The onset of OCD usually occurs in childhood

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Q: Can you please talk about OCD in children? We noticed that our youngest daughter, who is 6 years old, is developing rituals with numbers and bed and meal times. She gets quite annoyed if one of her brothers prevents her from finishing. Should we be worried?

A: You ask about obsessive-compulsive disorder, commonly known as OCD. It is a type of anxiety disorder that often begins in childhood and adolescence, although it can occur in adults as well. OCD is marked by a stressful cycle of unwanted and disruptive thoughts, images or sensations – it is the obsessive element – and repetitive behaviors that become a compulsion.

It is normal for children of all ages to develop a few habits or rituals to ease the steep learning curve of growing up. What sets OCD apart is the intensity and rigidity of thoughts and rituals. Rather than helping a child cope, these behaviors interfere with their daily life. Eventually, OCD begins to hamper a child’s development.

In OCD, obsessive thoughts often focus on the fear of germs, dirt, and disease; persistent fear that something bad is about to happen; a fixation on the smallest details; a thirst for symmetry; and concerns about physical security. Compulsive behaviors are often governed by rigid rules that can revolve around numbers and counting. They can include repetitive actions, such as checking and rechecking that a door is locked, or washing your hands all the time.

Initially, the rituals can indeed soothe or reassure a child. But these types of behaviors tend to spread and multiply. Their performance takes more and more time and energy and creates a barrier between the child and the rest of the world. The end result is often increased worry and anxiety. It can get so serious that children with OCD may develop trouble sleeping, become depressed, avoid spending time with other children or adults, and even have trouble leaving the house.

If you think your daughter’s behaviors match the pattern and intensity of OCD, you can ask your health care provider to have her evaluated. This involves a psychiatric assessment for her and a series of questions about her behaviors that the adults in her life must answer. If a diagnosis of OCD is made, the child’s age, mental and physical health, and the severity of symptoms will determine treatment.

Although there is currently no cure for OCD, a range of therapies and treatments can help a person with OCD manage their condition. This includes cognitive and behavioral therapies, which are appropriate for the age of the child. A therapist helps the child identify the fears or concerns that motivate the behavior and offers helpful alternatives to reduce or resolve them.

The behavioral component brings the whole family into the equation. This includes agreements and guidelines designed to limit and possibly modify OCD behaviors, as well as family therapy. In some cases, drugs may be prescribed to increase the levels of serotonin in the brain.

You can find useful information, as well as contacts for local services and support groups, on the International OCD Foundation website: kids.iocdf.org.

• Dr. Eve Glazier is an internist and associate professor of medicine at UCLA Health. Dr Elizabeth Ko is an internist and assistant professor of medicine at UCLA Health. Send your questions to [email protected]


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