OBSESSIVE COMPULSIVE

DISORDERS IN KIDS.
OLATUNJI OLUWAGBEMISOKE ESTHER
GROUP 20
INTRODUCTION
Obsessive compulsive disorder (OCD) is an anxiety disorder that affects two to three percent of the population (more than
500,000 Australians). It usually begins in late childhood or early adolescence. People with OCD experience recurrent and
persistent thoughts, images or impulses that are intrusive and unwanted (obsessions). They also perform repetitive and
ritualistic actions that are excessive, time-consuming and distressing (compulsions). People with OCD are usually aware of
the irrational and excessive nature of their obsessions and compulsions. However, they feel unable to control their
obsessions or resist their compulsions.
• Children at Risk

OCD affects as many as 1% of children (as common as childhood asthma)

50% of adult cases of OCD are diagnosed before age
2% of children are diagnosed between ages of 7- 12
OCD is more prevalent in boys (2:1 ratio)
20% of children with OCD have a family member with OCD
OBSESSIONS AND COMPULSIONS.
OBSESSIONS
Recurrent or persistent thoughts, impulses, or
images seen as intrusive or inappropriate that
cause marked anxiety/distress
Not simply excessive worries
Attempts are made to suppress or neutralize
obsessions
COMPULSIONS
Repetitive behaviors or mental acts driven to
perform in response to obsession, or according to
rules rigidly applied
 Behaviors or mental acts are aimed at preventing
or reducing distress or preventing dreaded event
or situation
THE OCD CYCLE
SYMPTOMS OF OCD

• Contamination themes • Washing or cleaning

• Harm to self or others • Repeating
• Aggressive themes • Checking
• Sexual themes • Touching
• Scrupulosity/religiosity • Counting
• Forbidden thoughts • Ordering/arranging
• Symmetry urges • Hoarding
• Need to tell, ask, confess Compulsions  
SYMPTOMS AT HOME

 May be worse at home than at school

• Repeated thoughts they find unpleasant – not realistic
• Repeated actions to prevent a feared consequence
• Consuming obsessions and compulsions
• Distress if ritual is interrupted
• Difficulty explaining unusual behavior
• Attempts to hide obsessions or compulsions
• Resistance to stopping the obsessions of compulsions
• Concern that they are “crazy” because of their thoughts
SYMPTOMS AT SCHOOL

•  Families often seek treatment once symptoms affect school performance

• Difficulty concentrating – problem finishing or initiating school work
• Social Isolation
• Low self-esteem
• Other conditions – ADHD
• Learning disorders/cognitive problems which are often overlooked
• Daydreaming – the child may be obsessing • Repetitive need for reassurance
• Rereading and re-writing, repetitively erasing – look for neatness, holes in paper • Repetitive behaviors – touching, checking,
tracing letters • Fear of doing wrong or having done wrong
• Avoid touching certain “unclean” things • Withdrawal from activities or friends
SIGNS OF OCD

• Contamination Behaviors ▫ Frequent cleaning/hand washing (red, chapped hands) ▫ Long

frequent trips to the bathroom. ▫ Avoidance of the playground, art supplies, sticky substances.
▫ Untied shoe laces (may be contaminated) • Checking and redoing activities/behaviors ▫
Compulsively going over letters and numbers with pencil. ▫ Taking excessive time to perform
tasks. ▫ Rereading and rewriting, and frequent erasing.
• Reassurance Seeking ▫ Am I okay, is this right? ▫ Asking frequent questions when the answer
is already evident. • Anxiety and Avoidance ▫ Withdrawal from usual activities or friends. ▫
Excessive fear of bad things happening to self or others. ▫ Excessive fears of making mistakes.
▫ Persistent lateness. • Counting and Organizing
TREATMENT OF OCD IN CHILDREN

Treatment of choice for OCD in children: is a combined treatment (CT) approach-- CBT & SSRI’s
Expert consensus treatment guidelines for 1st line treatments ▫ Prepubescent children: CBT (mild or
severe OCD) ▫ Adolescents: CBT for milder OCD; CBT & SRI (or SRI alone) for severe OCD
CBT for pediatric OCD
• Step 1: Psychoeducation for child and family • Begin to externalize OCD as the “enemy” and
treatment involves “bossing back” OCD
• Step 2: Cognitive Training (a training in cognitive tactics for resisting OCD) goals and targets and
reinforcements
• Step 3: Mapping OCD
PHARMACOTHERAPY

• Clomipramine – TCA SSRI’s –

• Fluoxetine
• Fluvoxamine
• Paroxetine
• Sertraline
• Citalopram
• Anti – Psychotics, buspirone, clonidine, MAO inhibitors
THERAPY
Effective mode of therapy, with success
rate as high as 80%

Exposure and response prevention

Desensitization

Thought stopping

Flooding

Implosion therapy

Patients must be truly committed to

improvement Behavioral therapy