A child or adolescent with obsessive-compulsive disorder (OCD) will be bothered by obsessions, compulsions, or both. Healthcare providers use criteria supplied by the American Psychiatric Association [APA], 2000, to make this diagnosis. Generally speaking, obsessions are recurrent or persistent, intrusive thoughts, impulses and images that cause distress or anxiety. The person may attempt to suppress or ignore these intrusive thoughts, or try and think about something else, because the person knows that the obsessional thoughts are from his or her own mind. Compulsions are repetitive behaviors, including hand-washing and repeatedly checking things, for example whether or not a specific object has been put away, or repetitive thoughts such as praying or counting silently. The person is driven to these behaviors by a compulsion or by rigid internal rules. The behaviors or mental acts are an attempt to reduce stress or prevent a dreaded event, but there is no real connection between the compulsion and what the person is trying to prevent. Adults and adolescents must have recognized that the obsessions or compulsions are excessive or unreasonable. Children do not have to make these realizations to have the diagnosis of OCD.
The obsessions or compulsions cause marked distress, are time consuming, or significantly interfere with the person’s normal routine, functioning, activities or relationships. To make the diagnosis of OCD, the obsession or compulsion cannot be caused by another psychiatric diagnosis, illness, or medication. While there are certainly children and adolescents with OCD, there are not good statistics about how many. One study found an incidence of clinical OCD of 0.7% of adolescents (Valleni-Basile et al. 2004). Others have found that as many as one in 100 children have OCD (Anxiety Disorders Association of America [ADAA], Retrieved 2009). While OCD may begin as early as age two or three, it peeks about ten years of age. Boys tend to develop OCD earlier than girls.
Treatment of OCD is best accomplished with a combination of medicine and cognitive-behavioral therapy (The Pediatric OCD Treatment Study [POTS], 2004). Cognitive-behavioral therapy or psychotherapy helps the individual deal with their specified obsessions and compulsions. In children, cognitive therapy might be tried first, because there are no side effects. To do this, a clinician will try to guide the child to alternative behavior. The treatment helps the child to develop positive instead of negative thinking and behavior. There is also Exposure and Response Therapy (ERP) in which the clinician exposes the child to an obsession and prevents ritual behavior for an increasing period of time as the sessions progress. (ADAA, Retrieved 2009).
Many medications have been used with success in children and adolescents. Good results have been obtained with fluoxetine (Prozac), (Geller et al., 2001), in patients age 7 to 17 years of age. Similar results have been noted with paroxetine (Paxil), and sertraline (Zoloft). One review found all SSRIs (serotonin reuptake inhibitors, which modify brain chemistry) to be equally efficacious for children and adolescents with OCD, while clomipramine showed even better results (Geller et al., 2003). Clomipramine has more side effects, so it would probably not be a first choice of medication for children. The decision of what medication to use should be based on the age of the child or adolescent and whether or not the drug is safe for their age group, as well as based on side effects (APA, 2007). There is evidence that these medications may increase the risk of suicidal thoughts and attempts in depressed adolescents, and this may be true for patients with OCD. Parents and clinicians must be aware of the risk. Alternative therapies that are suggested for OCD include natural herbal and homeopathic remedies (NativeRemedies The Natural Choice, Retrieved 2009). Most children and teenagers will improve with one or more of these therapies. Parents should feel confident that, in the right hands, the treatment of OCD is very successful.
References:
American Psychiatric Association. (2000). Diagnostic criteria from DSM-IV-TR. Washington, DC.
American Psychiatric Association. (2007). Practice guideline for the treatment of patients with
obsessive-compulsive disorder. Arlington, VA. Retrieved March 23, 2009 from http://www.guideline.gov/summary/summary.aspx?doc_id=11078&nbr=005841&string=obsessive+AND+compulsive+AND+disorder
Anxiety Disorders Association of America. Helping a child with OCD. Retrieved March 23,
2009, from http://www.adaa.org/gettinghelp/MFarchives/MonthlyFeatures(august).asp
Geller, D.A., Hoog, S.L., Heiligenstein, J.H., Ricardi, R.K., Tamura, R., Kluszynski, S.,et al. (2001). Fluoxetine treatment for obsessive-compulsive disorder in children and dolescents: A placebo-controlled clinical trial [Electronic form]. Journal of the American Academy of Child & Adolescent Psychiatry, 40(7), 773-779.
Geller, D.A., Biederman, J., Stewart, S.E., Mullin, B., Martin, A., Spencer, T., et al. (2003). Which SSRI? A meta-analysis of pharmacotherapy trials in pediatric obsessive-compulsive disorder [Electronic form]. American Journal of Psychiatry, 160, 1919-1928.
NativeRemedies The Natural Choice. Obsessive compulsive disorder (OCD) in children. Retrieved March 23, 2009 from http://www.nativeremedies.com/ailment/ocd-in-children-info.html
The Pediatric OCD Treatment Study. Cognitive-behavior therapy, sertraline, and their combination for children and adolescents with obsessive-compulsive disorder [Electronic form]. Journal of the American Medical Association 292(16), 1969-1976.
Valleni-Basile, L. A., Garrison, C. Z., Walle, J. L., Addy, C. L., McKeown, R. E., Jackson, K. L., et al. (2004) Incidence of obsessive-compulsive disorder in a community sample of young adolescents [Electronic form]. Journal of the American Academy of Child & Adolescent Psychiatry, 43(11), 1387-1396.
