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What does it look like?
Pediatric OCD is characterized by obsessive thoughts and compulsive ritualistic behaviors in children. It can cause severe disruption in social and academic settings. Children often believe their behaviors are silly or “crazy.” They might try to hide them for as long as they can because they do not want people to think they are weird. Compulsive rituals can begin gradually and parents may accommodate for the behaviors by serving “safe” foods, tolerating frequent bathroom breaks, or answering the same question over and over again. This allows the child to continue functioning with the rituals. Some of the common presenting symptoms of Pediatric OCD include: washing, grooming, checking rituals, confessing, apologizing, preoccupation with disease and danger to others.
Who is affected?
“Obsessive-compulsive disorder (OCD) was once believed to be relatively rare in children and adolescents, [but] OCD now is believed to affect as many as 2% of children. Among adolescents with OCD, the literature indicates that very few receive an appropriate and correct diagnosis, and even fewer receive proper treatment.” (JAMA, December 27, 2000 – Vol. 284; No. 24)
Where does it come from?
Some experts believe that childhood OCD may be different than OCD that begins in adulthood. They believe family history of OCD plays a larger role.
“Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection” or PANDAS is a rare type of childhood OCD that has a sudden and dramatic onset. It is related to a streptococcal (strep) infection, so many symptoms subside dramatically when the strep infection gets better.
How do we treat it?
The most effective treatment is Cognitive Behavior Therapy and Exposure and Response Prevention that has been tailored to fit the needs of children and adolescents.
A 7-year-old second-grader was brought to her pediatrician after an abrupt onset of abnormal behavior that began on a family trip to the zoo. She refused to touch or hold anything with her hands (for example, the walkway railings) and repeatedly requested to wash her hands at each rest room she passed throughout the day. The contamination fears increased over the next 2 days, until she was unable to clean herself or use the toilet without assistance. The washing of her hands became a ritual that involved counting to 10 for each finger she cleaned. She would cry and seem distressed as she washed, yet refused to leave the sink until the ritual was competed. By the time medical attention was sought, the fears and rituals had progressed to the point that her father had turned off the water to all but 1 of the sinks in the house and her mother had to brush her child’s teeth and bathe her at least twice a day. She also had developed fears that her food might be contaminated and refused to eat all but a few specific “safe” foods. (JAMA, December 27, 2000 – Vol. 284)