Overview of Obsessive-Compulsive Disorder (OCD) in children is a common anxiety disorder that is characterized by intrusive and unwanted thoughts or obsessions and repetitive behaviors or compulsions, both of which cause great anxiety and interfere with the ability to do daily tasks. It is important that children with OCD get a diagnosis and treatment as soon as possible.
Diagnosis of OCD in Children
In order to get a professional diagnosis, a qualified therapist or psychiatrist will review a health evaluation and compare responses from your child to the diagnostic criteria in the DSM-5. This can take time as qualified psychiatrists or other medical professionals will have to rule out any other potential causes of symptoms in accordance with appropriate diagnostic criteria.
Therapeutic Approaches for Treating OCD in Children
When it comes to the signs of OCD in children, the best approach involves cognitive behavioral therapy, short-term use of medication, and heavy involvement from family.
Cognitive Behavioral Therapy (CBT)
For OCD in children, Cognitive Behavioral Therapy (CBT) is the most common therapy. This is a type of treatment that helps children recognize automatic negative thoughts they might have about themselves or about the world around them and the way those thoughts directly influence how the child feels and how they behave.
From there, children work with a therapist to gradually replace those negative thoughts with more positive ones. Children soon learn that this replacement technique directly affects how they feel and behave, which can diminish their obsessions and compulsions.
Another aspect of behavioral therapy is to help expose children to the things that cause them anxiety but in a safe setting. This teaches children that if they don’t perform a ritual, for example, bad things don’t happen as a result. This can help children take time to understand what else might be causing that behavior and how they can control the impulsivity behind OCD symptoms.
Medication
SSRIs are the most common medication for symptoms of OCD in children. These are a very common type of antidepressant that works by increasing serotonin levels in the brain by preventing serotonin from being reabsorbed so it lingers for longer.
Treatment usually consists of six to twelve months’ worth of medication with regular monitoring of the impact it is having. After that, most children will be weaned from their medication with a focus on symptom management with the lessons and skills taught in CBT.
Family Therapy
When it comes to managing symptoms of OCD in children, parents and caregivers play an essential part of the therapeutic approach. Parents and caregivers, in particular, can participate in Family Therapy where they learn how they can:
- Best coach their child to manage symptoms
- Most effectively practice skills learned through therapy on a regular basis
- Provide daily support
Family therapy typically extends to parents and caregivers directly, although in some cases, families might choose to involve other members like grandparents and siblings. The more a child is given a support structure and regular reminders about symptom management, the more control the child will have over their symptoms.
Family therapy is useful in providing education for direct family members, but it’s important to remember that if you have OCD symptoms in children in your family, you will also participate in the other therapeutic approaches, including cognitive behavioral therapy, and it’s up to you to continually remind your child to practice the things that were introduced during those CBT sessions.
Integrative Therapy
Integrative therapy can take the form of changes to different levels of vitamins, minerals, or other naturally occurring elements in the brain/body that the body might not be producing regularly.
For example, there are several supplements that can be taken to help increase natural levels of serotonin, like vitamin C, vitamin B6, and magnesium. Using things like nutritional changes and behavioral changes can increase serotonin and decrease reliance on medication.
Comparing the Effectiveness of Different Therapies
Studies over several decades continue to confirm the effectiveness of cognitive behavioral therapy, exposure and response prevention, and the use of SSRIs.
Evidence-Based Research
Evidence confirms that cognitive behavioral therapy, particularly with a focus on exposure and response prevention, is the most widely supported, evidence-based treatment for children with OCD.
There’s a great deal of evidence surrounding the efficacy of SSRIs starting with low doses over the span of several weeks, particularly for children with OCD symptoms. Research has found that there is a significant dose-response relationship, so higher doses in children will greatly improve their OCD symptoms, but medication is always more effective when used in conjunction with therapy.
There is also evidence to support the use of serotonin-boosting additives as part of Integrative treatment.
Personalized Treatment Plans
What matters most is providing children with personalized treatment plans. Not every child showing signs of OCD needs medication. For example, you might ask, “What causes OCD in children?” and learn that your child has developed symptoms relating to particularly stressful life changes such as moving to a new city, divorce, or losing a sibling. In this case, therapy to help deal with the underlying causes might be a better long-term solution.
Supporting Children with OCD at Home and School
There are several ways that children with OCD can be supported at home and at school.
Home Strategies
At home there are several things that parents can do to support their child on a day-to-day basis, extending to making sure they have the right support at school.
- For starters, it’s important to work with a therapist and develop a personalized treatment plan.
- As parents participate in therapy and research more about OCD, they can learn to set limits, be understanding, and avoid enabling OCD.
- Parents need to encourage activities that help their children feel relaxed.
- Parents might consider keeping a journal of their child’s obsessions as compulsions so that any changes to those can be monitored.
- Parents can consider providing a safe space where children are able to go if they are struggling, something that can be offered at school as well.
For example:
A parent and school trying to provide a safe space for a child with OCD might use PVC pipes to create a small frame and drape a sheet over it, labeling it as a special place or a meditation space where a child can simply get up and go whenever they are feeling overwhelmed. They can close the sheet and take time to regroup.
School Support
School support can take the form of accommodations. The best way for the school to provide accommodations includes things like:
- Giving children extra time to complete their assignments
- Letting children work with a peer instead of on their own for specific tasks
- Giving prepared notes to children who struggle with note-taking because of the need to correct or rewrite content
Overcoming Challenges in Treatment
There are some challenges to treatment that many parents worry about, particularly preventing relapse of OCD symptoms in children and the risk of treatment resistance.
Relapse Prevention
For signs of OCD in children, relapse prevention is best achieved as part of a cognitive behavioral therapy program. The International OCD Foundation has noted that relapse prevention is something that happens near the end of treatment after a child has been taught how to control their symptoms.
From there, the focus of therapy is to help children maintain their progress with a deeper understanding of individual causes and triggers.
Dealing with Treatment Resistance
At present, there is limited research for treatment-resistant OCD in young children. Generally, treatment requires a multi-faceted, personalized approach with a combination of therapy and medication. If there are treatment-resistant OCD symptoms in children, changes to that plan can be considered with input from medical professionals.
For example:
- If one type of SSRI doesn’t work, another can be prescribed or at different doses.
- If SSRIs don’t work, Clomipramine can be considered.
- If Clomipramine doesn’t work, antipsychotic augmentation can be considered.
Conclusion
Overall, if you notice OCD in young children in your family, it is important to get professional help. There are several options for managing OCD in children, particularly with the right type of ongoing support and treatment customization.