Your child clings desperately to a particular piece of clothing or a rundown toy. He's stuck on one game, one type of food, one way of going through his daily routine. He has little rituals he goes through that make no sense to anyone but him. Could he have obsessive-compulsive disorder (OCD)? Sensory integration-related behaviors can appear to fit into this psychiatric disorder, but the reason behind the rituals may not be the same at all.
Making an OCD Diagnosis
To make a diagnosis of OCD, a mental health professional (such as a psychologist) will review information provided by parents and teachers and use DSM guidelines to identify certain patterns of behavior. OCD is indicated when a child is frequently troubled by obsessions, which are thoughts or mental images that meet the following criteria:
They are unwanted, inappropriate, and disturbing
They are unrelated to actual events and concerns
The child tries to block them out with other thoughts or actions
They come from her own mind and not someone's suggestion
The child frequently responds with compulsions, activities that meet the following criteria:
They are done to combat obsessions, or according to unchangeable rules
They are not realistic responses to actual events
They are done to avoid a feared outcome
The mental health professional would expect to see these obsessions and compulsions taking up a large amount of the child's time and attention, causing problems with her daily school and home routine, and keeping her from normal relationships and activities.
The Sensory Integration Difference
It's estimated that 1 million U.S. children and teens have obsessive-compulsive disorder, about 1 in 200. Although the cause is not known, a genetic connection is suspected. Children who have one parent with the disorder are as much as 8 percent more likely to be diagnosed with it.
If your child is hypersensitive to information coming in through her senses — that is, she perceives a threat from a touch or sight or sound that others would find harmless — she may set up routines and defenses for herself that could be mistaken for OCD. Additionally, if she has problems with planning out how to do a particular activity, she may become strongly attached to the one way of doing it that she has already worked out, or she may stick stubbornly to activities that are much simpler.
In both cases, though, she will likely be open to other alternatives that achieve the same effect. She may be willing to change routines if you very patiently teach her how to do it differently.
A child with OCD is obsessed with things that aren't real and develops compulsions to deal with them, whereas a child with sensory integration disorder is bothered by real things in her environment and develops routines and defenses to deal with them. If you can change those real things, you can most likely change the behaviors.