From Quirks to Compulsion, OCD in Children

Many children have quirks or superstitions, such as a lucky T-shirt, holding their breath through a tunnel or insisting on an ultraspecific bedtime regimen. But when do these idiosyncrasies classify as symptoms of obsessive compulsive disorder?

As a complicated anxiety-based disorder, OCD has increased in prevalence during the past 20 years. To calm anxiety, a child with OCD performs a ritualistic behavior. This compulsive habit can range from harmless to debilitating. An ultrastrict bedtime regimen is on the fully-functional side of the spectrum. In fact, some Type A personalities capitalize on functional OCD by performing high-precision jobs during adulthood.

The other side of the spectrum, however, features time-consuming, obsessive and harmful behaviors that interfere with daily life. Debilitating OCD leaves a child feeling encased by their fears and habits.

As many as one in 200 children and adolescents have OCD, according to the American Academy of Child and Adolescent Psychiatry. Research also shows that OCD primarily forms in elementary-aged children, before coping strategies for stress have fully-developed.

Children with OCD relieve personal anxieties with unique and individualized coping strategies. For example, a child terrified of germs may use three squirts of hand sanitizer every 10 minutes; a child obsessed with symmetry may have a system for eating, finishing chores and playing at recess; or a child with a phobia of lightening may perform nightly magical dances to protect her home.

Just because a child desperately demands their sandwich be cut a certain way doesn’t mean he or she has OCD. The same goes for children throwing tantrums because they don’t get their way. With reflection, parents can usually determine if the behavior is linked to hunger, tiredness or overindulgence, or if it’s a true ritual meant to relieve anxiety.

Although researchers haven’t determined the root cause of OCD, evidence points to serotonin levels and genetics. In recent cases, it has been shown that children can have a rapid onset of OCD symptoms. Researchers are studying these cases and a possible association with group A streptococcus infection, commonly called strep throat. The possible link with strep is referred to as P.A.N.D.A.S., or Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections.

Traditional OCD disorders can easily go unnoticed. Many children hide their rituals, feeling ashamed. And though it’s an anxiety-based disorder, children don’t always appear obviously anxious.

It’s important to know that a child with OCD can’t stop his habits by trying harder. It’s a true disorder with available treatment. A combination of psychotherapy and temporary high doses of antidepressants often manages the disorder. For example, I had a 7-year-old patient with OCD who coped with stresses of her parents’ approaching divorce by pulling her eyelashes and eyebrows out. With counseling and antidepressants, the behavior stopped. Unfortunately, like many OCD patients, this little girl relapsed three years later during another adverse life event. With more therapy and medication, her OCD became manageable again, and now she’s fully functioning.

I remind parents that though life events may trigger OCD, parents do not cause it. I also advise parents who feel suspicious of OCD in their children to provide a productive outlet for their child, teach stress management skills and talk with a family physician. If harmful habits or anger control issues surface, contact a health care provider immediately.

Anne Walker, MD, is a board-certified pediatrician and fellow of the American Academy of Pediatrics. She has been practicing medicine in the Charlotte area for more than 25 years and sees patients from birth to age 22.