Category — 2.9 Children with Mental Illness: Obsessive-Compulsive Disorder (OCD)

OCD is an anxiety-based disorder with two parts: obsession  and compulsion. Obsessions are unwelcome recurring thoughts and feelings that the child cannot get out of his or her head. This is the obsession. No matter how hard the child tries, he or she cannot get rid of these thoughts unless he or she performs a certain action, over and over again. This is the compulsion. For example, a girl keeps worrying that her father is going to get in a car accident while driving home from work. For some reason, the child feels that if she touches every wall in the house, the father will be safe. That is, the physical action of touching every wall in the house will save the father’s life and  get rid of the obsessive thought.

Most people with OCD understand that the obsessions and compulsions are not really related. For example, touching every wall in the house will not save the father’s life. But they do it anyway. Many adults with OCD say they fully understand their actions do not make any sense. But they still feel that they have to perform them. Ignoring the thoughts does not work. It leads to more anxiety, and this  leads to the compulsive behavior. OCD is a serious disorder. It  often hurts the child’s ability to lead a typical life. Imagine washing your hands 100 times or more before you leave the house. Imagine checking that you turned off the lights 100 times before you leave the house. Imagine not playing outside with your friends or classmates because you are afraid of getting germs.

The symptoms of OCD usually appear gradually but sometimes  they appear all of a sudden. OCD usually starts in the late teen to young adult years. However, more and more younger children (under ten years of age) are now being diagnosed with OCD.

There are many types (or themes, as they are called by psychiatrists) of obsessions and compulsions. Here are the most common types:

Obsessions:

• Fear of germs and getting contaminated or dirty;
• Fear related to safety: for example, fear of not turning off the oven, or not locking the door;
• Fear of hurting someone (usually present in teenagers and adults).

Compulsions:

• Washing one’s hands over and over;
• Checking that the door is locked or the oven is off, 100 or 200 times;
• Repeating certain actions over and over again: for example, touching every wall in the house, licking every flat surface in the house (even the dirty ones), walking on every tile in the bathroom or kitchen;
• Keeping everything in a room orderly. That is, the child makes sure that every item in the room has a place and makes sure nothing gets moved from its place (Fig. 1);
• Compulsions can also involve mental acts, such as praying, counting and repeating certain words over and over again.

Figure 1. Room in order

Children with OCD need a lot of help in the classroom. Many do not perform as well as they could in school and may have low-average IQ scores (see full Glossary). This  is because their OCD prevents them from focusing on their work. Instead of focusing on what the teacher is saying, the child focuses on the obsessions that are inside his or her head, and what actions they can perform to make these thoughts go away. To make the classroom experience as pleasant as possible for the child with OCD, the teacher can:

• Make sure the child knows that he or she is safe and welcome in the classroom;
• Let the child know that he or she will be allowed to act on certain compulsive behaviors if needed (this should be done in collaboration with the child’s therapist, please see below);
• Let all children in the classroom know, as sensitively as possible, that this child may sometimes engage in certain behaviors, and that this is ok;
• Give the child extra time for assignments, homework and tests if needed;
• Plans ahead for outings and field trips and collaborate with the child’s therapist to make it possible for the child to participate in these activities.

OCD does not go away and its symptoms could get worse under stressful conditions. Although OCD cannot be cured, there is a lot that can be done to help the child deal with the obsessions and their accompanying compulsions. To learn more about OCD, please watch this short video, available from the Anxiety BC website.

Children with OCD need help that cannot be provided by a classroom teacher or school counselor. They need psychotherapy. How much  psycho-therapy the child needs will depend on his or her symptoms. For example, some children actually put sharp and dangerous objects in their mouths in order to stop the obsessive thoughts. If the child has dangerous symptoms like this therapy session will need to be frequent (possibly twice a week or more). If the child’s symptoms are not very severe, the child may get therapy sessions once a week or once every other week. The most common type of psycho-therapy is cognitive-behavioral therapy. The child is taught how to think differently and approach his or her compulsions from a more positive angle. At the same time, they are taught new ways to deal with unwelcome obsessive thoughts.

It is believed that one of the causes of OCD is an imbalance in certain neuro-transmitters (see full Glossary)  (in this case, serotonin) in the brain. This imbalance can sometimes be fixed with medication. If the child’s family chooses to place him or her on medication, here are a few things to consider:

• What type of medication should my child take?
• What dosage should my child get?
• What are the side effects?
• What are the risks?
• Has this medication been tested on children my child’s age?

Although the obsessions and compulsions can be quite overwhelming, most people with OCD do lead happy and healthy lives. They (Fig. 2)  graduate from college, get jobs and have lots of friends and family who

Figure 2. A girl

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