OCD in Children: Three Mini-Portraits
Each of the following children demonstrates symptoms of OCD. Notice how the same obsessions, for example, a contamination fear or extreme worry about harm coming to a loved one, are expressed differently at each developmental stage.
Josh, age six, performs an elaborate ritual every night, saying the words “Mommy, one, two, three, four, five” as he touches each truck, game, and stuffed animal lined up on his toy shelves. By taking these steps, Josh believes he can prevent his mother's death while he sleeps. If for any reason he forgets or is prevented from carrying out this nightly ritual, his anxiety will spike along with his overall distress, and bedtime becomes a disaster for all.
Stacy, at ten, counts every word on each page as she reads her book. This elaborate process makes her reading assignments take two or three times longer, preventing her from finishing homework on time. Still, she feels she must count, or something far worse will happen to her.
Sixteen-year-old Sandra has developed a fear that germs in public restrooms, including the girls' bathroom in her high school, will give her AIDS. Because she can't leave the school building to go home midday, she washes up so often and harshly in the morning and afternoon that her hands and arms routinely are red and chafed.
Not all children have contamination fears. Some children limit their obsessions to a need for order. Others get bogged down in a need for certainty where there can be none. Children with OCD often change symptoms over time, or substitute one compulsive ritual for another. Another aspect of OCD is that it comes and goes, often for long periods at a time.
When Should Parents Be Concerned?
The parents of Josh, Stacy, and Sandra, whose stories are excerpted above, have cause for concern. Not only because of the specific behaviors performed (the content), but also because of their negative impact on the child's ability to cope with daily routines (the process).
There are three telltale signs of OCD in a child:
High anxiety level surrounding child's repetitive behaviors
Child's behaviors consume more than an hour per day
High degree of disruption caused in child's life
If you've seen behaviors similar to these, and if your child's behaviors are accompanied by high levels of anxiety, continue to monitor your child closely, taking particular note of how often and for how long the behaviors and moods occur.
Essential
As soon as you begin to see a pattern of OCD behaviors in your child, begin a symptom log, noting behaviors, with days and times, and situations, these are also called triggers, that set them off. Include length of event, and your child's anxiety or fear level, also called a fear thermometer, at the time of her symptoms. A symptom log will help you and your mental healthcare provider better evaluate whether your child has OCD and the degree of its severity.
Subsequent chapters of this book will spell out in more detail what to look for, the steps to take before visiting a doctor or therapist, and some coping strategies while you come to terms with having OCD in the family.
