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By Melissa Tennen, HealthAtoZ writer
Learn the signs for obsessive-compulsive disorder in children. Part three of a series shows what to look for.
Obsessive-compulsive disorder (OCD) in children can be hard to detect because its symptoms appear differently than in adults.
Children don't necessarily understand that their behavior doesn't make sense, says Mark Wellek, M.D., past president of the American Society for Adolescent Psychiatry. Adults have the cognitive ability to understand that their behavior and thoughts aren't necessarily normal. Children usually don't. Even if recognized by the sufferer, control without medication or therapy is impossible, says Wellek.
"It's a disorder of secrecy. Children virtually think they are stupid," says Susan E. Swedo, M.D., chief of the pediatric and developmental neuropsychiatry branch of the National Institute of Mental Health.
Children with OCD believe they don't have any control over their thoughts and behaviors. Consequently, many are embarrassed by their compulsions and go to great lengths to hide them, especially at school. But when their symptoms get to the point that it takes an hour to finish one problem on a test because they feel they can't write the number seven perfectly, that's when someone notices, Swedo says. Very young children may try to explain away their behaviors as silly. They may look for reassurance from their parents.
Hardest for a parent is discerning what is normal behavior in a developing child. The peak age for OCD is 10 but it can strike children as young as 2 or 3.
Swedo explains that many children go through developmental phases where they prefer certain routines. For instance, it's normal for a 2-year-old to prefer bedtime rituals of brushing their teeth, hearing a bedtime story and getting a kiss from their parents.
But there's a remarkable difference between a child's phases and OCD, she says. Namely, it's quality of life.
"How much of the day does it take up? How long has it been going on? Does it bother the child? Parents may think the obsessive thoughts may last 30 minutes, but it may be eight hours that they may be obsessing," Swedo says.
Generalized anxiety
A child may also have generalized anxiety disorder (GAD), which is a different mental disorder that sometimes co-exists with OCD. People with GAD have excessive anxiety and worry uncontrollably about everyday events or activities. Similar to OCD, GAD is difficult to control and causes notable problems in everyday life, including edginess, fatigue, difficulty concentrating, irritability, muscle tension and sleep disturbances. To be diagnosed with GAD, one must experience excessive anxiety a majority of the time over at least six months. GAD is found in children and adults.
"We aren't talking about the kids who are always dressed perfectly or do their homework neatly," says David Fassler, M.D., a child and adolescent psychiatrist and clinical associate professor of psychiatry at the University of Vermont College of Medicine and a spokesman for the American Psychiatric Association. "These are kids who are never going to be done with their homework because they have to keep rechecking each problem."
"Young kids may be worried that something bad will happen to them or their families. So they may keep checking the doors to relieve any anxiety. Older kids worry about getting sick and may repeatedly wash their hands," Fassler says. "They are doing behaviors that reduce or control anxiety. 'Only if I can be sure the doors are locked can I go to sleep.'"
"A kid might think, 'If I count my steps to the dining room, my food will be safe to eat,'" Fassler says. "Sometimes kids with OCD arrange their rooms in a certain, predictable way. They may get very anxious if someone comes into their room and picks up a book or moves a toy."
Children can respond well to treatment, but the road to therapy may be strewn with obstacles.
In the next installment, learn how children with OCD slip through the cracks and miss getting help.
This article was reviewed and updated June 2007.
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