How to Recognize Signs of OCD in Toddlers

Although we often think of obsessive-compulsive disorder (OCD) as an illness that affects mostly adults, between 0.25-4% of children will develop OCD. The average age of onset is approximately 10 years of age, although children as young as 5 or 6 may be diagnosed with the illness. Though children can start showing symptoms of OCD around age 3, it is extremely rare.

Many toddlers like to sort objects by color, shape, size or texture. At this age, they are growing and changing rapidly and engaging in this sort of behavior can help them make sense of their limited world. It also shows cognitive development as they learn to make distinctions between characteristics and group items by their similarity. This stage of development is very normal and positive.

You'll know this behavior is problematic if it begins to impact your toddler negatively. Sorting and organizing should be a positive part of play, so if it becomes an obsession and/or something your toddler begins to rely on to stop her fear or anxiety, and most especially if it's affecting her normal activities, it's time to get help.

Toddlers with OCD are sticklers for rules and order and need certain steps to be followed in a certain way. They may become very upset if a step is skipped or something is out of order and they likely seem very anxious a lot of the time.

While there is no doubt that parenting children with OCD can be a challenge, there are ways to cope. Getting informed about OCD, particularly as it is experienced by children, is the essential first step that every parent of a child with OCD should undertake to become an effective advocate for their child.

Some key facts:

• Children with OCD often have less insight into their obsessions than adults and may not yet have the capacity to understand the irrational nature of their thoughts.
• The content of a child’s obsessions can be different from that of adults. For example, it is not uncommon for children with OCD to have specific obsessions related to the death of their parents. The rituals or compulsions of children also may be more likely to involve or be centered around family members.
• In most cases, the current recommended treatment for childhood-onset OCD is a combination of individual or group cognitive-behavior therapy (CBT), and when severe enough, medications that augment levels of the neurochemical serotonin such as selective serotonin reuptake inhibitors (SSRIs). SSRIs are used cautiously in children and adolescents as there has been some suggestion that they may increase the risk of suicide in this age group.
• About 5% of children with OCD have the PANDAS or autoimmune subtype. The PANDAS form of OCD has a few key characteristics, such as the rapid onset of symptoms, that helps doctors distinguish it from more typical forms of childhood OCD. The PANDAS form of OCD may entail some differences in treatment, too.

Learning more about your child’s OCD will help to reduce your own stress levels and make it easier to carry through with at-home exposure exercises.

Research suggests that parental involvement is a strong predictor of cognitive-behavioral treatment success. Given the developmental cognitive limitations of children, the explanation of abstract concepts needs to be done in a way that is appropriate for the age of the child. Parents can be an invaluable resource in helping the therapist to develop ways of presenting material that will resonate with and make sense to the child.

On a day-to-day basis, parents can help remind young children that it is their OCD that is the “bad guy” who is responsible for their symptoms, and they and their parents and family are the “good guys.” Such a technique can help reduce the chances a child will feel blame or shame for having OCD.

Above all, work on fostering a strong partnership with the various professionals involved in your child’s care. Don’t be afraid to ask questions and ask about resources that you can take home to better absorb new information in small bits.

Each of us has different comfort levels when dealing with the emotional difficulties of others, even when it concerns our own family or children. If you are having trouble engaging your partner in becoming educated about your child’s OCD or helping out with at-home exposure exercises, talk about it, don't sweep it under the rug. Often a partner’s reluctance to help out simply reflects their own anxiety about the situation and does not mean they don’t want to help the child.

If you are the single parent of a child with OCD, look into available resources within your community. A good starting point can be a support group where people share tips for coping with a child who has OCD.

In addition to your partner, the rest of the family must be involved and aware of what treatment entails, especially exposure and response prevention therapy (ERP). It is not unusual for both adults and children with OCD to ask others to participate in their compulsions and family members often oblige so as to reduce their loved one’s anxiety, especially when it is a child. For treatment to work, compulsions need to stop and family members must be aware of this.

Finally, it is important to never give up hope. There are many different treatments available and if the first strategy doesn’t work there are often many other options available.

Sometimes it is simply a matter of finding the right therapist or the right combination of medication and psychotherapy. With the right treatment, many children are able to find relief from their symptoms.