In children, Obsessive Compulsive Disorder may manifest in a variety of ways. Common presentations in children involve: obsessive worry about loved ones, over-concern with the appearance of school assignments, rituals involving washing, specific bedtime rituals, repeatedly asking questions, checking and/or ordering objects, counting, or praying. A child with OCD will become markedly distressed when not able to complete a ritual; some children are able to articulate specific fears related to completing or not completing the tasks, while other children may express more general worries or discomfort, such as “something bad will happen,” or “it just doesn’t feel right.” If a child’s ability to fully engage with and enjoy life appears to be impacted by worries or rituals, a professional evaluation is indicated.
OCD is a neurobiological illness, and it is important to remember that it is neither the child nor the family’s “fault.” Appropriate treatment involves first correctly diagnosing OCD, and differentiating OCD from other anxiety or impulse-control disorders. Then, the therapist will guide the child and family in an age-appropriate Exposure and Response Prevention (ERP) protocol. This modality provides psychoeducation for both parents and children, helps to decrease the over-activity in the affected area of the brain, and provides the child and family with tools for relapse prevention. For some children, a referral to a qualified provider for a medication evaluation may also be indicated.