Children with Obsessive-Compulsive Disorder
by Peter W. Welty, M.D., F.A.A.P.
August 25, 2003
Obsessive-Compulsive Disorder, OCD, is a relatively common anxiety disorder in children and adolescents. A quote from Mental Health: A Report of the Surgeon General, Chapter 3 Section 6 states:
“Obsessive-Compulsive Disorder is characterized by recurrent, time-consuming obsession or compulsive behaviors that cause distress and/or impairment. The obsessions may be repetitive intrusive images, thoughts or impulses. Often the compulsive behaviors, such as hand-washing or cleaning rituals, are attempts to displace the obsessive thoughts.”
Its prevalence rate is 1% to 2%. It is generally a chronic, debilitating disorder which affects the psychosocial functioning of many children. This disorder has been documented as early as in toddlers three years of age; the mean age of onset is ten years of age. Children who present with early onset of OCD tend to be boys. There are likely to be others in the family with the same diagnosis. Children with OCD are more likely to also have the tic disorders, ADHD or learning disabilities.
The severity of the child‘s OCD symptoms may be affected by other family issues. For example, the parent’s mental health, the functioning of the marriage, the way that the children are disciplined in the family, and the family dynamics all can affect the expression of the child’s OCD symptoms. Parents are often involved in the rituals of the child with OCD, such as washing, checking, or reassuring. OCD causes significant disruption in a child’s personal, social, academic and occupational functioning.
A recent study out of UCLA studied the impact of OCD on the functioning of the children it affected. Close to 90% of children with OCD, as well as their parents, reported significant problems in daily functioning due to their OCD symptoms. The areas most commonly affected by these symptoms, according to parents’ report in the UCLA study, included problems concentrating on schoolwork (47%), problems doing homework (46%), and difficulty getting ready for bed at night (42%). According to the children’s report, during this same study, the problems they most encountered included concentrating on schoolwork (37%) and doing household chores (30%).
Treatment for OCD in this young population of children with early onset, includes, to a large degree, managing the interactions between the parent, the child, and the family. It becomes very clear that the child’s symptoms have a great impact on the functioning of the rest of the family. The child should be treated within the context of the family system, and difficulties dealing with that child’s symptoms in an appropriate, consistent manner must be addressed. Behavioral therapy and medication management have been shown to be most effective when combined together.
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