Although obsessive-compulsive disorder in children is not a common syndrome, it needs to be very careful. Because if the disease begins before the age of 15, it is easy to progress to severe disease and has a poor prognosis. Families need to detect and treat children in time to limit complications.
What is Obsessive Compulsive Disorder in Children?
Obsessive-compulsive disorder (OCD) is an anxiety disorder that can affect children and adolescents. Children with OCD experience unwanted thoughts, worries, or urges called obsessions. These obsessive thoughts are often very upsetting, difficult to control, forcing the child to perform repetitive actions to calm the anxiety, known as compulsions.
Often, compulsions are not related to the actual obsession. For example, a child may have an obsessive fear that their parent will be in a car accident. To deal with this fear, they may turn the lights on and off over and over again. Even if they know it doesn’t make sense, they feel that this ritual will keep their parents from getting hurt.
In fact, children under the age of 5 can still develop obsessive-compulsive disorder. At this age, children may not even realize that their thoughts and fears are exaggerated or unrealistic.
A child with OCD may try to hide their rituals until they become overwhelming. At this time, children will stop their rituals and behaviors at school but then act out when they come home.
Cases of early-onset obsessive-compulsive disorder before the age of 15 are often chronic and potentially have many serious complications. In fact, OCD in children has a more severe and complicated course than OCD in adults.
Signs of Obsessive Compulsive Disorder in Children
The telltale signs of obsessive-compulsive disorder in children can be classified into two categories. Includes obsessions and compulsions, specifically the following:
1. Symptoms of obsession
Obsessions refer to thoughts, images, or urges that occur over and over again. These thoughts will get stuck in the mind of the child with OCD.
Phobias can be accompanied by feelings of discomfort, anxiety, fear, doubt, and disgust. This is one of the worrisome conditions that parents need to be concerned about.
Here are some examples of common phobias experienced by children with OCD:
- Preoccupation with bodily fluids or waste, germs, dirt, chemicals, or sticky substances. Fear of contamination or the spread of perceptible contaminants.
- Worry about getting sick or getting sick.
- Worrying excessively about bad things happening, doing the wrong thing, or lying.
- Pay attention to presentation and form. Such as the symmetrical arrangement of objects, clothes, food or the look of homework.
- Worry about accidentally hurting a parent, sibling, or friend.
2. Compulsive symptoms
Refers to repetitive behaviors the child feels compelled to perform to cope with the obsession. Or behaviors may be subject to rigidly applied rules.
While children may not always be able to explain their own intentions, compulsive behaviors can help prevent or alleviate anxiety and stress. However, the coercive behavior is clearly excessive. Furthermore, they are not physically connected to the desired outcome.
Examples of compulsive behaviors in children with OCD include:
- Excessive hand washing, long showers, grooming, cleaning, or other efforts to decontaminate.
- Adhere to rigid rules or etiquette to ensure safety.
- Check to make sure that no damage or mistakes have occurred.
- Constantly questioning, seeking reassurance, and confessing.
- Perform spiritual rituals such as prayers, saying special verses, or reviewing situations.
- Rearrange things in a specific or symmetrical way.
- Constantly seek reassurance from family and friends.
- Avoid situations where your child thinks something bad will happen.
The compulsive and avoidant behaviors of children with OCD are sometimes referred to as “safe behaviour”. Because they are used to prevent risks and discomfort. However, symptoms of OCD in children do not follow the usual rules. Over time behaviors can become serious and have worrisome consequences.
Causes of obsessive-compulsive disorder in children
Until now, despite many studies, the exact cause of obsessive-compulsive disorder in children is still unknown. However, several factors may play a role in the pathogenesis.
Researchers believe that OCD in children is the result of a combination of biological factors and environmental influences. As follows:
1. Genetic and family factors
Although there is no specific gene that causes OCD, genetic factors play a role in the pathogenesis. Research shows that children born to a parent with obsessive-compulsive disorder are four times more likely to develop the condition.
In addition, some recent studies also show that children can develop OCD when living with someone with the disease for a long time (even if they are not related by blood). The reason is that during cognitive development, children can learn the thoughts and behaviors of the sick person.
2. Abnormalities in brain structure
Through positron emission tomography (PET), CT and MRI to study the brains of children with OCD, experts say, the left lobe and basal ganglia are hyperactive. In addition, the tail nucleus on both sides is also reduced in size.
This finding suggests that brain structure may play a role in the pathogenesis of obsessive-compulsive disorder in children. However, more in-depth research is still needed to get a definitive confirmation.
3. Imbalance of endogenous factors
The brain produces endogenous substances to control the functioning of all organs and regulate emotions, thoughts, and behaviors. For children with OCD, the levels of neurotransmitters in the brain are often out of balance.
Through the study, experts found that serotonin levels decreased markedly. In addition, there is an increased sensitivity to this neurotransmitter. A decrease in serotonin will cause emotional, cognitive, etc.
Low serotonin in addition to increasing the risk of obsessive-compulsive disorder is also the cause of a number of other psychological problems. For example, nervous tension, generalized anxiety disorder, etc.
4. Environmental factors
In fact, some external environmental factors can also influence and increase the risk of developing obsessive-compulsive disorder in children. Such as:
- Being physically and mentally abused
- Relatives passed away
- Parents divorce, separation causes children to live with 1 of 2 people
- Experiencing or witnessing a catastrophic accident
- Changing habitat too suddenly
- Being ostracized by friends, isolated
Statistics show that more than 50% of children develop OCD symptoms after facing trauma. However, this is only a factor in the onset of the disease, not the cause of the disease.
5. OCD Sudden Onset
Research shows that about 5% of children with OCD are caused by an immune response inside the brain. This is known as PANDAS-type OCD or autoimmune subtype.
PANDAS-type OCD is thought to be caused by an infection with the same bacteria that cause scarlet fever and pharyngitis (streptococcal). When a child’s immune system fights off an infection, it can mistake it and start attacking the basal ganglia inside the brain.
PANDAS-type OCD has several features, such as rapid onset of symptoms. Research shows that children with a genetic predisposition to OCD are more likely to develop PANDAS-type OCD.
Effects of obsessive-compulsive disorder in children
Obsessive-compulsive disorder in children causes a lot of trouble and has a negative impact on children’s lives. Specifically, it wastes time, disrupts the child’s life and learning process.
Unintentional thoughts that appear repeatedly will cause children to fall into a state of stress, anxiety and not be able to concentrate in the learning process. As a result, children’s academic performance declines, and children often get poor grades. This can lead to increased anxiety, ridicule, and ridicule by friends.
If children do not engage in compulsive behaviors, stress, depression, and anxiety will increase significantly. This makes children more sensitive, easily angry and grumpy with those around them. Some children with OCD may even scratch their own skin, pull out their hair, or bite their fingernails, driven by obsessive thoughts.
According to experts, if OCD in children is not treated early, it can adversely affect the child’s personality formation. Thereby increasing the risk of other forms of psychological and mental disorders. Such as attention deficit hyperactivity disorder, TIC disorder and depression.
What Should Parents Do When Their Child Has Obsessive Compulsive Disorder?
Currently, knowledge about obsessive-compulsive disorder is also limited. Therefore, many parents do not know how to handle when their child has OCD symptoms. Here are some tips for parents:
1. Talk to your child
Some children may not let their parents know about the thoughts, behaviors, and fears that OCD causes. Children may feel confused or embarrassed and try to hide the rituals they do. Many children develop OCD symptoms long before their parents realize it.
When noticing unusual symptoms in children, it is best for parents to talk to them. Need to talk in a way that listens, supports, and shows love. It is necessary to say things that are appropriate for the child’s circumstances, absolutely do not bully or put more pressure when seeing your child behave abnormally.
2. Take your child to the doctor
Parents need to talk to their child in advance that a checkup with a doctor can find out if their child’s symptoms are cause for concern. Please explain to your child, visiting the doctor will help him get better. Because there are many children who are very scared when it comes to the issue of going to the doctor.
Currently, children’s hospitals have psychological clinics, so parents can easily take their children to see a doctor. In addition, you can take your child to see a psychologist for support.
To diagnose OCD in children, doctors and specialists will take a look at your symptoms, personal and family history. In addition, the child may also be asked to take psychological tests and make other clinical diagnoses.
Currently, the ICD-10 or DSM-5 criteria are the most commonly used to make a definitive diagnosis of obsessive-compulsive disorder in children. Then, the doctor will rely on each specific case to have the right treatment.
3. Participate in therapy for your child
Psychotherapy is currently the mainstay of treatment for OCD in children. In this method, the psychologist will communicate with the child through words and gestures. This helps children express their thoughts and feelings in the most honest way.
After understanding and assessing the child’s psychological development, the specialist will have appropriate intervention. The goal is to help children change their minds. It also reduces anxiety and limits compulsive behaviors caused by obsessive thoughts.
It is important that parents participate in therapy with their children. Because part of psychotherapy for OCD in children is teaching parents how to deal with OCD symptoms in their child.
Parents will be provided with behavioral advice from an expert. At the same time, have appropriate words when children ask parents to perform coercive behaviors. Family participation in therapy also helps children feel secure. Especially avoiding thoughts like being weird, being different from everyone else.
4. Control your child’s medication use
In some cases, the doctor may order treatment for OCD in a child with a combination of psychotherapy and medication. In particular, drug treatment is only considered in really serious cases.
Selective serotonin reuptake inhibitors (SSRIs) are often prescribed by doctors. This class of drugs can help reduce anxiety in children. However, they must be used with great caution as they can increase the risk of suicide in children and adolescents.
Some of the SSRIs that have been approved by the FDA for use in children and adolescents with OCD include:
- Zoloft (sertraline): Can be used for children 6 years and older.
- Luvox (fluvoxamine): Approved for use in children 8 years of age and older.
- Prozac (fluoxetine): Can be used by children 8 years and older.
In the case of a child with PANDAS-type OCD, treatment may include:
- Antibiotics (penicillin, azithromycin)
- NSAIDs and corticosteroids
- Immune Globulin Intravenous
- Plasma exchange method
Medicines used to treat OCD in children need to be strictly followed the prescription from the doctor. Parents need to monitor the progress of children taking medicine. Remind your child to take the correct dose and time. Never let your child overdose or stop taking the medicine suddenly.
At the same time, parents need to monitor the child’s expression during drug treatment to better support the child. Immediately notify the doctor to have timely adjustment when your child experiences unusual symptoms.
5. Take proper care of your child
In fact, the treatment of obsessive-compulsive disorder in children still faces many limitations. Because the etiology and pathogenesis still have many points that have not been clearly studied.
Early-onset OCD often has a poor prognosis, most of which tend to be chronic. Meanwhile, children with late-onset OCD respond better to treatment, and the disease subsides over time.
In addition to participating in treatment with their children, parents need to pay attention to properly take care of their children. This will help alleviate the child’s obsessive-compulsive disorder.
Here’s how to care for a child with OCD:
- Recurrence of unintentional thoughts can lead a child into a state of stress and depression. Parents should encourage children to play, sing, draw, etc. to relieve stress.
- Collective games can be built to help children practice communication and integration. At first the scope of the game may be just family members. Then invite more friends and relatives to join in so that the child gradually gets used to interacting with strangers.
- Besides indoor games, children can go out to have fun. Simply taking care of plants or pets with your child will help reduce the fear of infection.
- If you find that your child is more comfortable, you can let him play freely outdoors. At the same time, encourage children to make friends and have fun with children their age.
- Absolutely do not show discomfort when children ask parents to perform coercive behaviors. Do as the child wants and gradually explain to the child that the behavior is not necessary.
- Develop a healthy diet and activities for children. This is an important factor to help your child develop comprehensively both physically and mentally.
- Children should be encouraged to exercise, play sports or pursue personal interests such as painting, learning the piano, etc. This helps children improve their health, while reducing stress and anxiety effectively.
Obsessive-compulsive disorder in children causes a lot of trouble. Parents need to take their children to see a doctor soon when detecting unusual symptoms. At the same time participate in treatment with your child and take care of him properly. This helps to improve children’s health and quality of life.