Obsessive Compulsive Disorder (OCD) is a type of anxiety disorder that may first appear as strange or odd behaviors. In children, the onset typically occurs between the ages of 8 and 13 and is rarely diagnosed in preschoolers.

People with OCD are distressed by constant, unwanted thoughts or impulses (obsessions). To relieve the anxiety that results, a behavior (compulsion) gets repeated over and over again. A child who is obsessed about germs, for instance, might wash his hands multiple times as a temporary form of stress relief.

Alicia Nordstrom, Ph.D. cautions concerned parents about distinguishing normal oppositional behavior that is common in the 2 to 4-year-old age group from compulsive behavior. "A compulsion is a behavior intended to reduce anxiety caused by an obsession (an intrusive thought) and is different than a child who is being stubborn, asserting independence, or trying to annoy her parents which is often the case with toddlers."

Where it Comes From

According to the Diagnostic and Statistical Manual of Mental Disorders, a professional journal published by the American Psychiatric Association (2000), OCD is classified as an anxiety disorders because anxiety is the driving force of the obsessions. "The person feels anxious and performs a compulsion to relieve the anxiety, but just temporarily because the intrusive obsession will crop up again shortly causing the person to repeat the compulsion, and the cycle continues," Nordstrom explains.

OCD does have a genetic component and many of the common OCD targets are similar between family members.

Diagnosing OCD

If you suspect a problem, consult your pediatrician who may refer you to a mental health professional. Nordstrom says it takes a well-trained and skilled clinician to differentiate whether a repetitive behavior stems from OCD or ASD (Autism Spectrum Disorder), a group of conditions that includes autism and Asperger Syndrome.

According to Nordstrom, the defining feature for OCD diagnosis is what is driving the behavior. If it's anxiety--"I must wash my hands or I will get a terrible illness" or "I must flip the light switch five times or else something bad will happen"--then it represents OCD.  "If the behavior stems from a need to block out an over stimulating world by narrowing focus on a very specific stimulus (circles on a rug), then it would represent ASD," explains the expert. "Although the behavior might appear similar, it is its function that defines it."

Treating OCD

While there are no preventive measures to reduce the incidence of OCD in children, early detection and intervention can reduce the severity of symptoms and improve the quality of life for sufferers.

Cognitive-behavioral therapy (CBT) alone or in conjunction with medication can be effective treatments for OCD in children.

"Therapists will often use an analogy of OCD as a 'monster' on their back to help children realize that the condition is controlling them and it is not their fault," Nordstrom explains. The "cognitive" part of CBT teaches children ways to identify obsessive thoughts and talk themselves out of them-thus, "noticing the monster". In the "behavior" part of therapy, children learn how to calm their anxiety through relaxation techniques, as well as the crux of the treatment--"facing the monster".  

Therapists help OCD children face their fears (the monster) by having them tolerate it in small doses which are gradually increased over time. This means that children are exposed to their obsessions then prevented from compensating with a compulsion. In place of the compulsion, the child must apply coping strategies.

National Institutes of Mental Health
http://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd/index.shtml and http://www.nichd.nih.gov/health/topics/asd.cfm

The Pennsylvania State University; Milton S. Hershey Medical Center, College of Medicine

Interview with Alicia Nordstrom, Ph. D. Misericordia University

Cincinnati Children's Hospital Medical Center