Little Minds, Big Worries: Understanding OCD in Children and How to Help

Obsessive Compulsive Disorder is a serious anxiety-related mental health condition. An individual experiences frequent, intrusive, unwelcome thoughts that are referred to as obsessions. These obsessions are extremely distressing. They can take the form of images and impulses as well as thoughts, and they lead the sufferer to carry out repetitive behaviours or rituals in order to alleviate anxiety and prevent any perceived harm caused by the preceding obsessions. These behaviours can include things such as avoiding certain people/places /objects, internal mental rituals such as counting, touching things or rearranging things in a certain way, constant reassurance seeking from other people, and excessive cleaning or washing. They are referred to as compulsions, because the sufferer feels compelled to carry them out in order to neutralise their obsessions. A compulsion won’t necessarily be logically linked to an obsession and can be anything that the individual needs to do in order to ‘feel right’.

Whilst OCD tends to be diagnosed during late adolescence and early adulthood, children as young as age 6 can develop symptoms. It used to be that individuals would go undiagnosed for many years but this has changed in recent times thanks to increased awareness of the condition fuelled by the wealth of accessible information accessed via the internet and social media. This has also helped reduce the stigma around OCD, resulting in sufferers sharing their symptoms more readily with others, when before they might have kept them hidden due to feeling embarrassed or ashamed.

That said, young children don’t tend to have access to the internet or social media. At 6 years old, the chances are they will not have heard about OCD. They may not be able to verbalise their emotions, let alone understand the concept of ‘mental health’. Anxiety symptoms will often present as physical ailments such as tummy aches, dizziness or achy muscles leading them to worry further about being poorly. It is likely that a young child will not understand why they are having certain thoughts and why they feel the need to act in certain ways.

Young children may, however, realise that the way they are acting is ‘strange’ or not socially acceptable, especially if their behaviour is met with a critical response from others. For example, the child who feels the need to count to a certain number without being interrupted before leaving the house might find themselves at the receiving end of a parent’s frustration, particularly if this takes place every morning before the school run. The child with undiagnosed OCD may in turn experience themselves as ‘bad’ or ‘defective’ in some way. For lack of a better explanation as to why they are having obsessions and compulsions, a child might start to believe that they are ‘going crazy’.

The cause of OCD in children is not fully understood; it is thought that genetic, biological and environmental factors all contribute to its development. What isn’t in doubt is how debilitating the condition can be, affecting not only the sufferer but their loved ones too. The good news is that it’s treatable, and with the right support, recovery is possible.

What to do if you suspect your child has OCD

1. Educate yourself about the condition. Learn about the different types of OCD and how they present. It is so much more than a desire for cleanliness or a need for order, and no one is ‘a little bit OCD’. Familiarise yourself with common obsessions and compulsions so you can begin to understand how these might affect your child. This will help you to empathise and view their behaviours in a different light.

2. Create a safe and supportive environment where your child can express their feelings and thoughts. If your child talks to you about their specific obsessions and compulsions try not to diminish them. Even if they seem trivial to you, for your child they are a huge deal. It may be that the opposite is true and you’re shocked by the thoughts your child is having. Pure OCD (also called Harm OCD) can lead to recurring thoughts about harming other people. In this case it is crucial to remain calm and non-judgemental. Validate how scary it must be to have these types of thoughts. If your child thinks that you, their trusted adult, are alarmed by the thoughts they are having then this will further fuel their own anxiety. Individuals with Pure OCD do not want harm to come to anyone. This is why their thoughts cause them so much anxiety.

3. With your child’s permission, seek help from a mental health professional. Evidence suggests that Cognitive Behavioural Therapy (CBT) is effective in treating OCD, although other approaches are valid too. If you choose the CBT route, the mental health professional will likely use Gradual Exposure and Response Prevention (ERP). This involves gradually exposing an individual to their obsessions and triggers, whilst at the same time supporting them to resist engaging in their compulsions.

4. Encourage healthy coping strategies that can ease your child’s anxiety around not completing their compulsive behaviours. Healthy coping strategies can include mindfulness and meditation, breathing techniques such as belly breathing, straw breathing and hand breathing, talking to a trusted adult about how they are feeling, exercising and active play, and any other enjoyable activity that helps your child to distract themselves from their obsessions and compulsions.

5. This is a tough one but…avoid accommodating their compulsions. Your child may plead with you to engage in a ritual, and refusing to do so is incredibly hard when all you want to do is ease your child’s anxiety. However, if you accommodate the compulsions you are feeding into the narrative that your child needs to do them. This will make the compulsions stronger. Instead, empathise with how difficult this is for your child and gently encourage them to resist. In this way you are empowering your child to manage their condition and supporting them on their road to recovery.

6. Introduce or keep to a daily routine. I mentioned earlier that the factors contributing to the development of OCD are complex, but a lack of control can exacerbate symptoms. The world can be a scary place for a child (and adults too!) and sometimes OCD can be a response to the need to feel a greater sense of control in a world/environment that feels unpredictable. A routine can support your child to feel more in control which in turn can help to reduce their symptoms. For example, having a set bedtime and wind-down routine, regular mealtimes, a regular and predictable contact schedule if parents are separated, and anything else that provides your child with stability.

As a parent it is distressing to see your child suffer, and natural to want them to be free of OCD as soon as possible. Whilst recovery can take time, keep encouraging your child and try to remain patient. Each child is an individual, and what works for one may not work for another. If you find yourself feeling frustrated, try to adopt a more curious approach instead, for example, ‘this didn’t work for you, I wonder what might work better? Let’s see what else we can try, do you have any ideas?’

Finally, if you as the adult are also suffering with OCD, it is important to access professional help for yourself first to enable you to best support your child. OCD is a complex mental health condition and I recommend seeking the guidance of a GP and a mental health professional to ensure you and/or your child receive tailored support that will meet your/their specific needs.