Obsessive-compulsive disorder in children

OCD is a mental disorder in which an individual has uncontrollable, recurring thoughts (obsessions) and behaviors (compulsions) that she needs to repeat continuously

Does your child indulge in a series of repetitive actions? Is she gripped by strong obsessions and unwarranted anxiety? Is she slow in getting ready for school and completing homework? Does she constantly erase and rewrite sentences to make them perfect? Has repeating sentences become an everyday ritual? Have you observed her switching electronic devices on and off several times? If any one or more of these behaviour symptoms are manifesting daily, your child is suffering obsessive-compulsive disorder (OCD).

The popular belief is that OCD is an adult affliction. But several studies indicate that 80 percent of adults diagnosed with OCD display symptoms before 18 years of age. OCD is a mental disorder in which a person has uncontrollable, recurring thoughts (obsessions) and behaviours (compulsions) that she needs to repeat continuously. It is defined by high anxiety and stress that have the potential to make everyday experiences intolerable especially for children. OCD symptoms are not limited to mere fascination with cleanliness — as commonly believed. This pathology can play havoc with a child’s day-to-day activities schedule such as playing with friends, going to school, or enjoying hobbies.

Causes

There is no known cause of OCD. Usually children develop this disorder if there is a family history of disquiet and anxiety or if the child has experienced a traumatic event.

Symptoms

Parents tend to misinterpret OCD symptoms as ADHD (attention-deficit hyperactivity disorder), depression, or general nervousness. Therefore it’s important that a correct diagnosis is made so that appropriate and timely medical intervention alleviates high anxiety. OCD symptoms usually manifest in children between 7-12 years of age. Typical symptoms displayed by a child or adolescent suffering OCD are:

* Repetitive obsessions characterised by unwanted, intrusive thoughts, ideas, visual images and fears that incite fretfulness.

* Compulsive behaviour and repetitive actions performed by the child to alleviate anxiety triggered by obsessive thinking.

Examples of obsessions

* Display of extreme interest in cleanliness and strong urge to protect herself from germs, dirt or illness. For instance a child may continually wash her hands and feet after returning home from play or school

* Expresses recurrent doubts about being able to complete tasks such as homework

* Excessive fixation with symmetry, order and exactness

* Unwarranted interest in remembering trivia

* Unwarranted attention to detail

* Aggressive thoughts towards self or others

Examples of compulsive behaviour

* Washing hands excessively and frequently

* Constantly checking notes or written work, excessive counting and recounting of numbers

* Regular repetition of words spoken by self or others or repeating sounds, words, numbers or musical notes

* Rigidly following self-imposed rules of order such as arranging personal items in a particular way and experiencing anxiety if the arrangement is disturbed

* Repeating questions and insisting on answers

Treatment

This disorder can be effectively treated in children, particularly if diagnosed early. Typically, mental health professionals use a combination of therapy (mental behavioural therapy) and medication (selective serotonin re-uptake inhibitors). Family therapy may also be recommended as parents play a vital role in helping children recuperate from this grave mental disorder.

Managing anxiety levels

Parents can help alleviate the anxiety levels of children suffering OCD by assuaging their doubts and fears. Here are some guidelines:

• Encourage your child to participate in relaxation exercises such as deep breathing, yoga and meditation

• Initiate positive verbal communication. For example, instead of discouraging/penalising them, motivate them to stop repetitive actions.

• Distract your child’s attention through engagement with activities such as reading or playing sports and games.

• Set small challenges and give rewards and prizes for accomplishment. For example, a child who is constantly washing her hands will earn stars if she lets dirt remain on her hands for an agreed period, or if she restricts washing to just one time.

Raising children with OCD can be daunting and draining for most parents. But remember, sympathetic parenting can go a long way in managing children’s obsessions and compulsions. The unconditional love, support and encouragement of parents is critical to helping children alleviate anxiety and enable children to shed OCD.

(Dr. Manjiri Deshpande is a Mumbai-based child psychiatrist with Docterz)

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