Children & Adolescents
OCD in Kids
Kids can get “stuck” on things and act in a rigid way but when does this stop being typical behavior and start being obsessive-compulsive behavior (OCD)? OCD is a disorder that affects how a child thinks and acts. Obsessions are intrusive and unwanted thoughts, images, and urges that repeatedly send the message: “something bad is going to happen.” Obsessions can feel as if they are on a continuous loop in a child’s mind. The unrelenting nature of obsessions make them difficult to control and very distressing for the child. Compulsions, or rituals, are behaviors that the child performs because the child believes this behavior will protect them from these bad things happening. However, compulsions don’t free the child from anxiety but actually trap the child in rigid patterns of behavior that can be embarrassing or interfere with their ability to engage in normal activities.
OCD is very confusing for children because their brain is repeatedly telling them to behave in a particular way while, at the same time, the child is overwhelmed by anxiety. Parents also struggle when their child is upset and are unsure how to help them. Approximately 25% of individuals who will develop OCD in their lifetime first experience OCD when they are 14-years-old or younger. Early intervention in the form of treatment can support children in learning skills to cope with anxiety in more adaptive ways so they can enjoy being a kid.
For many children and adolescents, school can be scary and overwhelming. This fear of school may lead to the child or adolescent withdrawing into themselves during the school day in order to “shut out” the environment or avoiding school altogether. There are various triggers for school phobia. The student may fear a certain aspect of school (i.e. testing, socializing, etc.) or may be uncomfortable with uncertainty of school (i.e. what will I do next?, who will I sit with at lunch? Will a teacher yell at me?, etc.). The student may also exhibit physical symptoms of anxiety (i.e. stomach aches, headaches, etc.) that quickly resolve after the student is allowed to stay home. Teachers and staff may misunderstand this behavior as being defiant if the student repeatedly misses school or leaves early. However, students suffering from school phobia are deeply distressed by school and need support to overcome their fears related to school. Students would school phobia would benefit from receiving psychological support to help the student identify fears that are triggering school phobia and challenging those fears so the student is able to function in school without distress. Treatment should be received as early as possible because avoidance maintains school phobia by sending the student the message that they can’t handle school.
Some children experience a type of anxiety disorder that leads to a consistent inability to speak in some environments, such as school, even though they are able to speak in other environments, such as home. In cases of selective mutism, there is not a language or communication disorder that would explain why the student is not speaking. Selective mutism is associated with intense social anxiety. Others often view students as excessively shy or cling only to a select few people they are comfortable with. The challenges in communicating creates difficulties for students with selective mutism to expand their social circle and can lead to social isolation if the disorder is not well accommodated in the classroom. Selective mutism often begins before age 5 but becomes increasingly problematic as the person ages and is unable to fully participate in school.
For many children with OCD, symptom onset can be gradual and seem as if it has always been a part of the child’s personality. However, children can also develop OCD symptoms “out of the blue” following an infection. Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus (PANDAS) is diagnosed when a sudden onset of OCD symptoms occur following a “strep” infection. Similarly, Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) is diagnosed when a sudden onset of OCD symptoms occur following other types of infections, including mycoplasma, mononucleosis, Lyme disease, and H1N1 flu virus.
Due to the overlapping physical and mental origins of both PANDAS and PANS, a combination of medicine and behavioral intervention is necessary. Antibiotics are needed to treat the infection and psychological treatments are needed to address the symptoms of OCD. Effective psychological treatments include cognitive behavioral therapy (CBT), exposure and response prevention (ERP), and habit reversal training.