Understanding Child & Adolescent OCD
We understand how hard it is to watch your child or teen struggle with obsessions and/or compulsions. This informational page aims to provide valuable insights into OCD, its symptoms, treatments, and available resources.
What is OCD?
Children and teens who have Obsessive-Compulsive Disorder (OCD) may struggle with obsessions, compulsions, or both. Obsessions are recurrent and persistent thoughts, urges, or images that are experienced as intrusive, unwanted, and that in most individuals cause marked anxiety or distress.
Compulsions are repetitive behaviors or mental acts that the person feels driven to perform in response to an obsession, or according to the rules that must be applied rigidly. The behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation. However, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive.
Examples of OCD Obsessions in Kids & Teens
Contamination: This is the most common obsession in children. Children with this obsession worry about other people sneezing and coughing, touching things that
might be dirty, checking expiration dates or getting sick.
Magical thinking: Children might worry that their thoughts can cause someone to get hurt or get sick. A child might think, “Unless my things are lined up in a certain
way, mom will get in a car accident.” Think of this obsession as a kind of superstition.
Scrupulosity: This is when kids have obsessive worries about offending God or being blasphemous in some way.
Aggressive obsessions: Kids may be plagued by a lot of different kinds of thoughts about bad things they could do. “What if I hurt someone? What if I kill someone?”
The “just right” feeling: Some kids feel they need to keep doing something until they get the “right feeling,” though they may not know why it feels right.
Examples of OCD Compulsions in Kids & Teens
Cleaning compulsions- excessive or ritualized washing and cleaning
Checking compulsions- checking locks, checking to make sure a mistake wasn’t made and checking to make sure things are safe
Repeating rituals- rereading, rewriting and repeating actions like going in and out of a doorway
Counting compulsions- counting certain objects, numbers and words
Arranging compulsions- ordering things so that they are symmetrical, even or line up in a specific pattern
Saving compulsions- hoarding and difficulty throwing things away
Superstitious behaviors- touching things to prevent something bad from happening or avoiding certain things
Rituals involving other persons- asking a person the same question repeatedly, or asking a parent to perform a particular mealtime ritual
General Treatment for OCD:
Cognitive Behavioral Therapy
The most popular treatment for OCD is a form of cognitive behavioral therapy known as exposure and response prevention (ERP). ERP involves helping children to confront the sources of their anxiety in a structured, gradual manner within a safe environment. This approach allows children to confront anxiety-provoking situations without resorting to compulsive behaviors, supported by the therapist. By facing their triggers, children learn to endure their anxiety and eventually realize a decrease in its intensity.
Children often experience symptoms of OCD outside of a clinical office such as at home or in public settings like school or sports practice. Therefore, it's important for treatment to extend beyond the office. Therapists should administer ERP in real-world settings where children encounter anxiety triggers and ensure that caregivers understand how to reinforce ERP techniques outside of therapy sessions.
SPACE Anxiety Treatment
SPACE stands for Supportive Parenting for Anxious Childhood Emotions and is a parent-based treatment program for children and adolescents with anxiety, OCD, and related problems. SPACE was developed by Dr. Eli Lebowitz at the Yale Child Study Center and has been tested and found to be efficacious in randomized controlled clinical trials.
SPACE aims to treat children and adolescents with anxiety disorders and obsessive-compulsive disorder. Parents who participate in SPACE learn skills and tools to help their child overcome anxiety, OCD or related problems. The treatment focuses on changes that parents can make to their own behavior, they do not need to make their child change. The two main changes that parents learn to make in SPACE treatment are to respond more supportively to their anxious child and to reduce the accommodations they have been making to the child symptoms.
To read more about SPACE and how it works visit our SPACE Treatment page or the SPACE website.
Working with Parents
Given that parents typically have the most interaction with their children, it's vital for the family to be actively involved in the treatment process. You should anticipate close collaboration between your child's clinician and yourself, with clear explanations of the treatment approach and assigned homework to practice the skills learned in therapy.
Since children often seek reassurance or assistance with their obsessions or compulsions from their parents, it's crucial for parents to understand how to respond effectively without inadvertently reinforcing their child's OCD. Providing reassurance may momentarily alleviate the child's distress, but it ultimately reinforces their anxiety in the long term and hinders the development of coping skills. Likewise, accommodating a child's aversion to certain words by avoiding them or apologizing for their accidental use inadvertently strengthens the OCD symptoms. The clinician should collaborate with the family to devise supportive responses to requests for reassurance that do not reinforce OCD behaviors.
Working with School
Often, children may exhibit symptoms of OCD while at school. In such instances, it is beneficial to involve the school in the treatment process. One crucial initial step involves educating teachers and school administrators about OCD. This education is essential because many behaviors associated with OCD can be mistaken for other issues, such as oppositional behavior or learning disorders. For instance, a child's OCD symptoms might lead to distraction, resembling ADHD, or prolonged task completion times, resembling a learning challenge. When educators grasp the specific challenges a child faces and recognize that these behaviors are not mere defiance, they can provide more effective support.
Your child's clinician should offer tailored guidance on collaborating with the school. This includes explaining your child's OCD triggers, devising a plan for how teachers can assist when symptoms arise, and mitigating any behavioral challenges.
Moreover, your child's clinician might suggest strategies to enhance your child's learning experience, such as preferential seating, access to private testing rooms to reduce distractions, or extended time for completing tests and assignments.
Medication Treatment for OCD
Children with more severe presentations of OCD often receive a combination of therapy and medication. Selective serotonin reuptake inhibitors (SSRIs), a type of antidepressant medication, are commonly prescribed to alleviate a child's anxiety, thereby enhancing their receptiveness to therapy.
OCD Related Disorders and Diagnosis
It's common for children diagnosed with OCD to struggle with more than one mental health disorder. Depression, eating disorders, and panic disorder often co-occur with OCD. When a child is diagnosed with multiple mental health disorders, it's crucial for them to receive specialized treatment tailored to address each condition.
During the diagnostic process, it's essential to discern whether a child solely presents with obsessive-compulsive disorder or if there's a concurrent presence of another disorder. This distinction is important as it impacts the treatment approach. Additionally, it's important to consider disorders closely related to OCD, such as acute-onset OCD or conditions within the obsessive-compulsive spectrum.
Available OCD Treatment in Tampa
Understanding and managing OCD in children and adolescents involves a collaborative effort between parents, educators, and healthcare professionals. By providing appropriate support, interventions, and access to resources, children and adolescents with OCD can thrive and reach their full potential.
At Tampa Pediatric Psychology, we offer OCD evaluations, parent training, parent workshops, and individual therapy for adolescents specializing in OCD.
Don't hesitate to reach out to our team of licensed child psychologists today. Tampa Pediatric Psychology is ready to support you and your family in any way we can.