Even young children can have OCD

The symptoms of obsessive-compulsive disorder are familiar to most -- hand washing, checking, tapping, counting. But many may not be aware that these behaviors can be evident in children as young as 4.

A recent study found that very young children can exhibit full-blown OCD symptoms on a par with older children. "What's been studied before has been older kids and adolescents, but not younger kids in this 8-and-under range," says Abbe Garcia, the study's lead author and a staff psychologist at the Bradley Hasbro Children's Research Center in Providence, R.I. She adds that many adults and adolescents with OCD report having had symptoms as children.

She quickly makes the distinction between OCD and what she calls "normal development rituals" that young children can display -- asking a parent to read the same bedtime story three times, for instance. OCD behavior must meet specific criteria that includes obsessive and compulsive actions such as repetitive and anxiety-provoking thoughts and ritualized behaviors such as hand washing, cleaning and checking something over and over. The rituals offer only temporary relief, however, and not doing them can result in even more anxiety.

In the study, published online this month in the Journal of Psychopathology and Behavioral Assessment, 58 children between 4 and 8 with OCD were given clinical psychological evaluations. Researchers found that, on average, onset occurred at about age 5. Almost 50% experienced a gradual onset; and 29% had a chronic course, while 28% had a waxing and waning course. Many of the children had co-morbidities that included general anxiety disorder and separation anxiety.

The additional disorders were a surprise to Garcia: "We thought we'd just find OCD," she says, "and that the cascade of correlates might not be found at this age." Treatment for children with OCD typically consists of psychotherapy and/or medication such as selective serotonin reuptake inhibitors.

As for how the disorder could affect these children as they age, Garcia says the jury is still out. "We don't really know even for older kids and adolescents what the prognosis is," she says, adding that some research suggests symptoms might decrease with age, while other studies show they might worsen.

"If parents are concerned about their child," she says, "if their behavior is causing problems in the daily routine, then they should take their child to their pediatrician -- someone who knows the child well. If the level of concern is beyond that, take them to a child psychiatrist for evaluation. . . . Early intervention is important. The sooner they take their children in, the sooner they can get information and start a course of treatment."

-- Jeannine Stein

Photo credit: Kirk McKoy / L.A. Times

Comments

[Steven List]

Yet another supposedly "scientific" study that fails to note that there are (still!) no truly objective tests to determine if a child really has a "disorder" like OCD (no blood test, MRI, tissue sample, etc.) Diagnosis of OCD, like all such scientifically suspect maladies, is based solely on observation of behavior symptoms. In this case, absurdly enough, observation of four year-olds. What 4 year-old doesn't display obsessive and compulsive behavior? THAT'S WHAT FOUR YEAR-OLDS DO!!

Of course, the suggested treatment is medication with SSRI drugs. And yet the writer fails to even inquire whether the researchers involved have received drug company funding for this or other studies they've conducted. Nor does the article mention the overwhelming amount of valid scientific evidence documenting the serious side effects associated with SSRI treatment, especially in children (the FDA put "Black Box" warnings on these drugs in 2004, remember?)

For years, the pharmaceutical industry has been spending mind-boggling amounts of money to get more kids on psychiatric drugs. Children are the fastest growing "market segment" for Big Pharma, and the more parents who get scared into thinking their kid has a "disorder," the more young customers will wind up on their products. This article will go a long way towards helping them achieve that goal. It ought to just be pasted straight into a pharmaceutical company brochure - that's who paid for these new "findings" anyway.

Shame on the L.A. Times for so uncritically forwarding the drug company line. Truly flaccid reporting.

[Keren Brigantti]

I think I started with OCD and torrette-like symptoms at about 6 years old. I really think I had both. I also had symptoms of depression, mania, and eventually psychosis. I turned out to be schizo-affective by the age of 20. I think all correlated for me.

[Anonymous]

I've suffered from OCD since early childhood. And, with all due respect Mr. List, there is a big difference between true OCD and normal obsessions young children may have. My OCD manifested itself in mostly numbers, checking and prayers. It may not be as simple as a child doing repetitive behavior just for the fun or comfort of it; when you have OCD, you feel like your life and the lives of those you love depend on it.

If you ignore your compulsions, irrational thoughts don't just go away, you get more obsessed and filled with panic. I remember creating and memorizing prayers that I would have to say over and over a certain number of times PERFECTLY, or else I thought my mom was going to die in a terrible car crash on the way to pick me up from school every afternoon. This fear consumed my thoughts for years. I also had to do a variety of other rituals or else I was positive something terrible would happen to me, or worse, my family.

I'm not condoning pumping a child full of drugs, but OCD can be a serious problem for children who suffer from its clutches; it is all consuming, and I feel like a huge part of my childhood was lost. I unfortunately never voiced the fact that I was suffering miserably from these irrational thoughts and compultionsp; I didn't know any differently since it was all I ever knew. I did have a feeling something was "off," but I was too scared to say anything. In hindsight, I think some psychotherapy could have helped. I'm almost 30 now, and with regular therapy, and, yes, medication, my OCD is much more under control. It angers me when people who have no clue are quick to make judgements on others. Consider yourself lucky that you've never had to experience such a damaging mental disorder. Unless you've been there, you have no idea how traumatizing and all-consuming OCD can be.

[Mel]

I have had OCD at least since 5th grade. I remember vividly having to check the cleanliness of my shirt a certain way, a certain number of times. That switched to twisting my ring, and now as an adult has manifested itself into obsessively checking my things in my purse, my door, making sure everything is in its place. My numbers are 3, 5, 10. Like anonymous, if I don't do them PERFECTLY i have to start over and it is very anxiety producing. I don't even want to calculate how many hours it wastes in my day....I am currently not on meds.

[.]

Anonymous,

I'm glad that you are receiving treatment for your disorder. As a sufferer of OCD myself I understand to a certain extent what you've gone through.

At the same time, there is a world of difference between the way your brain and body as a 30 year old can handle SSRI drugs, and the way a 4 year old's brain and body can. There are serious risks, as outlined in many journals, including Harvard Health: http://www.health.harvard.edu/press_releases/ssri_side_effects.htm

^Those are some of the side-effects for adults- think of how much worse they could be in children whose brains and bodies are still developing. Another problem is that these drugs haven't really been tested on children, so the dosage prescribed to them can be too much for their young bodies to handle. There have been numerous cases where children have died because of this. The risks do not outweigh the benefits. Parents should only give their children therapy as a tool to combat these types of disorders. Not drugs.

[Matt]

I had that disorder when I was a young kid and it was sheer, unremitting Hell. That kind of early years misery has got to affect them in later life. Fortunately, my condition gradually vanished in my teens.

Any little tyke suffering from OCD needs to be in treatment.

[Major Variola (ret)]

If it bothers you, its a disease. Otherwise
don't worry about it.

But don't claim
its just a drug company scam. People
do have problems --real problems to
themselves, like depression and
anxiety, even if not visible to others--
that meds help.

[Charleen Krueger]

There are non-drug treatments for OCD, anxiety, ADHD, and depression. Neurofeedback (a form of biofeedback) is being used for these conditions and others such as post-traumatic stress disorder. The brain can be trained away from the eeg patterns that accompany these disorders into patterns that are more toward the norm. The side effects of medications in children are poorly documented due to the lack of studies on non-adult males.