Obsessive Compulsive Disorder (OCD) is a disorder that affects about 1% of children. According to a study carried out by the Universitat Rovira i Virgili, it is estimated that in Spain it has an incidence of 1.8% in schoolchildren, a figure that increases to 5.5% in the case of less severe OCD. Basically, it is an anxiety disorder characterized by the presence of intrusive and recurrent thoughts, as well as repetitive behaviors, the repercussions of which affect children’s behavior.
The causes of OCD in childhood
So far , the causes of OCD are unknown. However, some scientists believe that it could be related to brain neurochemistry, specifically with an alteration in serotonin receptors, as revealed by a doctoral thesis carried out at the Complutense University of Madrid. In this study, it was also found that those who suffered from the disorder presented slight alterations in the basal ganglia, the orbitofrontal area and the cingulate gyrus.
Genetics could also be at the basis of the disorder. Another study , this time conducted at the Broad Institute of MIT and Harvard, found four genes involved in the development of OCD in childhood: REEP3, HTR2A, NRXN1, and CTTNB2. All these genes are linked to the brain circuit that links the striatum, the cortex and the thalamus, and one of them, HTR2A, is specifically responsible for encoding one of the serotonin receptors.
In addition, the combination of biological and social factors plays an important role in the appearance of the disorder. On the one hand, it is known that having first-degree relatives with OCD increases the risk of developing the disease , while having had an overly strict and controlling upbringing from an early age can increase the chances of developing this disorder in childhood.
What are the most common symptoms of OCD in children?
Identifying children with OCD is not usually very complicated since their recurring ideas and stereotyped rituals give them away. They are usually children with very well structured rules, who find it difficult to break the rules that they themselves establish. In most cases, these signs begin to be noticed before they start school and manifest themselves in any setting, whether at home, at school or during a walk. Among the most common symptoms described by the DSM 5 are:
have obsessive ideas
Basically, it is an idea or thought that is repeated over and over again, over which the child has no control. In most cases, the little one does not want to have these thoughts because they are annoying, but he is unable to stop thinking about them, which ends up causing a high level of anxiety and persistent fear. Sometimes these thoughts appear only occasionally, but over time they can occupy a large part of the day and interfere with the child’s daily life. Among the most common obsessions is the fear of dirt or germs,the concern for order, symmetry or accuracy, as well as the disgust for waste or bodily fluids and the need to continually check an action that has been carried out perfectly, such as making the backpack for school.
Compulsion is a stereotyped ritual behavior that children with OCD carry out when they feel nervous or afraid.In general, it is a behavior that they perform for longer than “normal” and continuously until the obsessive idea and the emotions that it arouses disappear. Usually the child cannot control these behaviors. Sometimes these can be simple rituals like washing your hands several times after using the bathroom, but sometimes they can be more elaborate rituals like washing your hands with a special antibacterial soap for a specific amount of time. Some of the most common compulsions among children include excessive grooming, repeatedly checking to see if they have completed an action, arranging objects in a very peculiar way, or repeating behaviors such as going in and out of a door.
Parents may suspect that their child has OCD if they notice any of the following signs:
- Cracked or damaged hands from constant washing.
- Excessive use of soap or toilet paper.
- Too much time in common activities such as going to sleep or preparing the backpack.
- Repetitive behaviors with no apparent explanation and frequently.
- Excessive concern for order and organization, even outside your room.
- Unusual denials, such as stepping on a line or walking normally under a door.
- Issues with objects not meeting a uniformity standard.
How is OCD diagnosed in children?
The diagnosis of OCD is the responsibility of the psychologist, although it can also be done by a child psychiatrist or a pediatrician with training in this area. The diagnosis is made based on the diagnostic criteria of DSM 5, through an exhaustive psychological evaluation of the child and interviews with her parents. In some cases, standardized rating scales may also reveal information of interest.
When making the diagnosis, it is important to assess the intensity of the symptoms and the degree of involvement in the different spheres of the child’s daily life . This is essential to identify the needs in each case and, later, implement the most appropriate treatment guidelines for each child. However, it is worth clarifying that the diagnosis of OCD in childhood is subject to many factors that can make the symptoms worsen or disappear during growth.
Is OCD curable? Effective treatments for childhood OCD
There is no cure for OCD, but its symptoms can be greatly improved with the right treatment. In general, the treatment is aimed at stimulating self-control through cognitive-behavioral therapy, with which the child is offered tools to regulate his obsessive ideas and put an end to her compulsions.
In this sense, one of the most used therapies is cognitive restructuring, in which the interpretation of obsessive ideas is modified and then the intrinsic logic that is at the base of compulsive behaviors is reconsidered. Likewise, the technique of exposure with response prevention is used with the aim of training the child to avoid his compulsive response when exposed to her obsessions. In many cases, relaxation, while not having a direct benefit on OCD symptoms, does facilitate emotional control.
Pharmacotherapy with serotonin reuptake inhibitors such as fluvoxamine, fluoxetine, sertraline and clomipramine have also shown good results, especially in the most severe cases of the disorder. A review conducted at the University of London including 17 studies found that those treated with serotonin reuptake inhibitors were almost twice as likely to achieve a clinical outcome compared to those given a placebo.
Family collaboration is also important in the treatment of OCD. For this, parents are usually offered information about the disorder and some useful educational measures are recommended, such as avoiding punishment in the face of symptoms, showing empathy without giving in to the demands of participating in rituals, and trying to explain to the child the logic behind their idea obsessive or compulsive