealing with OCD-related contamination fears.
“I don't want to eat peas. They have bugs.”
“I hate having food mixed up on my plate, with everything touching. The worst is Chinese. I have to separate each piece if I'm going to count them. And I have to separate and count them before I eat any.”
“This glass isn't clean. Are you sure this glass is clean?”
“I put my books in the microwave to burn off the germs that got on them at school.”
“You touched the dog. Don't touch the milk carton. Don't touch me!”
If your child displays any of these symptoms on a regular basis, then you know how easily they can disrupt her daily functioning and create chaos for the entire household.
The dangers that any young child perceives may (to you) be nothing more threatening than an imaginary monster or ghostly presence. But it's important to realize that a child with OCD who experiences these fears believes he's in very real, immediate peril. And, as a consequence of this perceived danger, he feels he must act, often by performing a ritual or prayer to stave off ominous consequences.
“As soon as I heard that stupid rhyme I couldn't get it out of my head. Now I have to count all the cracks in the sidewalk. Of course I never step on them. If someone talks and interrupts me, I have to start all over again.”
A girl's father, a fireman, died on a TV show. “Now, I know Daddy is going to die. I have to check on him all the time to see if he's still here.”
Safety fears like these can prompt severe distress and crying fits in the child with OCD, especially if she is not able to perform the ritual she has designed to forestall the negative consequences she fears. As future chapters spell out in detail, the way to help your child conquer imaginary fears is not by telling her these fears are not real, but rather by assigning the blame for her fear where it belongs: to her OCD.
The need to create order in his environment reflects a child's desire for certainty in the face of what he perceives as chaos, which to a child with OCD can be a source of great anxiety. In some cases this desire can be harmless, even positive. A child with mild OCD may, for example, prefer to have the shirts in his closet and the socks in his bedroom bureau lined up by color. With this done, he hopes he can quell the anxiety that greets him every morning when the alarm wakes him up for school.
But, with more acute cases of OCD, ordering fears can interfere with the child's daily routines and his ability to learn.
“I can't finish my math homework because I keep going back to the beginning and starting over.”
“I erased the answer on my paper so many times, now there's a hole in it.”
“I can't go to sleep unless the curtains are pulled together exactly in the middle of the window.”
The key for you as a parent is to help your child determine where normal, helpful ordering crosses a line and becomes obsessive compulsive. Here a mother describes her fifteen-year-old son's ordering obsession as it relates to time.
He can't do anything without timing it. From beginning to end of a movie, a song, a walk, he watches the clock or his watch. If we go out, he times it. Sometimes he'll time something down to the second. If his timing gets disturbed, it really throws him off.