Obsessive-Compulsive Behavior in Children

Introduction

Obsessive-compulsive disorder is a neurobiological disorder and has the potential to disturb the intellectual, social, and professional performance of the affected person. The most crucial aspect of the disorder is the persistent obsessions and compulsions which the child witnesses, hindering daily life.

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Obsessive-compulsive disorder is an illness that affects many children and teenagers. Most children worry or fear about something or the other, but when a child has an obsessive-compulsive disorder, the worry just doesn’t seem to evade the child or the affected person. It is this compulsion to worry and doubt which changes or alters their behaviors and they are forced to behave in compulsive ways, constantly and recurrently.

This disorder in young children is not uncommon, and approximately 1 percent of the children and adolescents are affected by this disorder (Valleni et al., 1994).

The disorder is marked by persistent redundant and repulsive thoughts or doubts and worries, which are the symptoms of the disorder. Very often the children are embarrassed by these recurring symptoms and in most cases prefer to keep this as a closely guarded secret from their friends and sometimes even their family members. In cases when the symptoms are apparent in very young children, very often the family members do not construe them to be signs of some disorder.

The disorder is characterized by some kind of habitual and continual behavior or pattern which generally persists for more than one hour daily. As such, there is an intrusion in the child’s daily routine and the obsessive thoughts cause the child tremendous anguish and suffering, due to the embarrassment they tend to feel. The behavior at most times tends to make the child feel bizarre and unreasonable and it is due to this peculiarity that the children may tend to hide the behavior and maintain it as a secret from others.

Usually, children are diagnosed with obsessive-compulsive behavior when they are about seven years to twelve years old. Even when the disorder is not diagnosed, most adults with the late diagnosis have reported that their initial symptoms began when they were children (Rasmussen & Eisen).

The symptoms of obsessive-compulsive behavior are very easily recognizable to teachers, parents, and pediatricians, as they can be easily differentiated from the normal childhood fallacies and worries. Obsessive-compulsive disorder not only causes suffering among the affected children but also interferes with the academics and socialization of the children. Research has indicated that the occurrence of the disorder is likely to hinder the growth of the child greatly and in some cases is even related to chronic gloominess and can in some cases cause severe long-term social harm to the affected children (Bolton D., Luckie M. & Steinberg D.) It has been proved that in order to reduce the long-lasting injury caused by the disorder, it must be detected as early as possible and be treated assertively (Leonard et al., 1993).

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According to a study, the disorder affects as many as 2.2 million Americans (Kessler et al., 2005) and may cause several other disorders such as eating disorders (Wonderlich & Mitchell, 1997) and other anxiety disorders or sometimes even cases of depression (Robins & Regier, 1991; Regier et al., 1998).

The disorder is known to affect males and females equally and generally onsets in childhood adolescence or the periods of initial youth and adulthood ((Robins & Regier, 1991). Nearly a third of the patients with the disorder, develop symptoms in their early childhood years and there have been several indications that the disorder may be genetically transferred or inherited (NIMH Genetics Workgroup, 1998).

The disorder or the disease does not follow any fixed course or path and the symptoms of the disorder may range from being very severe to mild, off and on. However, if the disorder is very severe, the daily routine of the affected child may be disrupted to a very great extent. Adolescents affected by the disorder are known to be using alcohol or sometimes even drugs in order to regain their calm (Regier et al., 1998; Kushner et al., 1990). Most children and adolescents have been reported to respond well to the treatments and medications.

Causes for Obsessive-compulsive disorder

Although there is no evidence of any specific genes in the occurrence of the disorder among children, there is considerable research that suggests that the disorder may be inherited from the genes of close relatives. The disorder is believed to be running in families with a history of the disorder.

In many cases, the disorder has been associated with injury of the brain and postencephalitic states along with other disorders such as the basal ganglia disorders namely the tics and Tourette syndrome (McGuire, 1995). Studies of images have revealed in patients with the disorder, there were obvious irregularities of the structural as well as the functional basal ganglia, making the obsessive-compulsive disorder the first psychiatric disorder where the combined result of drugs and psychiatric therapy has successfully reversed the functional metabolic changes (Schwartz et al., 1996). The activities undertaken by the affected patients in order to achieve perfection have invited numerous psychodynamic explanations and analyses. There is however growing evidence that the disorder is related to the brain and its functional deformities.

Psychodynamic causes

According to the Psychodynamic theory, Freud categorized obsessive-compulsive disorder as psychoneurosis. He stated that the prime cause for the disease was due to one or many problems in the development of the child. Freud did agree that inheritance or heredity could play a potential role in the disease but firmly believed in the theory of infantile sexuality, where the child passes through several oral, anal, and oedipal sexual stages in the early developmental years. Freud stated that if the child does not advance to each of the stages in a successful manner, difficulties are most probable.

Biological Causes

Recent studies and research point to biological causes for the occurrence of Obsessive-compulsive disorder among children. The PET scans of the brain have shown the occurrence of certain abnormalities of the sub-orbital cortex and the basal ganglia of the brain, which are the lower or base portions of the brain.

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Some cases of the disorder are also known to be associated with Tourette disorder which is typified by numerous convulsions or tics. Children suffering from the obsessive-compulsive disorder may also have attention deficit disorder. Recent research has also identified the role of certain bacteria in the occurrence of the disorder among children. The bacteria are identified as the B-hemolytic streptococcus, which produces the PANDAs syndrome in children. The bacterial antibodies may attack several sections of the brain to produce the disorder.

Associated Disorders

Several other disorders are known to be associated with obsessive-compulsive disorder in children. However, Tourette disorder is more likely to be found in boys who develop obsessive-compulsive disorder at a relatively younger age. The identification of both distinct disorders is crucial because they require different treatments. Research has indicated that children and adolescents with obsessive-compulsive disorder have a greater likelihood of developing attention deficit disorder.

There are some other anxiety disorders that depict similarity to obsessive-compulsive disorder in children. These are termed the obsessive-compulsive spectrum disorders and they include symptoms of children pulling and twirling the hair or the notion that one or more of their body parts are disfigured or unattractive. They may also include the symptoms of biting the nails. The researchers have not been able to exactly pin-point the true relationship between the two spectrum disorders commonly found in children.

Early signs and symptoms of Obsessive-compulsive disorder in children

The obsessive compulsive disorder is an anxiety disorder in which the brain of the affected individual gets jammed on one particular notion or idea. The thought process of the child becomes compulsive and the child begins to feel that if a certain behavior or action is not repeated, something terrible is likely to take place. Very often the child gets signals from the brain that the situation could be life-threatening if a certain action or idea is not repeated again and again. This thought process causes the child to get extremely worried and alarmed and the child gets signals in the form of feelings from the brain to go on and on repeating a certain task or behavior. It is this obsessive behavior that is caused due to certain obsessions in the brain of the affected child and causes the disorder.

Obsessions

The repetition of thoughts, ideas, and notions signaled from the brain of the individual are known as obsessions, causing the child to behave in a particularly distinct manner. These thoughts and obsessions are not normal. Sometimes children do tend to ignore or repress these obsessive and compulsive thoughts with some other act. For instance, a child who is inundated with some particular doubts or worries, like washing the hands to keep them clean, will constantly keep washing the hands, again and again, to ensure that they are absolutely clean and germ-free. The child goes on repeating the action incessantly and obsessively.

Compulsions

When affected with the disorder, the child experiences obsessive thoughts and notions to behave in a particular manner. The compulsions or habits which the child constantly performs or indulges in, to get relief from the apprehension of the obsessive thoughts, are known as compulsions. For instance, the fear of dirt and germs may cause a child to clean the surface of the table repeatedly or to wash the plate constantly.

It is very important for the family and the teachers to understand that the child is not in control of this behavior, and is directed by the brain to obsessively and compulsively perform some action or the other. Some of the very common symptoms of the disorder include the fear of germs and dirt, the feeling of harm to oneself or someone else, the constant occurrence of forbidden thoughts, extreme doubts regarding religion, unstoppable instances of washing, checking, counting, and touching.

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Consequences of OCD

If obsessive-compulsive disorder is not treated in childhood, the disorder becomes long-term and poses many problems to the overall development and growth of the child. This development may not simply be academic but in most cases personal as well as professional and societal too. If the disorder is neglected, over longer periods of time individuals tend to experience symptoms of gradual weakening. Obsessions and rituals tend to take up the maximum time of their daily duties and this could ultimately lead to depressions and chronic anxiety disorders. The children who are not treated may spend a great deal of their regular time in rituals, owing to which there may be a lack of focus on the more important academic and social functions. The time wasted in the perfection of the written assignments in class or at home due to the compulsions will make the child lag behind in the class and studies. Friendships will also suffer due to the wastage of time in the rituals of cleanliness and perfection. All this is most likely to result in bad results and in most cases even failure which will ultimately lead to low self esteem, lack of confidence and finally depression in the affected children. As such it is highly important that the disorder is diagnosed at the correct time and treated as soon as it is recognized. Childhood is a prime stage in the development of the personality of the child, and great care and caution must be exercised to see that the future of children is not in jeopardy due to the obsessive compulsive disorder in children.

Treatment

The obsessive compulsive disorder in children has been typically known as an anxiety disorder, as fear and apprehension is the prime facet of the disorder. However, in order to achieve optimal results of treatment among children, both the characteristics, psychological as well as neurobiological must be carefully considered and taken into account when treating the children.

Not all treatment will respond equally to the same treatment, and as such the psychological aspect needs to be considered in great detail.

According to a review in the Cochrane Library issue dated October 18th, the severity of obsessive compulsive disorder in children and adolescents can be effectively reduced by the treatment of cognitive behavioral therapy (Medical news today). The treatment is believed to reduce the anguish and apprehensions among children and adolescents. Researcher O’Kearney, (director of clinical training for psychology at the Australian National University) and his colleagues affirm that cognitive behavioral therapy along with therapeutic medication have been proved to be effective in treating children with the disorder.

Cognitive-Behavioral Psychotherapy

When diagnosed and recognized, it is imperative the obsessive compulsive disorder in children is treated with great care and precision. It is important that the family members of the affected child are educated about the disorder. They must also be informed about the biological basis of the disorder. When the family and the affected child have substantial knowledge of the biological basis, the symptoms are more easily revealed. It is important that the children and their family members realize that it is the symptoms of the disorder that are at fault and not the child.

Some of the most successfully treated cases of the obsessive compulsive disorder cases in children have been treated with the behavioral therapy in addition to therapeutic medication. The cognitive behavioral psychotherapy enables a child to effectively try to change the repetitive thoughts and feelings. This is done by helping the child to first try to alter the behavior. In doing so, the professionals expose the children to their own apprehensions and fears, and by doing so the fear and anxiety is substantially reduced. For instance, a child who is afraid of germs will be exposed to dirt so that there will be no fear, once the fear has been faced again repeatedly, and no harm comes to the child, even after the exposure to dirt. When the child realizes that the exposure to dirt is not as dangerous or fatal as he had initially imagined the obsession and compulsion to repeat the action will eventually subside.

In order for a successful exposure to the fear of the child, it is combined with a prevention of response, so that the rituals or compulsive behaviors of the child are blocked by the professionals. For instance, if the child fears dirt and germs, the child will be exposed to the dirt but will not be allowed to wash it off immediately or soon. By doing this the response of the child is blocked and the child is able to experience that exposure to the dirt has not harmed him in any way he had earlier imagined. If the disorder is not treated in a professional and consistent way with the help and support of appropriate professionals, the situation and the conditions of the child can worsen further.

The support and help of family and particularly parents is extremely crucial in the treatment of the disorder in children. There may be some children who will react well to the behavioral therapy, while the therapy may simply not be enough for some others. In such cases there will have to be a combination designed for the affected child.

Therapies enable the family to learn the strategies, so that the treatment can continue even at home. The common medication drugs for the treatment of the disorder the selective serotonin reuptake inhibitors (SSRI) which have the potential to diminish the impulse of compulsive behavior or rituals.

It is important that the family, the child and the doctor discuss and evaluate the best strategy for treating the disorder in the child effectively. Reiteration of the fact that the child is not at fault for the behavior will go a long way in restoring the lost confidence of the child and in some cases even the parents. The parents should be highly supportive and must ignore the minute daily compulsive rituals which the child indulges in. on the contrary, the child must be praised and applauded for any improvements he may have achieved during the course of treatment. This will go a long way in building a healthy and trustful relationship between the parent and the child. All routines and daily chores must be normally attempted and the child must be treated as any other child. The positive and supportive approach will ensure the success of treatment and the removal of the horrid obsessive compulsive disorder in children.

References

Bolton D, Luckie M, Steinberg D. Long-term course of obsessive-compulsive disorder treated in adolescence. J Am Acad Child Adolesc Psychiatry 1995;34:1441-50.

Kessler RC, Chiu WT, Demler O, Walters EE. Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry, 2005;62(6):617-27.

Kushner MG, Sher KJ, Beitman BD. The relation between alcohol problems and the anxiety disorders. American Journal of Psychiatry, 1990; 147(6): 685-95.

Leonard HL, Swedo SE, Lenane MC, Rettew DC, Hamburger SD, Bartko JJ, et al. A 2- to 7-year follow-up study of 54 obsessive-compulsive children and adolescents. Arch Gen Psychiatry 1993;50:429-39.

McGuire PK. The brain in obsessive-compulsive disorder. J Neurol Neurosurg Psychiatry 1995;59:457-9.

Rasmussen SA, Eisen JL. Epidemiology of obsessive compulsive disorder. J Clin Psychiatry 1990;51:10-3.

Regier DA, Rae DS, Narrow WE, et al. Prevalence of anxiety disorders and their comorbidity with mood and addictive disorders. British Journal of Psychiatry Supplement, 1998; (34): 24-8.

Robins LN, Regier DA, eds. Psychiatric disorders in America: the Epidemiologic Catchment Area Study. New York: The Free Press, 1991.

Schwartz JM, Stoessel PW, Baxter L Jr., Martin KM, Phelps ME. Systematic changes in cerebral glucose metabolic rate after successful behavior modification treatment of obsessive-compulsive disorder. Arch Gen Psychiatry 1996;53:109-13.

The NIMH Genetics Workgroup. Genetics and mental disorders. NIH Publication No. 98-4268. Rockville, MD: National Institute of Mental Health, 1998.

Valleni-Basile LA, Garrison CZ, Jackson KL, Waller JL, McKeown RE, Addy CL, et al., 1994. Frequency of obsessive-compulsive disorder in a community sample of young adolescents. J Am Acad Child Adolesc Psychiatry;33:782-91.

Wonderlich SA, Mitchell JE. Eating disorders and comorbidity: empirical, conceptual, and clinical implications. Psychopharmacology Bulletin, 1997; 33(3): 381-90.

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