OCD in Children: Are you Completely Missing the Signs?

OCD in Children: Are You Missing the Signs

If you or someone in your family has OCD (Obsessive-Compulsive Disorder) – your child is more at risk of getting OCD. OCD in children is believed to be inherited. So, along with eye color and hair color – your child can get OCD and Anxiety. [to listen to the podcast version of this click here]

I have seen OCD symptoms in very young children in my therapy practice. Often children suffer with symptoms for years before parents or teachers recognize the issue as OCD. The earlier a child can get help for OCD – the better the prognosis is long-term. I am going to give you a simple break down of what OCD is and what behaviors to watch for.

So let’s arm you with some facts about OCD in children:

OCD has two parts – obsessions (unwanted thoughts that cause distress) and compulsions (acts or behaviors that are meant to reduce the distress). Obsessive thoughts can be centered around safety or health – or it can be an unwanted, inappropriate thought that makes the child feel bad. OCD goes way beyond germs and hand washing – and that might be a big part of why parents miss these early signs.

OCD in children has many faces and at times it can disguise itself pretty well. I have picked out the most common types of OCD along with possible warning signs. This list is not exhaustive and it is meant to be a brief introduction to OCD in children. Typically children have symptoms in a few categories. Having some of these symptoms does not mean your child has OCD – but may indicate a need for further assessment by a pediatrician or child therapist.

Rituals/Compulsions in General:

It is easy to mistake early ritualistic behavior for routines. There is a difference between a routine and a ritual. Routines are comforting, but if you veer from your routine – your child doesn’t go into a panic. If it is a ritual, your child will panic and will insist you “redo” the ritual correctly. Children often require these rituals to ensure nothing “bad” will happen to them or to those they love. Ritualistic behavior may first start around the bedtime “routine.”

Example of Possible Early Signs:

Having to do the same exact behavior when tucking your child into bed (e.g. flatten out sheets, check for bugs).

Having to say an exact phrase back to your child (e.g. saying I love you in a particular way).

Having to tell your child an exact phrase at bedtime or before you leave the house.

Your child has to do things in a certain way and will start over if interrupted.

Movements or Gestures:

Children who are bombarded with distressing thoughts, will often make up a gesture or a movement to counteract these thoughts. They believe that if they do these movements – it will stop the OCD thought from happening.

Example of Possible Early Signs:

Movements that look like tics, but are done on purpose (e.g. blowing air into their hands).

A series of body movements that are non-sensical and can be controlled (e.g. shoulder shrugs).

Head nodding in a pattern that can be controlled.

Purposeful eye movement in a pattern that can be controlled (e.g. moving eyes up and down or left to right).

Constant throat clearing.

Constant nose sniffing (without a cold).

Having to tap or touch things for no reason.

Special Numbers:

Some children with OCD develop a special number that helps ward off negative thoughts. They may favor odd or even numbers to counteract their OCD thoughts.

Example of Possible Early Signs:

Things have to be done a certain amount of times (either a special number or an even or odd amount of times).

Avoiding even or odd numbers (on the TV, on the radio)

Counting their steps or skipping steps on the stairs.

Having to say or repeat things a certain amount of times.

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Order:

A child’s predisposition to being neat or messy is no indication of whether they have OCD or not. Order in OCD does not have to do with cleanliness. Some children with OCD place their toys, stuffed animals and other belongings in a certain way and feel considerable distress if someone moves it out of its designated spot.

Example of Possible Early Signs:

Having stuffed animals in a particular order that cannot be altered (especially around the bed).

They get very upset when objects are touched or moved in their room.

If something is moved or placed in a different position they will put it back to its original position.

[Click here to learn more about Symmetry OCD]

Contamination:

Contamination is a hard thing to wrap your brain around. We’ll start with a child with a germ theme. Lets say that child touches an object that they believe had germs. They then proceed to touch another object (favorite toy etc.). They will make a rule in their head that they can no longer touch that favorite toy ever – as it now has germs on it as well. The amount of contaminated objects can grow, creating a long list of things and areas the child has to avoid and cannot touch.

Contamination thoughts go way beyond germs though. Items can get contaminated due to other themes as well. Some children have a fear of urine, bird poop or even just bad thoughts they are having while touching or wearing something. The common denominator in this category is avoidance of an object, toy, room etc. due to the belief that they can no longer touch it.

Example of Possible Early Signs:

Avoiding certain objects, toys, rooms or areas.

Asking you to do something for them (touch the remote, open the garbage can lid etc.).

Rigidity in routine (has to have the same exact seat in the car because other seats are contaminated, won’t touch certain door handles).

Walks in strange patterns to avoid certain areas of tile or floor.

Confessional Thoughts:

This category is a bit tricky to detect. OCD can make children second guess their actions, behavior and thoughts. They might feel guilty about thoughts that are inconsistent with how they actually feel (e.g. I think I called you stupid in my head). They might worry they did something that in reality, they did not do (I think I might have cheated on my test). Relief is only achieved when the child “confesses” these thoughts to a parent. The confessing behavior is the compulsion component of the OCD.

[Click here to learn more about Moral OCD]

Example of Possible Early Signs:

Tells you things they thought in their head (e.g. I thought I hated you just now).

Tells you they are having bad thoughts (e.g. I am thinking she is fat).

Is embarrassed to tell you what type of thoughts they are having (older children may have inappropriate sexual thoughts).

Confesses to behaviors that are small or inconsequential (e.g. I think I bumped someone at school).

Confesses to behaviors that they do not do or can’t remember doing (e.g. I think I cheated on test).

OCD in children can be a complicated and confusing disorder. It can look different in each child. This list is not exhaustive and it is not meant to diagnose your child. If you are seeing some of the early signs listed here, consult with a child therapist who specializes in childhood OCD and Anxiety.

Young children are very resilient and adaptive. Once your child is armed with tools on how to fight their OCD – they will have much more success decreasing and possibly eliminating their symptoms.

[Click here to learn the 8 most common themes of OCD]

If you want to learn how to help your child with OCD at home, take my online parenting class, Parenting Kids with OCD. To enroll in my free mini-class click here.

To learn more about the online OCD class click here. Watch a Youtube video about the class:

Other Great Books on OCD in Children: