Question1. For our readers will you tell, what does childhood OCD mean? And how is it different from OCD in adults?
To start with, OCD is the commonly used abbreviation for Obsessive – Compulsive Disorder. It is a disorder of brain that is widely prevalent in all age groups. The manifestations in children & adults are similar in many ways but they also share important differences. The hallmark of OCD are unwanted repetitive thoughts & fears which compels an individual to perform compulsive behaviours across ages. As these rituals are continual, easily noticeable and highly upsetting, they are brought to attention by adults themselves or their family members. But children are more secretive about the nature of their problems. They try to hide their behaviours and consequently remain concealed from parents for a long period of time.
Question 2. How common is OCD in children? Is there any age range to be watched for?
Initially, this disorder was considered to be infrequent in children and adolescents. However, over the years, it has been identified in younger ages as well. It is common in 2-3 % of general population. It can be recognized in children as young as 4 years but it is more usually seen in minors aged 7 – 10 years. It kicks off in males before puberty and females are naïve around puberty. Also, as much as 50% of adults have been shown to have a beginning of their problems in childhood.
Question 3. How does OCD present in children? What are the “look out” signs for parents?
It is natural to have some ritualistic behaviours at early age. For example, a child might want the parents to behave in a particular way, insist on the same type and pattern of meals or perform some conventional behaviours before bed time. But these practices usually fade away after the age of 2-3 years and do not interfere with the daily functioning. But when OCD is expressed in children, they spend a lot of time in these behaviours which affects their day to day activities. The ‘obsessions’ are identified as constant thoughts, doubts, fear or images which are troublesome, meddling and considered silly. Though the child might want to cut off from these thoughts, he/she might not succeed in doing so. If one calculates the magnitude of time used up, it easily exceeds an hour and may even take up to 8 hours a day. As these thoughts are very nagging, he/she starts carrying out actions which are again ceaseless called as ‘compulsions’. The child now spends equal or more amount of time in these actions as they bring about a temporary relief in the uneasiness. Still as the abatement is only for a short while, the child reengages in these thoughts and actions with the cycle continuing till the day lasts.
As already mentioned, the ritualized actions are easily discernable even if the parent is unable to understand the series of thoughts leading to them. Some of the children might keep on repeating the actions till they feel ‘just right’ and in such situations the actions speak louder than thoughts as the child might find it difficult to explain the reasons behind it. The typical themes that are recognized as obsessions are concerns regarding germs, dirt and environmental toxins; fear that some dreadful event might happen (e.g. death of both parents in a car crash); fear of causing harm to self or others, doubt that things are not arranged in order or are missing. On the other hand, the compulsions are counterpart of these concerns that lead to excessive bathing or handwashing; repeating rituals to check for the dreadful event; checking repeatedly to ensure things are at place or not forgotten.
Question 4. If the parents suspect that their child has OCD, what should they do? Does any parenting mistake cause OCD in children?
If the parents are in doubt regarding the nature of behaviour seen in the child, they should immediately consult a mental health professional. As the disorder has negative impact on the functioning of the child, they should avoid any delay in consultation if they feel that the child has any of these behaviours.
Anyhow, no parenting mistake can give rise to this disorder in children.
Question 5. Do children with OCD need treatment? Is there any need for medications? If yes, how safe are they?
Children suffering from OCD need help from mental health professionals. It is not possible for most of them to resist and control these thoughts by themselves. The medications are not the initial choice in many cases but could be required depending upon the severity of the symptoms and the presence of co-existing psychiatric disorders. The drugs used for OCD work by increasing a chemical known as Serotonin in various parts of the brain. They are popularly known as antidepressants which have traditionally been helpful in tackling depression. Nevertheless, they form the cornerstone of treatment in OCD and are used in higher doses than used for depression. They are considered to be generally safe in children with mild side effects. Though there was a warning issued in children and adolescents for risk of increasing the suicidal tendencies, there been a steady rise in the use of these drugs as their potential in alleviating the problems exceeds far more than the risk.
Question 6. Is there any way to manage OCD other than medications? Is it better than medications?
There are various psychological therapies that can be offered to children with OCD. The mainstay of therapy is exposure and response prevention (ERP). In this therapy, the child is gradually exposed to situations that bring about compulsive actions but is stopped from performing these actions simultaneously. Training in managing anxiety because of the situations is also imparted. It is equally effective as medications but has an edge when it is combined with medications to treat the symptoms.
Question 7. Is there any course or time duration of treatment for OCD in children?
OCD is a longstanding disorder requiring long term treatment. Unfortunately, there is no time duration fixed for which treatment can be offered. But it is recommended that the treatment should continue for at least six months after there has been a complete improvement in symptoms.
Question 8. What is role of parents in treatment of OCD in children?
It is a challenging task for parents to manage such children. They might themselves experience anxiety due to the repetitive rituals present in the child. This might force them to accommodate such behaviours by helping the children perform the actions. The child might show temper tantrums or bursts of anger if the parents attempt to stop their compulsive rituals. This might add to the pressure to accommodate to the faulty behavior of the child. Such conduct by families will escalate the difficulties in treating the disorder.
Notwithstanding, the involvement of family members is extremely important in the management of OCD in children & adolescents. Imparting knowledge & guidance regarding the illness will empower them to correct their flaws and enable them to learn alternative healthy behaviours.
Question 9. Does OCD in children have a barrier on their career? Do they need special school?
OCD in children might achieve chronicity. Only 50% children show partial response to the initial treatment with medications. In spite of advances in management, at least 10 % of the children remain severely affected. These children could have difficulty in attaining their goals in their personal and professional lives due to the impairing nature of the symptoms. It could be that the nature of the symptoms are such that the choice of career is not compatible with the existing symptoms. It is only in such circumstances that OCD assumes the form of a barrier in pursuing a successful career. In any case, children with OCD do not need a special school.
Question 10. Is this genetic? Can parents do anything to prevent OCD in children?
OCD is a highly heritable disorder when it has its onset in childhood. In any individual suffering from OCD, the first-degree relatives are at highest risk of developing the disorder, the risk decreasing as the relatives get more distant in the blood line. At this point of time, little is known about the role of environmental aspects contributing to the disorder, so with the restricted information it would be hard to provide any suggestions with regards to role of parents in prevention of OCD.
Dr. Varun Mehta