When OCD Presents in Childhood

My mom worked with Poison Control for some time, and because of this (and her

love of candy-flavored medicine and multiple trips to the emergency room as a child), she

was very careful to tell me not to take more than one of my Flinstones vitamins. I was

probably 6 years-old at the time and I remember asking her “what happens if I take more

than one?” “You’ll die.” And that’s when it began. Every day when I thought about taking

one of those colorful delicious vitamins, I thought “did I already take one today? “Do I

think I didn’t take one today and I’m remembering a time I did take one and really it was

today?” Ultimately, I stopped taking my vitamins and no one ever asked why.

Around the same time, I became plagued with the thought that I would somehow

forget to breathe. “How did I breathe so naturally but the second I thought about it I felt

like I would never breathe again?” was a thought that literally kept me up at night. So I’d

breathe in and out over and over again until I eventually stopped thinking about breathing until the next day when the thought returned. Obsessive Compulsive Disorder (OCD) affects 1 in 100 children and teens globally. 1

While OCD can develop at any age, most adults experience symptoms of OCD

during childhood. Children may not ask for help or talk about what they are experiencing

even though their symptoms cause great distress. OCD is often mistaken for attention difficulties or oppositional defiance. 2 Children can experience a variety of emotions as a result of their obsessions including anxiety, uncertainty, fear, irritability, and anger. 3 When compulsions are prevented or interrupted, children can experience “rage attacks” due to a significant urgency to complete rituals. Children’s attention is hijacked by intrusive thoughts, threat monitoring, mental rituals, and emotional dysregulation. 4, 5 Parents may notice that their child is taking longer than usual to perform ordinary tasks like getting ready for school or doing their homework. They may also notice that their child becomes frustrated easily when something isn’t performed just right. Parents may not be sure what exactly is happening to their child, but they have a gut feeling that something is wrong.

Family members often become involved in OCD rituals and avoidance. Children

may ask for reassurance that their fears won’t come happen. They may require that they

parents do things a certain way and start over if it’s not exact (i.e., following a bedtime

script). 6 Parents may begin to feel like they can’t set boundaries with their children. They

worry that in doing so, their child will become inconsolable or frightened. 7 They may find

themselves leaving work or are unable to engage in leisure activities because they are

tending to their child’s OCD needs. 8

Exposure and Response Prevention (ERP) learn to face OCD fears without relying

on compulsions or avoidance. Through practice, children discover they can tolerate uncomfortable thoughts and feelings, handle uncertainty, and choose how to response rather than letting OCD make the decisions. 9 Through parenting-based treatments such as Supportive Parenting for Anxious Childhood Emotions (SPACE), parents learn to reduce accommodations that maintain OCD symptoms while increasing responses that build their child’s coping skills and resilience. 10

Interested in getting started?

If you or someone you know could benefit from working from working with Amanda,

contact her at (405) 451-3476 or amanda@panaceatherapygroup.com.

Resources

A Thought is a Thought (… and here’s what it’s not.) a book about OCD by Chad McCoy, LPC-S

Up and Down the Worry Hill: a Children’s Book about Obsessive-Compulsive Disorder and it’s Treatment by Aureen Pinto Wagner, Ph.D

Breaking Free of Child Anxiety and OCD: A Scientifically Proven Program for Parents by Eli Lebowitz, PhD