How do I know if my child has OCD? What are the signs?

An estimated 3% of children in the United States experience OCD. The condition is more prevalent than many other childhood disorders or illnesses, but kids often keep the symptoms hidden from their families because they're embarrassed about them.

OCD in children is usually diagnosed between the ages of 7 and 12. Since these are the years when kids naturally feel concerned about fitting in with their friends, the discomfort and stress brought on by OCD can make them feel scared, out of control, and alone.

Behaviors that may be signals of OCD include spending long, unproductive hours on homework, retracing over letters or rereading paragraphs. Dramatic increase in laundry and toilets overflowing from excessive use of paper may warn of contamination fears. Long, rigid bedtime rituals, exaggerated needs for reassurance, or requests for family members to perform certain acts to make the child "safe" may all indicate a child who has OCD. Hoarding of useless objects, such as fingernail clippings or used bandages should be distinguished from normal childhood collecting of rocks, baseball cards or sentimental treasures.

It is important to distinguish between normal developmental rituals or superstitions and possible OCD behaviors. Although ritualized behaviors are common for the young child around times of transition, OCD-related behaviors are typically excessive and occur at a later than expected age. If your child becomes distressed when prevented from doing that behavior and the behavior takes up a lot of his/her time, it's more likely a symptom of OCD.

Common OCD Behaviors in Children

OCD can make daily life difficult for kids and their families. The behaviors often take up a great deal of time and energy of the child with OCD, making it more difficult to complete tasks, such as homework or chores, or to enjoy life. In addition to feeling frustrated or guilty for not being able to control his or her own thoughts or actions, a child with OCD also may suffer from low self-esteem from the shame or embarrassment about what he or she is thinking or feeling.

A child with OCD also may feel pressured because he or she doesn't have enough time to do everything. The child might become irritable because he or she feels compelled to stay awake late into the night or miss an activity or outing to complete compulsive rituals. The child might have difficulties with attention or concentration because of intrusive thoughts.

Among kids and teens with OCD, the most common obsessions include:

• fear of dirt or germs
• fear of contamination
• a need for symmetry, order, and precision
• religious obsessions
• preoccupation with body wastes
• lucky and unlucky numbers
• sexual or aggressive thoughts
• fear of illness or harm coming to oneself or relatives
• preoccupation with household items
• intrusive sounds or words

The following compulsions are the most common among kids and teens:

• grooming rituals, including hand washing, showering, and teeth brushing
• repeating rituals, including going in and out of doorways, needing to move through spaces in a special way, checking to make sure that an appliance is off or a door is locked, and checking homework
• rituals to undo contact with a "contaminated" person or object
• touching rituals
• rituals to prevent harming self or others
• ordering or arranging objects
• counting rituals
• hoarding and collecting things
• cleaning rituals related to the house or other items

Signs and Symptoms

Recognizing OCD is often difficult because a child can become adept at hiding the behaviors. It's not uncommon for a child to engage in ritualistic behavior for months, or even years, before parents know about it. Also, a child may not engage in the ritual at school, so parents might think that the ritual is just a phase the child is going through.

When a child with OCD tries to contain these thoughts or behaviors, this creates anxiety. A child who feels embarrassed or as if he or she is "going crazy" may try to blend the OCD into the normal daily routine until he or she just can't contain it anymore.

It is common for a child to ask the parent to join him or her in the ritualistic behavior: First the child has to do something and then the parent has to do something else. If a child says, "I didn't touch something with germs, did I?" the parent might have to respond, "No, you're OK," and the ritual will begin again for a certain number of times. Initially, the parent might not notice what is happening. Tantrums, overt signs of worry, and difficult behaviors are common when parents fail to participate in their child's rituals. It is often this behavior, as much as the OCD itself, which brings families into treatment.

Parents can look for the following possible signs of OCD:

• raw, chapped hands from constant washing
• unusually high rate of soap or paper towel usage
• high, unexplained utility bills
• a sudden drop in test grades
• unproductive hours spent doing homework
• holes erased through test papers and homework
• requests for family members to repeat strange phrases or keep answering the same question
• a persistent fear of illness
• a dramatic increase in laundry
• an exceptionally long amount of time spent getting ready for bed
• a continual fear that something terrible will happen to someone
• constant checks of the health of family members
• reluctance to leave the house at the same time as other family members

Environmental and stress factors can signal the onset of OCD. These can include ordinary developmental transitions (such as starting school) as well as significant losses or changes (such as the death of a loved one or moving).

Diagnosing OCD

In screening for OCD, your child's doctor or mental health professional will likely ask about your child's obsessions and compulsions in language that your child will understand, such as:

• Do you have worries, thoughts, images, feelings, or ideas that bother you?
• Do you have to check things over and over again?
• Do you have to wash your hands a lot, more than most kids?
• Do you count to a certain number or do things a certain number of times?
• Do you collect things that others might throw away (like hair or fingernail clippings)?
• Do things have to be "just so"?
• Are there things you have to do before you go to bed?

Because it might be normal for a child who doesn't have OCD to answer yes to any of these questions, your child's doctor also will ask about your family's history of OCD, Tourette syndrome, and other motor or vocal tic disorders. OCD has a genetic component, which means that children whose family members have had any of these disorders may be more prone to OCD.

How Can I Help My Child?

It's important to understand that the obsessive-compulsive behavior is not something that a child with OCD can stop if he or she just tries harder. OCD is a disorder, just like any physical disorder - it's not something the child can control.

Once a child is in treatment, it's important for parents to participate, to learn more about OCD, and to modify expectations and be supportive. Keep in mind that kids with OCD get better at different rates so try to avoid any day-to-day comparisons of your child's behaviors, and recognize and praise any small improvements. Keep in mind that it's the OCD that is causing the problem, not the child. The more that personal criticism can be avoided, the better.

It's can be helpful to your child to keep family routines as normal as possible, and for all family members to learn strategies to help the child with OCD.