School Age

Obsessive compulsive disorder (OCD) in children and teenagers

Obsessive compulsive disorder (OCD) in children and teenagers

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What are obsessions?

Obsessions are thoughts, images or urges that a child doesn't want but can't get out of his head. When a child has these thoughts, he might also feel very anxious or fearful.

Some examples of obsessions might be:

  • imagining loved ones getting hurt
  • being scared of getting sick from touching dirty handles
  • feeling that something terrible will happen if your books aren't in the right order.

What are compulsions?

Compulsions are things a child feels she must do over and over. Sometimes children might do this to try to stop an obsessive thought. But sometimes children don't know why they feel and behave this way.

Some examples of compulsions might include:

  • washing hands repeatedly
  • praying
  • hoarding - that is, not being able to throw anything away
  • counting or tapping
  • behaving in mildly superstitious ways, like always wearing the same t-shirt to dance class
  • pulling at hair or picking at skin.

Obsessions and compulsions: should you be worried?

Many children have obsessions and compulsions. They can be a normal part of children's development. For example, your child might go through a stage of wanting his bedtime ritual to be exactly the same every night.

Obsessions and compulsions that don't get in the way of your child's or family's life aren't usually anything to worry about.

When obsessions and compulsions become obsessive compulsive disorder (OCD)

If children have unwanted thoughts or compulsive behaviour, or both, which don't go away and which interfere with daily life, they might have obsessive compulsive disorder (OCD).

You might have your child checked for OCD by a health professional if you notice your child has:

  • more severe obsessions and compulsions than her peers
  • obsessive thoughts and/or compulsive behaviour that upset her and stop her from enjoying life or that interfere with your family's everyday activities
  • obsessive thoughts and/or compulsive behaviour that last for more than six months.

Obsessive compulsive disorder is an anxiety disorder. It won't go away on its own. And sometimes children who have OCD go on to have other emotional health problems later in life. So getting professional treatment for your child with OCD is important.

How OCD affects children and families

Because obsessive thoughts and compulsive behaviour affect your child's ability to relax and enjoy life, your child with OCD might have challenges like:

  • problems at school - for example, your child has trouble paying attention or doing homework
  • disrupted routines - for example, your child won't go to school, come to dinner or go to sleep until his rituals are done
  • physical problems from feeling stressed or not getting enough sleep
  • social problems - for example, your child spends more time on his obsessions and compulsions than with his friends, or he feels ashamed of his OCD or has trouble dealing with other people's reactions to his behaviour so he avoids social situations
  • self-esteem problems - for example, your child worries that he's different from his friends and family or that he isn't in control of his behaviour
  • other mental health problems - for example, child anxiety, child depression, teenage anxiety or teenage depression.

Sometimes families just get used to their child's rituals and compulsions, and it can be hard to see how much the behaviour affects family life. If this sounds like your situation, you could try asking yourself, 'How would our life be different if our child didn't have these obsessions or compulsions?'

If your life would be changed quite a bit, or if obsessions and compulsions are stopping your child from having fun and doing everyday things, think about seeking help.

Getting help for your child with OCD

A first step to helping your child overcome OCD is getting a referral from your GP to a psychologist, paediatrician or a child psychiatrist. The health care professional you see will assess your child's symptoms and develop a management plan by talking with you, your child and possibly staff at your child's school too.

Cognitive behaviour therapy (CBT) is the best way to treat OCD. This therapy helps your child develop skills to change her pattern of thinking and behaviour when she's in a situation that makes her anxious.

Many health professionals also use relaxation techniques, breathing exercises and mindfulness together with CBT. These techniques can help your child manage symptoms better and reduce the chance that the OCD will come back in the future.

In severe cases, medication might be used in combination with therapy. But there isn't much information about how well medication works in children under seven years.

Your GP will probably talk with you about a GP Mental Health Treatment Plan for your child. Getting a Plan doesn't always mean your child has a serious problem. But if you have a Plan, you can get Medicare rebates for up to 10 sessions with a psychologist. You can also get Medicare rebates for visits to a paediatrician or psychiatrist. Your GP can help you find the right health professional.

Helping your child with OCD at home

There are also a few things you can try at home to support your child. If you want to try any of these ideas, it's always best to let your health professional know what you're doing.

Supporting your child
It can be scary and lonely for a child to go through OCD. Children with OCD often notice they're different from other children.

So it can help your child to know he's not alone. Tell him you're there to listen when he needs to talk about his worries. For example, 'It sounds like you feel really worried about what will happen to Dad if you don't check you've closed the fridge door'.

It might be frustrating for you, but try to avoid criticising or getting frustrated with your child about her rituals.

Understanding anxiety
You can talk with your child about how anxiety and worry are helpful sometimes - for example, if you're worried about a test, you'll often study harder.

But some worries go off like a false alarm when there's nothing to really worry about. So you could explain that bad things won't happen if your child doesn't do what his worries tell him to do. For example, you could say, 'How many of your friends have got sick from touching a dirty handle?'

Managing anxiety
You can help your child with some strategies for managing worries and facing fears. These strategies might include:

  • relaxation - for example, deep breathing, muscle relaxation and meditation
  • positive self-talk - for example, 'I can stop doing this', 'I will be OK if I don't do this'
  • distraction - your child does something else that she enjoys, like reading a book or shooting hoops, for at least 15 minutes
  • a worry box - for example, your child writes down or draws worries and puts them in the box to look at later with you
  • a calm place where your child can do activities that distract her from worries.

When your child is learning to manage anxious behaviour, it helps to start small. If he can't stop the behaviour completely at first, break it down into small steps. For example, instead of turning the light on four times, turn it on only three times.

You can set small challenges for your child, and use rewards to help her achieve them. For example, a child who compulsively washes hands can earn star stickers if she lets dirt stay on her hands longer before washing.

It might be hard to understand your child. Sometimes you might feel like saying, 'Just stop it!' Finding someone to talk to can help you to stay calm and positive. You could try starting a conversation with other parents in an online or a face-to-face support group.

Causes of OCD

We don't know what causes obsessive compulsive disorder (OCD).

We do know that it's common for children to develop OCD if family members have a history of anxiety or if children have been through a stressful or traumatic event.

And in some rare instances, children develop OCD symptoms after a streptococcal infection (a bacteria that can cause throat infections).

If your child develops OCD, it isn't your child's fault, and it isn't your fault.