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 symmetrical 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 report from the International Obsessive-Compulsive Disorder 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 Syndrome. 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.