Obsessive Compulsive Disorder in Children: What is it and how to treat it?

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Obsessive Compulsive Disorder in Children

Obsessive-Compulsive Disorder (OCD) is a disorder that affects about 1% of children. According to research, it is estimated that in the United States it has an incidence of 1 in 100 adults, or between 2 to 3 million adults in the United States — currently have OCD. Basically, it is an anxiety disorder that is defined by the presence of interfering and recurring thoughts, as well as repetitive behaviors, whose consequences affect children’s behavior.

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Causes of Obsessive-Compulsive Disorder (OCD) in childhood

So far the causes of Obsessive-Compulsive Disorder (OCD) are not identified. But, some experts believe that it could be linked to brain neurochemistry. Particularly an alteration in serotonin receptors, as shown in a doctoral thesis carried out at the Complutense University of Madrid. In this research, it was also discovered that those who experienced the disorder had slight alterations in the basal ganglia, the orbitofrontal area, and the cingulate gyrus.

Genetics could also be at the root of the disorder. Another research, this time conducted at the Broad Institute of MIT and Harvard, discovered four genes related to the development of Obsessive-Compulsive Disorder (OCD) in childhood: REEP3, HTR2A, NRXN1, and CTTNB2. All these genes are connected to the brain circuit that links the striatum, the cortex, and the thalamus, and one of them, HTR2A, especially responsible for encoding one of the serotonin receptors.

Besides, the combination of biological and social factors plays an essential role in the growth of the disorder. On the one hand, it is understood that having first-degree relatives with Obsessive-Compulsive Disorder (OCD) increases the chance of suffering from the disease while having an education that is too strict and controlling from an early age can increase the chances of developing this disorder in childhood.

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What are the most common Obsessive-Compulsive Disorder (OCD) symptoms in children?

Identifying children with Obsessive-Compulsive Disorder (OCD) is normally not very difficult as their recurring ideas and conventional rituals give them away. They are normal children with very well structured rules, who find it hard to break the rules that they set themselves. In most maximum cases, these symptoms begin to be noticed before they start school and show themselves in any setting, whether at home, at school, or during a walk. Among the most popular symptoms DSM 5 describes are:

Have obsessive ideas

Basically, it is an opinion or thought that is repeated over and over again, over which the child has no control. In most cases, the child does not want to have these thoughts because they are irritating but is unable to stop thinking about them. Which ends up creating a high level of anxiety and determined fear. Sometimes these thoughts emerge only infrequently, but over time they can control a large part of the day and conflict with the child’s daily life. Among the most popular obsessions is the fear of dirt or germs, the concern for order, symmetry, or accuracy, as well as the dislike of body waste or fluids and the need to continually check an action that has been carried out perfectly, such as doing the school backpack.

Frequent compulsions

Compulsion is a stereotypical ritual behavior that children with Obsessive-Compulsive Disorder (OCD) perform when they feel afraid or nervous. In general, it is a behavior that they carry out for longer than “normal” and without delay until the obsessive idea and the emotions that it arouses disappear. Usually, the child cannot manage these behaviors. Sometimes these can be simple rituals like washing your hands several times after using the bathroom, but sometimes they can be more complex rituals, like washing your hands with a special antibacterial soap for a specific time. Some of the most obvious requirements among children include excessive grooming, checking several times that they have completed an action, organizing objects in a very peculiar way, or repeating behaviors such as entering and leaving through a door.

Parents may suspect that their child has Obsessive-Compulsive Disorder (OCD) if they notice any of the following signs:

  • Damaged or cracked hands from constant washing.
  • Excessive use of soap or toilet paper.
  • Too much time in normal activities like going to sleep or packing a backpack.
  • Frequent and unexplained repetitive behaviors.
  • Excessive concern for order and organization, even outside your room.
  • Unusual denials, such as stepping on a line or going under a door normally.
  • Problems with objects that do not meet a uniformity standard.

How is OCD diagnosed in children?

The diagnosis of Obsessive-Compulsive Disorder (OCD) is the responsibility of the psychologist, although it can also be made by a child psychiatrist or a pediatrician with training in this area. The diagnosis is made based on the diagnostic criteria of DSM 5, through an exhaustive psychological evaluation of the child and interviews with his parents. In some cases, standardized rating scales can also reveal information of interest.

When making the diagnosis it is important to assess the intensity of the symptoms and the degree of involvement in the different spheres of the child’s daily life. This is essential to identify the needs in each case and, later, implement the most appropriate treatment guidelines for each child. However, it is worth clarifying that the diagnosis of Obsessive-Compulsive Disorder (OCD) in childhood is subject to many factors that can make the symptoms accentuate or disappear during growth.

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Is OCD Cured? Useful treatments for Obsessive-Compulsive Disorder (OCD) in children

There is no cure for Obsessive-Compulsive Disorder (OCD), but your symptoms can greatly improve with proper treatment. Treatment is generally aimed at stimulating self-control through cognitive-behavioral therapy, which offers the child tools to regulate his obsessive ideas and curb his compulsions.

In this sense, one of the most used therapies is cognitive restructuring, in which the interpretation of obsessive ideas is modified and then, the intrinsic logic that is at the base of compulsive behaviors is rethought. Likewise, the response prevention exposure technique is used to train the child to avoid his compulsive response when exposed to his obsessions. In many cases, relaxation, although it does not have a direct benefit on Obsessive-Compulsive Disorder (OCD) symptoms, facilitates emotional control.

Drug therapy with serotonin reuptake inhibitors such as fluvoxamine, fluoxetine, sertraline, and clomipramine have also shown good results, especially in the most severe cases of the disorder. Research conducted at the University of London, including 17 studies, revealed that those treated with serotonin reuptake inhibitors were almost twice as likely to achieve a clinical outcome compared to those who received a placebo.

In treating Obsessive-Compulsive Disorder (OCD), it is also important to have family collaboration. For this, information is usually offered to parents about the disorder and some useful educational measures are recommended such as avoiding punishment for symptoms, being empathetic without giving in to the demands of participating in rituals, and trying to explain to the child the logic behind their idea obsessive or compulsion.

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