Rabbi Azriel Hauptman
Levi is a six-year-old boy who has some interesting rituals. He spends a lot of time cleaning between his toes before taking a bath since his teacher once told him that germs can hide between your toes. Levi also makes sure that the door to his closet is closed when he goes to sleep because there might be monsters in the closet. Additionally, he will not go to sleep until his mother tells him “Good Night.” Does Levi have an anxiety disorder? Being that Levi is only six years old, not necessarily.
Compulsive and ritualistic behaviors in early childhood are part of normal development. A child who has only been on this earth for a few years does not yet understand what is real and what is imaginary. Which fears and anxieties should he or she take seriously? Will his or her parents die and no one will be there in the morning? Childhood is extremely confusing. Between the ages of four and eight is the prime time for this developmental form of anxiety. If that is all that it is, then the child will most likely outgrow it.
However, children who have a genuine anxiety disorder will not just outgrow it. Therefore, parents who have an anxious child often wonder when it is time to seek intervention. In this article, we will focus on Obsessive Compulsive Disorder (OCD), which is one type of anxiety disorder, and briefly describe how it manifests itself in children. If you notice some of these signs in your child, it is recommended to seek professional help from a therapist who has an expertise in the diagnosis and treatment of pediatric OCD.
OCD contains two components, obsessions and compulsions. Obsessions is when one excessively worries or thinks about something despite not wanting those worries or thoughts, and compulsions are repetitive actions or thoughts that one does in an attempt to have relief from the obsessions. Obsessions include fear of dirt or germs, a need for symmetry, religious obsessions, unlucky numbers, and fear of illness or death in oneself or a close relative such as a parent. Compulsions include grooming rituals (hand washing, showering, and teeth brushing), checking rituals, touching rituals, counting rituals, arranging objects, and “undoing” rituals (to undo “contamination” from a person or object).
OCD in childhood often has negative consequences on school performance and social interactions. The constant noise in the mind may lead to difficulty concentrating on school work and embarrassment regarding the ritualistic compulsions may lead to social isolation. Additionally, the constant reassurance-seeking that children may seek from parents to assuage their fears may be overwhelming for the parents.
The treatment of OCD in children also has its unique aspects. One of the differences between OCD in adults and children is that adults usually understand that their obsessions are extreme and unrealistic but feel helpless in controlling them, but children often do not fully appreciate how their fears and anxieties are irrational. Another difference is that the treatment must involve collaboration with the child’s caretakers, which are the parents and the school.
When seeking treatment for a child with OCD it is imperative that the clinician has expertise in OCD and also knows how to apply the treatment to children. Children have certain unique needs in therapy for OCD, such as understanding that this is not their fault, learning how to differentiate between themselves and the disorder, and being educated about their disorder in a way that they can comprehend it on their level.
As with many aspects of life, the best defense is a good offense. Early intervention can spare your child years of suffering. It might be expensive, but the alternative is costly in more ways than one.
