How to Spot OCD in Children and Teens.

Most people experience unwanted thoughts every so often. But they do not cause much distress because most of us know they do not have much meaning and are irrelevant. But for someone struggling with Obsessive-compulsive disorder or OCD,  these unwanted thoughts can become disturbing and can start affecting their day-to-day functioning. 

Obsessive-Compulsive Disorder (OCD) is a mental health condition characterized by unwanted, intrusive thoughts, fears, images, or sensations that lead to substantial distress, such as anxiety, disgust, or just “not a right feeling’. They are called obsessions. To avoid distress or prevent the feared stimuli, a person then engages in repetitive behaviors that are called compulsions. 

OCD can begin as early as age 3, but there are generally two age ranges when OCD tends first to appear. One is between the ages of 8 and 12, and the second is between the late teen years and early adulthood. Recognizing OCD in teenagers can be challenging due to the natural behavioral changes during adolescence. However, early identification and intervention are crucial for effective management. Here are key signs and symptoms to help spot OCD in teenagers:

1. Obsessive Thoughts

Teens with OCD often experience persistent, unwanted thoughts that cause significant anxiety. These can include:

• Fears of contamination or germs.

• Worries about harm befalling themselves or loved ones.

• Intrusive thoughts about symmetry, order, or perfectionism.

• Distressing sexual or violent images.

2. Compulsive Behaviors

To manage their anxiety, teens may engage in repetitive behaviors or mental acts. Common compulsions include:

• Excessive hand washing or cleaning.

• Repeatedly checking if doors are locked or appliances are turned off.

• Arranging items in a particular order or symmetry.

• Repeating actions or words a specific number of times.

Pure O, or Pure Obsessional OCD, is an internal form of OCD that can affect teenagers. It’s characterized by distressing, intrusive thoughts that are persistent and different from everyday worries. Children and adolescents with Pure O may experience unwanted thoughts and images accompanied by anxiety, guilt, shame, and confusion.

3. Avoidance Behaviors

Teens with OCD might avoid certain situations or objects that trigger their obsessions. This avoidance can interfere with their daily activities and social interactions.

4. Significant Time Consumption

If obsessions and compulsions take up more than an hour a day, it may indicate OCD. This time-consuming nature can impact school performance, social life, and overall well-being.

5. Emotional Distress

Teenagers with OCD often feel embarrassed or ashamed of their thoughts and behaviors, leading to significant emotional distress. They may become irritable, withdrawn, or depressed.

6. Family History

A family history of OCD or other anxiety disorders increases the likelihood of developing OCD. Genetics can play a significant role in the condition.

OCD is now considered a form of neurodivergence. Neurodivergence refers to the diversity of the human brain and cognition, encompassing a range of conditions and neurotypes like Autism, ADHD, Dyslexia, traumatic brain injury, PTSD, and OCD. These conditions represent natural variations in the human brain. 

When to Seek Help

If you notice these symptoms in a teenager, seeking professional help is important. A mental health professional can provide a proper diagnosis and develop a treatment plan, which consists of therapy and medications. 

Psychotherapy:

Common forms of therapy utilized for OCD include Cognitive Behavioral Therapy (CBT), specifically Exposure and Response Prevention (ERP), and Acceptance and Commitment Therapy ( ACT). 

Parents of children with OCD are usually drawn into their child’s disorder through complex patterns of enmeshment and entanglement involving participation in symptom-driven behaviors and modification of personal and family routines. These accommodations have a negative impact on the clinical course of the child’s disorder and predict poorer response to treatment.

The Supportive Parenting for Anxious Childhood Emotions (SPACE) Program is a manualized treatment program consisting of 10 weekly hour-long sessions focused on reducing accommodation and coping supportively with the child’s responses to the process. It was developed by Lebowitz and Omer in 2013 and has been found to be very effective in children and also reduces distress in families. 

Medication

Doctors may prescribe selective serotonin reuptake inhibitors (SSRIs), such as Zoloft, Prozac, or Luvox, for children with moderate to severe OCD. Other factors that may guide medication choice include a positive response to a certain drug by other family members, the presence of other disorders, the potential for side effects, cost, or availability.

 Many parents make the mistake of telling a child to ‘ Stop it”.  OCD is not a behavioral disorder. It’s a brain disorder. Your child cannot help it when their brain is telling them to tap five times and wash their hands until it feels “just right.” or whatever other intrusive thoughts they are getting.  

Your child probably already feels crazy and “weird” for having those thoughts and compulsions, and you don’t want to add to those self-hating thoughts.

Recognizing OCD early in teenagers can lead to timely intervention, which significantly improves outcomes. By being aware of the signs and symptoms, parents, teachers, and caregivers can support teens in getting the help they need.

Helpful Resources for parents and educators.

• National Institute of Mental Health (NIMH): Provides comprehensive information on OCD, including symptoms, treatments, and research updates.

• International OCD Foundation (IOCDF): Offers resources for individuals with OCD and their families, including support groups and educational materials.

• American Academy of Child and Adolescent Psychiatry (AACAP): Provides resources on diagnosing and treating OCD in children and adolescents.

References

1. National Institute of Mental Health. (n.d.). Obsessive-Compulsive Disorder. Retrieved from NIMH.

2. International OCD Foundation. (n.d.). What is OCD? Retrieved from IOCDF.

3. American Academy of Child and Adolescent Psychiatry. (2013). Obsessive-Compulsive Disorder in Children and Adolescents. Retrieved from AACAP.

4. https://www.anxioustoddlers.com/child-with-ocd-2/#:~:text=%232)%20Don’t%20tell,it%20feels%20%E2%80%9Cjust%20right.%E2%80%9D

5. https://www.sciencedirect.com/science/article/abs/pii/S2211364913000651

6. https://www.cedars-sinai.org/health-library/diseases-and-conditions—pediatrics/o/obsessive-compulsive-disorder-ocd-in-children.html

7. childmindinstitute.org.

8. https://neurodivergentinsights.com/