Mental Health

Quick Guide to OCD in Children and Adolescents

What is OCD? 

Obsessive-Compulsive Disorder, according to DSM 5, is characterized by the presence of obsessions and/or compulsions. Obsessions can be inclusive of recurrent and persistent thoughts, urges, or images that are experienced as intrusive and unwanted, whereas compulsions are repetitive behaviors or mental acts that an individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.

In children and adolescents, the disorder often is accompanied by a wide range of comorbidities, including mood, anxiety, attentional, behavioural, and learning disabilities.

Obsessions can be characterised as:

  • Having recurrent and persistent thoughts,
  • Making attempts to ignore or suppress such thoughts

Compulsions can be identified as:

  • Possessing repetitive behavioural characteristics (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently)
  • Behaviours aimed at preventing or reducing anxiety or distress

Another salient feature of the above criteria is that the obsessive-compulsive symptoms are not attributable to the physiological effects of substance abuse (e.g alcohol, amphetamines, morphine, cocaine, etc.).

Etiology

Research tells us that OCD occurs in about 1.9 – 3% of the teenage population, which works out as approximately one to three in every 100 adolescents.

  • To date, data suggest that abnormal brain serotonin metabolism is a key factor in OCD: serotonin is believed to mediate the expression of OCD symptoms. Research also suggests that dysfunction in the cortico-striato-thalamo-cortical circuitry, as well as the areas of the brain associated with procedural learning and implicit memory, may relate to OCD symptoms.
  • Soft signs are non-localized deviant performances in a motor or sensory test, without other signs or presence of focal neurological disorder. Soft signs in child psychiatric patients have been well studied and implications of soft signs have been thoroughly analysed in a general population of pre-school and school children. Most studies conducted on OCD children have shown an opulence of soft signs, compared to normal control groups.
  • Autoimmune factors have also been implicated in the pathogenesis of pediatric OCD. Swedo et al. (1998) coined the term Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus (PANDAS) – a malfunction in the immune system associated with the onset and progression of neuropsychiatric disorders such as OCD and Tourette’s disorder due to infection by Group A β-hemolytic streptococci (GABHS).
  • Family studies report prevalence rates of 7% to 15% in first-degree relatives of the child and adolescent probands with OCD. These findings are consistent with reports of an increased familial loading in probands with early age at onset.

How does OCD affect your child’s life?

Obsessive-compulsive disorder (OCD) can be found in about 2-4% of the general population and is characterized by various compulsions and obsessions that interfere with the person’s quality of life from a mild to a severe degree.

The impact of OCD on your child might influence him/her in various ways: school work, home life, and companionships can frequently be impacted. Many children with obsessive-compulsive disorder (OCD) experience the ill effects of pathological doubting, which can vary from a mild form to an incapacitating form of extreme severity, in which the child is uncertain about their own understandings.

Some children are too young to understand that their thoughts and activities are unusual. They may not comprehend or have the option to make sense of why they should go through their rituals. If your child is older they may feel embarrassed, they don’t want to be ‘different’ from their peers, and may worry that they are ‘going crazy’.

Children with OCD sometimes experience extreme anxiety, embarrassment, low self-esteem, and sometimes even bullying.

The most striking feature of the symptoms presented by obsessive-compulsive children is the severity of the psychopathology in the absence of formal thought disorder. Subsequently, Obsessive-Compulsive disorder can weaken all areas of brain functioning and produce devastating results on patients and their families.

Numerous research findings have time and again suggested that individuals with OCD tend to have a significantly lower global quality of life (QOL) than controls in the study. A considerable number of children and adolescents with OCD had higher symptomatology of anxiety and depression than controls, as well as higher rates of thought problems. Children and adolescents with OCD also exhibited higher rates of externalizing problems as well. This latter finding is considered important and needs to be highlighted in terms of case management and treatment.

Diagnosis

An OCD diagnosis is justified when these obsessions and compulsions become so tedious that they disable day-to-day functioning (e.g., social, school, self-care, and so on). Commonly, these symptoms have a progressive onset, developing throughout a little while or months.

Differential Diagnosis 

OCD symptoms should be distinguished from normative behavior, therefore it is critical to find developmental normal repetitive behaviour, like bedtime rituals, from persistent distressing thoughts and compulsions. Recurring thoughts happen in a few clinical circumstances as well. By way of illustration, in eating disorders, the center is one’s appearance and the feeling of dread toward putting on weight, with gross distortions of body image, and much time is committed to pondering food and calories.

Another instance regarded is of a depressed patient who contemplates again and again with negative self-denying thoughts about oneself and their future, as well as guilt. Children with separation anxiety will primarily stress over leaving their caregiver, with serious fears over their parent’s health and safety. Hence, a proper diagnosis is mandatory in the case of juvenile OCD.

Treatment

The field of child psychiatry and the nature of care for our patients have significantly profited from the many advances in neurosciences and evidence-based approaches somewhat recently. It has presently concurred that OCD is a neurodevelopmental problem, and with the chance of appearing, by neuroimaging, brain changes as the aftereffect of the different treatments accessible.

Since every patient is unique, with different family dynamics, health care workers have to learn more, through research, about parental characteristics, such as personality features and psychopathology as well as familial influences on symptoms and severity of illness. The identification of comorbidities has in fact improved most treatment strategies as well.

At present, cognitive and behavioral therapies (CBT) have shown to be highly effective psychotherapeutic approaches for the treatment of the obsessive-compulsive disorder. Nevertheless, more studies are still needed, mainly those focusing on long-term follow-up, group treatment, and the combined use of serotonin-reuptake inhibitors.

With younger patients, it is important to take into account the cognitive level of development in order to use an age-appropriate technique such as family-based CBT.

Cognitive Behavioural Therapy:  This approach aims to identify connections between thoughts, feelings, and behaviour, and through various tasks, challenge unhelpful thoughts so that behaviours and feelings can change. CBT will help a child:

• Track down their negative or pointless perspectives

• Check and test the evidence for their negative and pointless thoughts

• Develop more accommodating perspectives

• Figure out how to stop finishing compulsions

• Decline anxiety to a reasonable level

• Figure out how to tolerate low degrees of anxiety

• Track down better approaches to adapt to their other unpleasant feelings

How can a parent help?

  • Remember the child/young adult might feel scared or humiliated by their thoughts and rituals – approach them delicately and in private.
  • Encourage the child to portray their fears and rituals.
  • Figure out how disruptive the thoughts or rituals are, and the areas of life that are affected
  • Look for stressors in their day-to-day routine; like bullying, academic tests, family meetings, or unfamiliar social settings.
  • Reassurance is the key. Reassure them that intrusive thoughts and rituals are fairly common and that we all experience them to a greater or lesser extent, but do not trivialise their experience.
  • Explain that you understand how difficult it is to control these thoughts and behaviours.

The current mainstay of treatment includes CBT, both individual and family-based, and SRIs (Serotonin Re-uptake Inhibitors). Medication should be a secondary option and given alongside CBT. Indeed, outcomes are more optimistic than for adult OCD; up to two-thirds of children achieve remission and a substantial additional proportion show a partial response.

References:

https://pubmed.ncbi.nlm.nih.gov/9785727/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3263388/

https://www.anxietyuk.org.uk/wp-content/uploads/2020/10/Helpling-your-child-with-Obsessive-Compulsive-Disorder.pdf

https://pubmed.ncbi.nlm.nih.gov/27110880/

Author

Prachi Sinha

Dr. Prachi Sinha is an MBBS graduate from Smt. N.H.L Municipal Medical College, Ahmedabad. She makes her home currently in Ahmedabad with her family, a tiny undisciplined garden, and a growing number of incomplete baking projects. She has garnered much acclaim for her animal activism and adoption drives across Ahmedabad. When she is not working in the hospital, Prachi spends most of her time conducting online webinars for unprivileged women and catching her treasured Bollywood movies. An admitted food fanatic, she feeds her addiction to sushi by taking on her favorite sushi joints on Sunday afternoons

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