OCD in Children and Adolescents – Symptoms and Treatment
Unfortunately, many people, including many psychotherapists, mistakenly think that OCD in children and adolescents is rare. As a result, children and adolescents with OCD are frequently misdiagnosed with depression, ADHD, conduct disorder, or other conditions. In actuality, childhood-onset OCD is fairly common, occurring in approximately 1% of all children. Furthermore, recent research indicates that approximately half of all adults with OCD experience clinical symptoms of the disorder during their childhood.
Symptoms of Childhood and Adolescent OCD
Symptoms of childhood-onset OCD vary widely from child to child. Some common obsessions experienced by children and adolescents with OCD include:
- exaggerated fears of contamination from contact with certain people, or everyday items such as clothing, shoes, or schoolbooks
- excessive doubts that he/she has not locked the door, shut the window, turned off the lights, or turned off the stove or other household appliance
- marked over-concern with the appearance of homework assignments
- excessive worry about symettrical arrangement of everyday objects such as shoelaces, school books, clothes, or food
- fears of accidentally harming a parent, sibling or friend
- superstitious fears that something bad will happen if a seemingly unconnected behavior is done (or not done)
Some common compulsions experienced by children and adolescents with OCD include:
- Compulsive washing, bathing, or showering
- Ritualized behaviors in which the child needs to touch body parts or perform bodily movements in a specific order or symmetrical fashion
- Specific, repeated bedtime rituals that interfere with normal sleep
- Compulsive repeating of certain words or prayers to ensure that bad things don’t occur
- Compulsive reassurance-seeking from parents or teachers about not having caused harm
- Avoidance of situations in which they think “something bad” might occur
In addition to the above symptoms, children and adolescents with OCD may exhibit secondary problems that arise due to the impact of their obsessions and/or compulsions on daily functioning. Academic difficulties, behavioral problems, peer conflicts, sleep disturbances, and family conflict are just some of secondary symptoms that frequently appear in children and adolescents with OCD. Unfortunately, these difficulties often become the focus of therapeutic attention, while the OCD that actually leads to these problems remains untreated.
Genetics and OCD in Children and Adolescents
According to a recent report from the International Obsessive-Compulsive Foundation (IOCDF), “there is evidence that OCD which begins in childhood may be different than OCD that begins in adulthood. Individuals with childhood-onset OCD appear much more likely to have blood relatives that are affected with the disorder than are those whose OCD first appears when they are adults”. In fact, one recent study found that children with OCD are much more likely to have a close relative with OCD when compared to the general population. This finding suggests that, while the cause of OCD is not fully understood, genetics plays a significant role in the development of OCD symptoms, and that the condition appears to be heritable. In fact, recent research has uncovered six specific genes which appear to play a role in the development of OCD. Unfortunately, researchers do not yet understand the exact mechanism that connects these genes to the onset of OCD symptoms.
However, it is crucial to note that there is a learning component to OCD as well. Like adults, children and adolescents with OCD perform compulsions and/or avoidant behaviors in an effort to reduce the anxiety caused by unwanted obsessions. While this may at first reduce the anxiety and obsessions, it actually reinforces and worsens both in the long-term. This in turn leads to more compulsions, which leads to even more obsessions and more anxiety. In the course of going through this cyclical process, the child develops a “learned response” in which he/she automatically become anxious in reaction to specific thoughts, objects or situations. While the specific thoughts and behaviors of OCD may vary with each individual, this process, called the Obsessive-Compulsive Cycle, is identical. For children and adolescents with OCD, this can become a near-constant cycle of obsessive thoughts and compulsive behaviors that significantly interferes with daily functioning at home and school. To learn more about this Obsessive-Compulsive Cycle, click here.
Childhood OCD and PANDAS
Over the past 15 years, researchers have published a number of studies suggesting a possible link between common strep infections and sudden-onset OCD and tics in children. This relatively unknown syndrome has been called pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS).
Research in this area was initiated when reports surfaced that some children with strep throats were experiencing the sudden onset of severe OCD, as well as tics similar to those seen in Tourette’s Disorder. Clinicians and researchers discovered that when these children received a course of antibiotics for their strep throats, their OCD and tic symptoms also decreased significantly.
Researchers then discovered that children with strep and rapid-onset OCD had increased levels of the antibodies associated with strep infection. Later research found that children with this syndrome exhibited brain swelling similar to that seen in situations in which the brain has been compromised by the body’s immune system in diseases such as Sydenham’s Chorea. More recent research has supported the thesis that for some children, exposure to the strep antibodies (not the strep virus itself) leads to neurological changes and development of OCD and tics in these cases.
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While these findings are controversial, it appears that, in some cases at least, the rapid-onset of OCD and tics in children may be caused by the immune system doing what it is designed to do – creating antibodies to fight infection. This research contributes to a growing body of evidence that indicates that OCD may in some cases have its origins in neurological and biological pathology. To learn more about this research, click here.
For many children with PANDAS-based OCD, the treatment is the same Cognitive Behavioral Therapy (CBT) used to treat other types of OCD. The only difference would be during an active strep infection, in which case the strep is treated with antibiotics. In those situations, one could expect a reduction in OCD symptoms as the strep infection is reduced as a result of the antibiotic. So the only time the treatment would vary from standard OCD treatment would be when a child has a strep throat.
Unfortunately, antibiotics and CBT are not always successful in reducing the severe OCD symptoms that are experienced by children with PANDAS. This has led to the development of other more controversial treatments. One such approach called plasmapheresis involves intravenous injections of immunoglobin (blood plasma) from healthy donors. Unfortunately, research studies on plasmapheresis completed thus far have had contradictory results, with some children experiencing little or no benefit, along with significant side effects. Investigators continue to research this and other alternative approaches as potential treatment options for Childhood OCD related to strep infections.
Treatment for Children and Adolescents with OCD
Fortunately, for most children and adolescents with OCD, the basic principles of treatment are the same as for adults with OCD. A specific type of Cognitive-Behavioral Therapy (CBT) known as “Exposure and Response Prevention” (ERP) has been found by researchers to be the most effective treatment for OCD in children, adolescents, and adults. Another CBT technique that is extremely valuable in the treatment of children and adolescents with OCD is called “Cognitive Restructuring”. And a variant of ERP has been developed that has also been found to be extremely effective with the “pure obsessional” symptoms often seen in children and adolescents with OCD. This method, called imaginal exposure, involves writing short stories based on the child’s obsessions. When combined with standard ERP and Cognitive Restructuring, imaginal exposure can greatly reduce the frequency and magnitude of the child’s symptoms. To learn more about Cognitive-Behavioral Therapy for the treatment of OCD in children and adolescents, click here.
It is important to note that, while the basic treatment for children and adolescents with OCD and related conditions is the same as for adults, childhood-onset OCD presents specific age-related issues that complicate treatment. Many children and adolescents with OCD do not yet have the emotional and cognitive skills to fully address their irrational fears and compulsive behaviors. As such, they may have difficulty identifying and articulating their fears and/or why they feel compelled to do certain behaviors. They also may not recognize that their fears are exaggerated or unrealistic. Furthermore, children with OCD may be resistant to discussing these problems with anyone, even their parents. Likewise, children and adolescents with OCD may anticipate being very uncomfortable or frightened by the prospect of discussing these issues with a psychotherapist. It is not unusual for children and adolescents with OCD to exhibit “magical thinking” in which they believe that their fears will come true if they talk about them with a therapist (or anyone). Others may deny symptoms, or want to avoid dealing with them in the hope that their OCD will just go away by itself. And some children just want to avoid dealing with their OCD due to embarrassment or shame.
As a result of these issues, it is critical that children and adolescents with OCD be treated by a therapist who not only specializes in the treatment of OCD, but also specializes in the treatment of children and adolescents. If your child or adolescent is experiencing any of the above OCD symptoms, and you would like to discuss treatment at the OCD Center of Los Angeles, you can call us at (310) 824-5200 (ext. 4), or click here to email us. If you live outside Southern California, we recommend that you contact a licensed Cognitive-Behavioral therapist in your local area.
Intensive Treatment for Children with OCD and Anxiety
We also offer an intensive treatment program for children and adolescents suffering with OCD and other anxiety issues. This program is designed to meet the needs of kids for whom standard outpatient treatment is either unavailable or insufficient. Our intensive outpatient program is ideal for children and adolescents from other states or countries who cannot find effective treatment near to their homes, and for kids whose symptoms require a more rigorous treatment protocol. Please note that some younger children may not be developmentally appropriate for intensive treatment. To learn more about our intensive outpatient treatment program, click here.
About the OCD Center of Los Angeles
The OCD Center of Los Angeles is a private outpatient treatment center specializing in the treatment of OCD and related anxiety based conditions. We treat adults, adolescents, and children, and offer services six days a week, including evenings and Saturdays. We have offices at four locations in Southern California:
- Woodland Hills
- Orange County
- Santa Barbara
For more information on treatment for your child or adolescent with OCD or a related anxiety based condition, please call one of our client coordinators at (310) 824-5200 (ext. 4), or click here to email us.