OCD in children: Symptoms, Cause & Treatment

Causes

The exact cause of OCD in children is yet unknown. However, it is believed to be a combination of genetic, biological, and environmental factors. Many factors of OCD in children overlap with that of schizophrenia in kids.

Some significant factors that can OCD in children include—

• Genetic Factors:

This mental health disorder tends to run in families, indicating a significant genetic component. If a child has a parent or sibling with OCD, their risk of developing the disorder increases. Research shows specific genes may contribute to the development of OCD, although no single gene is solely responsible.

• Biological Factors:

Abnormalities in brain structure as well as its function have been linked to OCD. Neuroimaging studies show individuals with OCD often have differences in the orbitofrontal cortex, anterior cingulate cortex, and striatum — areas of the brain involved in decision-making, emotional regulation, and response to stress. Additionally, imbalances in neurotransmitters like serotonin, which helps regulate mood and anxiety, are thought to play a role in OCD.

• Environmental Factors:

Environmental influences can trigger or exacerbate OCD in genetically predisposed children. Stressful life events, such as trauma, illness, or changes in family dynamics, can increase the risk of developing OCD. Moreover, certain infections, particularly streptococcal infections, have been linked to a sudden onset of OCD symptoms in children, a condition known as PANDAS (i.e., Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections).

Symptoms

Detecting OCD in children can be challenging because the symptoms often overlap with other developmental and behavioural disorders. However, early identification is crucial for effective intervention. Here are some key symptoms to look out for —

• Obsessions:

Children may suffer from intrusive, unwanted thoughts, urges, or images causing significant anxiety or distress. Common obsessions in children include fears of contamination, harm coming to themselves or loved ones, and concerns about symmetry or exactness. A child might repeatedly worry about getting sick from touching something dirty or fear that something terrible will happen if things are not arranged in a specific order.

• Compulsions:

These children suffer from compulsions. They have repetitive behaviours or mental acts and feel driven to respond to a particular obsession or conform to rigid rules. These actions reduce anxiety or prevent a feared circumstance but are not realistically connected to the outcome or are excessive in nature. Common compulsions in children include excessive handwashing, checking, counting, arranging items symmetrically, and seeking reassurance. For example, a child might wash his/her hands until he/she can alleviate fears of contamination.

• Impact on Daily Life:

OCD can significantly impair a child's daily functioning. The obsessions and compulsions can take up a considerable amount of time, interfering with schoolwork, social activities, and family life. A child with OCD might struggle to complete homework due to the need to check his/her work repeatedly or have difficulty making friends because he/she avoids social situations that trigger obsessions.

• Avoidance Behaviours:

To prevent anxiety, children with OCD often avoid situations that might trigger their obsessions. This avoidance may lead to a restricted lifestyle, impacting their ability to engage in normal activities. For instance, a child might avoid touching doorknobs or refuse to eat certain foods out of fear of contamination.

Treatment

Treating OCD in children involves a combination of therapy, medication, and supportive services to manage symptoms and improve quality of life.

• Cognitive-Behavioural Therapy (CBT):

CBT, particularly Exposure and Response Prevention (ERP), is the most effective mode of treatment for OCD in children. ERP involves gradually exposing the child to feared situations or thoughts without allowing them to engage in compulsive behaviours. This process helps the child learn that his/her anxiety will decrease over time. CBT also includes cognitive strategies to challenge and change distorted thinking patterns related to obsessions.

• Medication:

Sometimes, medicines may help manage OCD symptoms. SSRIs i.e., Selective Serotonin Reuptake Inhibitors are the commonly prescribed medications. These help improve serotonin levels in the brain, reducing the severity of OCD symptoms. Finding the correct medication as well as dosage can be a process of trial and error, and ongoing monitoring is essential to manage side effects.

• Family Therapy:

Family involvement is crucial in the treatment of childhood OCD. Family therapy educates parents and siblings about the disorder, helps them understand how to support the child effectively, and addresses any family dynamics that might contribute to the child's symptoms. Families learn strategies to avoid accommodating the child's compulsions and encouraging exposure tasks.

• Educational Support:

Children with OCD often need tailored educational plans to accommodate their learning needs. Special education services and individualised education programs (IEPs) can help address cognitive and behavioural challenges, ensuring the child receives appropriate support in school. Teachers and school staff can be valuable allies in providing a supportive learning environment.

• Support Services:

Comprehensive treatment often involves collaboration with various support services, including case management, occupational therapy, and community resources. These provide a holistic approach to care, addressing the child's overall well-being and helping them integrate into their community. Support groups for children and parents can also provide valuable peer support and practical advice.