What to do about obsessions and compulsive behaviour in kids

24 May 2014

Constant hand-washing and an unreasonable fear of germs can indicate obsessive-compulsive disorder – and it affects children as much as adults.

When her son first began acting strangely she thought it was a phase he would soon grow out of. But when 12-year-old Donovan* began going to the bathroom every hour to wash his hands, spent up to 10 minutes doing so and refused to dry them twice on the same towel Pauline Meyer* of Boksburg realised something was wrong. At the dinner table he insisted on being served first and would not use the serving spoons if someone had used them before him.

When he began withdrawing from activities with the family such as playing with the dogs or playing darts because they were “dirty” Pauline sought help from his school psychologist.

At age 13 Donovan was diagnosed with obsessive-compulsive disorder (OCD). It was a shock to Pauline; she thought it affected only adults – a common misconception. “At least half the adults with OCD developed it in childhood,” says Paul Serebro, founder of the OCD Association of South Africa.

He says there has been a steady increase in the number of parents seeking help for their children with the disorder as more people become aware that it affects kids. OCD is common between the ages of seven and 18 but can occur in children as young as two. It’s estimated one to three children in a hundred suffer from it.

Adults are deemed better equipped to deal with the obsessions and compulsions of OCD but the symptoms are a frightening experience for children. This is why experts say early intervention is crucial to help kids manage the disorder’s intrusive effects as they grow older.

“For months Donovan’s brothers teased him about his disorder, not understanding it,” Pauline says. “It would hurt him and he would lock himself in his room for hours. It was very frustrating for him and he tried desperately to hide his behaviour as much as he could.

“I think he felt abnormal; he knew he needed to do something that was different to the behaviour of everyone in the family and at school.”

After Donovan was diagnosed Pauline sat the family down, explained OCD to them and asked for their support. Six years later Donovan is still in therapy and takes medication that manages his symptoms.

OCD is known as a silent disease because many children hide their symptoms out of shame and embarrassment. While most adults with OCD recognise their actions are unusual, children may not realise their behaviour is out of the ordinary until it affects their lives detrimentally, according to the Anxiety and Trauma Clinic. Kids may also have trouble verbalising what they experience.

OCD has been found to increase the risk of suicide because it can be so demoralising. It also increases the risk of alcohol and substance abuse as sufferers turn to unhealthy coping mechanisms. It’s important to understand more about the disorder if your child suffers from it and what you can do to help him or her.

Most people have rituals, such as checking to see if the stove is off or that the door is properly locked – sometimes several times before leaving the house. For people with OCD their rituals reach a point where they drastically interfere with daily life. The repetition of their actions becomes time-consuming and distressing.

OCD is characterised by recurrent and intense obsessions and compulsions. Obsessions, mostly irrational and intrusive thoughts, are more than the usual worries. A younger child with OCD may have persistent thoughts that someone is trying to harm a family member and will check doors and windows after their parents are asleep in an attempt to prevent this from happening and relieve their anxiety.

Teens with OCD may fear they will become ill because of germs and wash their hands often enough to cause extreme dryness or even bleeding. Compulsions are the repetitive rituals such as hand-washing, hoarding and repeatedly checking or counting that aim to relieve the distress the obsessions bring about. Performing these rituals is not pleasurable for those with OCD because it produces only temporary relief.

A single cause of the incurable disorder hasn’t yet been found but experts point to hereditary factors and external factors such as trauma (abuse or illness). Close relatives of children and teenagers with OCD are up to 12 times more likely to have the disorder, says Professor Christine Lochner of the SA Medical Research Council’s Unit for Stress and Anxiety Disorders.

She adds that the later the disorder develops the more likely that external conditions played a role. Children with OCD are also more likely to have another anxiety disorder, attention deficit hyperactivity disorder (ADHD) or depression.

Management of OCD usually includes cognitive behavioural therapy and medication. “OCD patients will never stop having intrusive thoughts but can learn to deal with them,” Serebro says.

*Not their real names.

Signs to look out for

  • Seek professional advice if you notice these possible signs of OCD in children.
  • Raw, chapped hands from constant washing
  • A noticeable drop in school marks
  • Long, unproductive hours spent doing homework
  • Requests for family members to repeat strange phrases or keep answering the same question
  • An intense fear of illness
  • A dramatic increase in laundry
  • Spending an unusually long time getting ready for bed
  • Continual fear something terrible will happen to someone
  • Constant checks on the health of family members
  • Reluctance to leave the house and spend time doing outdoor activities

How parents can help

  • If you notice possible OCD symptoms (see Signs of OCD) in children check if their compulsions are intruding on their life. Some repetitive behaviour in children is normal and can be overlooked; check if performing compulsions causes your child anxiety and takes up a lot of time.
  • Find a therapist/psychologist who specialises in OCD. They may be able to diagnose the disorder in your child or determine whether there’s a different problem and discuss treatment options.
  • Once a child has been diagnosed with OCD gather the family together and emphasise the importance of support – this is crucial in the treatment of someone living with OCD. “It’s important for family members to get the facts about the disorder so they’ll know what to expect. Uncertainties may lead to too much anxiety and many misunderstandings,” says Professor Christine Lochner of the Medical Research Council’s Unit for Stress and Anxiety Disorders. “The family needs to talk about the condition and be open about it.”
  • Get rid of guilt. It’s common for parents to be racked with guilt when a child is diagnosed with OCD and think they’re partially to blame. “It doesn’t help to feel guilty about what could have caused it,” Professor Lochner says. “It is probably much more complex than one factor and guilt won’t help.”
  • Don’t participate in or enable your child to practise OCD rituals. Your psychologist should give you strategies specific to your child that will help you avoid doing this.
  • Make sure your child takes medication as prescribed and attends therapy appointments.
  • Stay calm when faced with tantrums or tears of frustration from children with OCD as they’re prone to this behaviour. For a younger child who acts out it helps to say in a slow, calm voice, “When you can talk to me in an ordinary voice I can help you.”
  • For a preteen say, “Slow down and tell me what happened.”

Useful contact numbers

  • The mental Health information Centre of South Africa 021-938-9229
  • The medical Research Council’s Unit for Stress and anxiety Disorders, Department of Psychiatry, Stellenbosch University 021-938-9179
  • Obsessive-Compulsive association of SA 011-447 2875
  • The South african Depression and anxiety group 0800-20-50-26

- Kim van Reizig

Extra sources: www.knowyourocd.co.za, www.aacap.org, www.atclinic.co.za, www.kidshealth.org

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