Compulsive Behavior in Children

Compulsive behavior in children is found in tandem with obsessive thoughts, resulting in a diagnosis of obsessive compulsive disorder (OCD). The compulsive behavior is persistent and significant enough to disrupt the child's daily activities. Typically diagnosed in adolescence but occurring as young as age 7, early treatment helps prevent OCD from continuing into adulthood.

Definition

• OCD is a neurological disorder defined by recurrent intense thoughts (obsessions) and behaviors (compulsions) severe enough to interfere with normal functioning. The American Academy of Child and Adolescent Psychiatry states that OCD is found in as many as 1 in 200 children and adolescents. OCD is classified as an anxiety disorder because the obsessions are caused by anxiety and they then cause compulsive behavior in an effort to reduce the anxiety.

Obsessions

• Obsessions are uncontrollable and repeated thoughts or images. Children's obsessions tend to focus on things that may cause harm or be dangerous. The frightening thoughts enter their mind without an obvious trigger and the child can't make them stop. Compulsive behaviors are frequently based on the obsession as the child tries to stop the thoughts or prevent something bad from happening. For example, if a child's thoughts obsessively focus on germs and illness, then she may compulsively wash her hands to be sure that they are free of germs and to prevent illness.

Compulsions

• A compulsion results when the child feels that he must perform a certain behavior. He is not able to control this compulsion and will repeat the behavior over and over, creating rituals to help relieve the anxiety. These behaviors consume time and energy, along with the child's attention, leaving her unable to focus and complete expected tasks at home and school. Children frequently draw their parents into the compulsion. Using the hand-washing example, the child may need to ask a parent if her hands are clean after every washing. The parent must answer "yes" or risk escalating behaviors, sometimes even anger and tantrums.

Common Compulsions

• The most frequent compulsive behaviors in children include grooming, repeating and checking rituals. In a grooming ritual, they may need to repeatedly wash their hands, bath, comb their hair or brush their teeth. Repeating rituals are when children must perform behaviors a certain way and repeat doing them. Checking rituals mean that they need to repeatedly check something to be certain it is done, or done correctly. Sometimes, there will be a specific number of times that the task "must" be completed. Other rituals can revolve around a need to cleanse after touching another person, ordering or arranging toys, books or other objects in a very specific way, hoarding items, and rituals to prevent whatever harm their obsessive thoughts insist will happen to them or their family.

Signs and Symptoms

• Compulsive behavior in children can be difficult to notice because they tend to hide the behavior. It also may look like it is part of a phase. Look for signs that would result from the different types of behaviors, such as chapped hands, requests for family members to repeatedly answer the same questions, fears that something horrible will happen, overuse of soap or paper towels, and changes in grades, socialization or ability to complete chores. Since some behaviors can represent developmental stages and because OCD may exist with other psychiatric disorders, it is important to find a specialist to make an accurate diagnosis.

Treatment

• Behavior therapy is one of the most successful treatments for children. The therapist works with the child to gradually confront his fears until the anxiety lessens. Medications to help control anxiety and lessen the need to perform behaviors may be necessary in combination with therapy. Family members may be included in therapy so that they can learn about the disorder and how to best help the child with OCD.