Over a quarter of the cases of OCD have symptom onset by the age of 14. Males have an earlier age of onset than females, with nearly 25% of males with OCD having an onset before 10 years of age. Interestingly, while females are affected with OCD at a slightly higher rate than males in adulthood, males are more commonly affected in childhood. While childhood or adolescent onset of OCD can lead to chronic symptoms, 40% of children with OCD experience remission by early adulthood. These rates illuminate the importance of early detection and treatment of symptoms to impede the chronicity or impairment associated with the disorder.
Many children exhibit some level of preoccupation and ritualistic behavior; young children can become fixated on small details and engage in repetitively routinized behaviors. However, the difference between these developmentally normative experiences and clinically diagnosable symptoms is the level of distress and impairment in functioning. Furthermore, if these preoccupations and rituals are excessive or persist beyond developmentally appropriate periods, the thoughts and behaviors could be indicative of OCD.
Among pediatric populations, compulsions are usually more easily identifiable than obsessions because young children may not be able to articulate the reasons for their repetitive behaviors or mental acts. Furthermore, unlike obsessions, compulsions are often observable by others. However, just because a child cannot articulate the obsessions, does not mean obsessions are not present. In fact, research suggests that most children experience both obsessions and compulsions.
While exposure and response prevention (ERP) is the treatment of choice for children and adolescents with OCD, there are some important treatment considerations when addressing pediatric OCD. Children often struggle more than adults to understand the potential benefit of exposing themselves to feared situations without the relief of ritualistic behavior. The therapist will help the child get past the discomfort of giving up rituals that seem protective by using a time sensitive approach. Specifically, with child OCD treatment, more time is spent ensuring readiness for ERP treatment.
To ensure treatment readiness, significant time is spent helping children and families understand how compulsive behaviors and avoidance strengthen OCD, the utility of exposure, and the importance of habituation, or getting used to the anxiety. In general, parental involvement in pediatric treatment is crucial. With a pediatric trained ERP therapist, parents are equipped with tools to help their child, first, increase treatment readiness, then aid in the successful completion of exposures and response prevention. ERP is a collaborative treatment approach, with the therapist, parents, and child working together as a team to overcome OCD symptoms. To properly cultivate this collaborative effort, other issues may need to be addressed first prior to engaging in ERP. For instance, significant family conflict may need to be treated before a child can engage in OCD-specific treatment. A trained therapist will assess for potential barriers to ERP treatment and address them, as needed, prior to initiating OCD-specific treatment.
Learn more about evidence-based treatment for OCD and how to find an effective OCD therapist for your child.