Obsessive-Compulsive Disorder (OCD) can feel like an invisible force, quietly shaping the world of children and young people, often without anyone knowing. It’s not just about having habits or being particular about things, it’s a battle of thoughts, fears, and compulsions that can affect every aspect of daily life. But what happens when a child’s struggle with OCD goes unnoticed? And how can parents, caregivers, and professionals help children reclaim their lives?
Dr. Kat Harper, one of our clinical psychologists at CAYP Psychology, has extensive experience working with young people affected by OCD. Drawing on her expertise across diverse therapeutic approaches, Dr. Harper’s work emphasises the importance of early intervention, a collaborative approach, and tailoring treatments to fit each young person’s unique needs. In this blog, Dr. Harper will explain what OCD is, the differences between OCD and preference behaviours or repetitive rituals, and much more. Whether you are supporting a child or young person with OCD, suspect OCD-like behaviours, or struggle with OCD yourself, this article is for you.
What is OCD, and how is it typically diagnosed in children and young people?
People will OCD experience frequent, unwanted, and distressing thoughts or images, these are the ‘obsessions.’ These intrusive thoughts often revolve around the belief that something bad will happen. As a result, the person feels anxiety, worry, or distress. To manage these feelings, they engage in repetitive behaviours, also known as ‘compulsions,’ in the hope that this will prevent the feared event from occurring.
Can OCD compulsions always be seen, or do they sometimes happen internally?
Sometimes, these behaviours are visible, like washing hands repeatedly or checking things over and over. However, compulsions can also occur in the mind. For example, a person might feel the need to count to a certain number before doing something, believing that this action will stop something bad from happening.
How do professionals typically diagnose OCD in children and young people?
When you seek support for OCD, a professional will usually have a conversation with you about your experiences to understand whether they fit the criteria for OCD. They may also ask you to complete questionnaires that help assess how you are feeling and the frequency and intensity of your obsessions and compulsions.
What are the key differences between obsessive-compulsive behaviours and preference behaviours in children and young people?
OCD occurs when someone feels they have to do something in order to prevent something bad from happening. This belief drives the compulsive behaviour, which is done to neutralise the anxiety caused by the obsession. In contrast, preference behaviours are simply actions or routines that someone likes to do in a particular way, not because they believe something bad will happen, but because it’s just how they prefer it.
Can you give an example to help distinguish the two?
Let’s take Jason, for example. He’s very particular about having all of his toys in size order and gets upset if someone changes this arrangement. To understand whether this is an obsessive-compulsive behaviour or just a preference, we’d want to have a conversation with him.
We could ask questions like:
- “Is there a worry that something bad will happen if the toys aren’t in size order?” (This would point to OCD)
- “Do you just like the toys to be that way?” (This would suggest it’s more of a preference)
So, the key difference is whether there’s anxiety tied to the behaviour?
Exactly. If there’s anxiety and a belief that something negative will occur if the behaviour isn’t completed, then it’s likely OCD. If the behaviour is more about comfort or routine without that underlying fear, it’s more of a preference.
How can we differentiate between typical development and OCD when it comes to repetitive behaviours or rituals in young children?
Children naturally engage in repetitive behaviours as part of their development. For example, they may repeat actions or rituals as they learn new skills, explore their environment, or find comfort in routine. These behaviours are usually harmless and a normal part of growing up.
However, when these repetitive actions start to cause distress, it may indicate something more serious, such as OCD. If a child feels like they have to engage in a behaviour to prevent something bad from happening, even if they don’t want to, this is a sign that the behaviour could be linked to OCD. In these cases, the child might feel overwhelmed by anxiety or fear if they cannot complete the ritual.
It’s important to observe whether the child’s repetitive behaviour is causing them distress or is simply part of their normal routine. If the behaviour is driven by fear or an intense need to do something to avoid negative outcomes, it’s worth exploring the possibility of OCD further.
Are there specific signs or symptoms of OCD that we should be aware of in children who may also be neurodivergent?
Neurodivergent children, including those with autism or ADHD, may experience OCD differently compared to neurotypical children. One of the key challenges for neurodivergent young people is identifying and articulating their thoughts. Rather than having a specific fear, such as thinking they might catch germs and get very sick, they might experience what they describe as “a bad feeling” or a sense of discomfort without a clear cause.
Even though they may not be able to pinpoint the source of their anxiety, the distress that comes from the need to perform certain behaviours (compulsions) can still be very real. They might feel compelled to act, but it’s important to note that these behaviours are not something they want to do, they feel forced to do them to relieve the discomfort.
Therapy for neurodivergent children might take a bit longer because it requires adapting to their unique ways of processing and expressing thoughts. Treatment can still be highly effective and tailored to meet their individual needs.
How do the symptoms of OCD manifest differently in children versus adults, and are there age-related factors to consider when diagnosing OCD in younger individuals?
The symptoms, diagnostic criteria, and treatment for OCD are generally similar for both children and adults. However, there are some differences in how OCD presents at different ages. Children, for instance, are more likely to involve family members in their compulsive behaviours. This might include seeking constant reassurance from parents or engaging them in rituals, such as checking things repeatedly or needing them to say specific things to ease their anxiety.
When diagnosing OCD in younger individuals, it’s important to consider the child’s developmental stage and how they express distress or anxiety. Since children may not be able to articulate their thoughts and feelings as clearly as adults, it’s essential to look for behaviours that suggest compulsions, even if they aren’t always connected to clear obsessions.
At CAYP Psychology, we have a team of highly specialised clinicians, including Dr. Kat Harper, who are dedicated to supporting children, young people, and families across the UK. If you are concerned about OCD-like behaviours in a child or young person, or if you need guidance on treatment and support, don’t hesitate to get in touch with us. Our team is here to help, using a tailored, compassionate approach to ensure the best possible care for every individual.
Resources for Support
- Breaking Free from OCD (This is aimed at young people and can be worked through together with a caregiver) Break Free from OCD: Overcoming Obsessive Compulsive Disorder with CBT: Amazon.co.uk: Challacombe, Dr. Fiona, Oldfield, Dr. Victoria Bream, Salkovskis, Paul M: 8601401162407: Books
- Everyday Mindfulness for OCD: Tips, Tricks and Skills for Living Joyfully
Downloadable booklets on OCD are available at OCDUK.org.
0 Comments