She won’t eat dinner if her vegetables touch her pasta. She gets anxious when her toys or books aren’t lined up perfectly, and she insists on doing her homework with the same green pencil. Are these just quirks in her personality, or are they warning signs of Obsessive Compulsive Disorder (OCD)?
It’s a question plenty of parents ask themselves, since about one-third of adult OCD symptoms begin in childhood, according to the National Institute of Mental Health (NIMH). What’s more, OCD, which is thought to run in families, is one of the most common childhood conditions (even more prevalent than juvenile diabetes), affecting about 1 in 100 kids, according to the World Health Organization (WHO).
Children are usually first diagnosed with OCD between the ages of seven and twelve, but kids as young as four can be symptomatic, says psychologist Tamar E. Chanksy, Ph.D., author of Freeing Your Child from Obsessive-Compulsive Disorder: A Powerful, Practical Program for Parents of Children and Adolescents. And even when kids are able to overcome symptoms, they can come back at any time—as evidenced by Lena Dunham’s character Hannah on the HBO show Girls, whose teenage OCD returned with a vengeance when she was under extreme stress, forcing her to do everything multiple times.
Is It OCD or Just a Quirk?
Child psychiatrist Sherry Barron-Seabrook, M.D., a member of the New Jersey Chapter of the American Academy of Pediatrics (AAP), says it all comes down how kids handle kinks in their routine. “Children with OCD get very stuck in rituals, and get very upset if they’re interrupted.” An inability to distract the child or get her to try the activity another way might be a parent’s first clue. “On the surface, you may not think much of it,” she says, “Until you realize the child can’t deviate from the plan in her brain.”
Schedules tend to be comforting for children who don’t suffer from OCD, but for those who have the disorder, they can become confining rituals that take on outsized importance.
“When a child has OCD, the routine becomes more important than other things,” explains Chanksy. “It’s no longer the way to get things done efficiently.”
OCD can be managed with cognitive behavioral therapy, medication or both. Chansky and Barron-Seabrook suggest parents who are worried see a pediatrician, who can rule out a specific type of OCD triggered by infections like strep and can offer referrals to a therapist or child psychiatrist specializing in the disorder.
In a study published last year in JAMA Psychiatry, 72 percent of OCD-suffering kids treated using family-based behavioral therapy—in which the parents and the child learned tools to manage and ease symptoms—saw a significant improvement in their condition, often within four to six months.
If a child doesn’t respond to therapy in three months, says Barron-Seabrook, that’s when medications are considered, like the SSRI sertraline (Zoloft). And while some parents worry about the side effects of the drugs given for OCD, Barron-Seabrook says that “in the right circumstances and with the right monitoring, medication is safe.”
Life After Treatment
For many children, therapy is enough, though plenty struggle with the disorder in some form throughout their lives.
“Because of the nature of OCD, we can’t cure it completely,” Chansky says. “But the good news is children learn how to spot the signs of OCD, so if another symptom comes along months or years later, they know what to do to control it.”