Talking with Kids About OCD
Many adults with OCD can clearly trace the beginnings of their symptoms back to childhood. Recalling feelings of shame, isolation and fear, adult sufferers say they wish someone had taken the time to sit and talk with them about their odd behavior, instead of criticizing them for it. Children are aware that they are doing things other kids their age aren’t. In fact, they are dreadfully self-conscious of this. They are afraid of telling a parent (or any authority figure) about dressing routines, brushing teeth a certain number of times, weird and crazy thoughts about God or hurting people, “germs” on the desk at school, crossing “t’s” just right, shooting the basketball until a “good” thought replaces a “bad” thought. Kids, adolescents and adults try very hard to hide the compulsive behaviors out of fear that if anyone knew: “They’d lock me up.” “They’d know I am really crazy.” “They’d take me away.” Unaware of psychiatric treatment, children assume there is something intrinsically wrong with them that cannot be corrected. They also, like adults, think they might be the only one alive to be this way.
You can imagine how terrifying it might be for a child who is just mastering the developmental task of differentiating real from make-believe to have thoughts such as those mentioned above. Having an adult to talk to who can help them identify the thoughts as OCD can provide much initial relief. The first step is to recognize excessive ritualistic behavior or preoccupation with thoughts. Beware though - most children go through a developmental phase that is steeped in rituals. Bedtime rituals and prayers provide a sense of security and comfort; so do “lucky” charms, ordering toys, collecting “special” items. When rituals and “routines” begin to interfere with the child’s social and school functioning - like staying home to “finish up” incomplete assignments, withdrawal from usual activities a warning sign should flash. In addition, if interruption in the “routine” creates undue anxiety, frustration and hostility, it is probably time to seek psychiatric advice. Another sign that accompanies early onset of OCD symptoms is a marked and decreased sense of confidence in class, and with friends. In light of how scary and overwhelming the OCD thoughts may be for a child, it makes sense that their level of self-confidence would be impacted.
An anecdotal note from an OCD sufferer who is now 34 highlights the issues often faced as a child with OCD. This woman recalls great emotional pain as a child afflicted with aggressive obsessions (worrying she somehow hurt someone). The worst part she says was keeping all of her fears in, because her parents expected her to “snap out of it” and “pull it together.” She strongly asserts, as do others, that parents should open the door for discussion when they suspect something is troubling their child. Making an attempt to connect with the child on an emotional level, offers them an opportunity to respond; it’s like extending a hand. Children need to be given some framework to understand what is happening to them. Sometimes they don’t have the ability to explain unless an adult offers some possibilities. With relief a child may say, “Wow! That is exactly what happens to me. . .how did you know?” This phenomenon is not exclusive to children. It occurs at any age when one feels desperately alone in their experience only to find out someone else feels the same way or understands.
Some suggestions on how to open discussions with children who might have OCD include: “Your mom tells me that you seem so preoccupied all the time, can you tell me what’s on your mind.” “All people have worries and it’s okay to tell us about yours.” “We notice you repeating the same action, do you know you are? Are you afraid something will happen? Can you try to do it once? What happens then? Does it just not feel right?”
There are now many books out there to help children at all developmental stages learn about what OCD is. It is often easier for a child to identify one’s feelings through a third person such a character in a story or through play and so sharing some of these stories can open the door to talk about feelings and fears that they have. This can introduce the concept of psychiatric treatment in child friendly terms. Books such as these or video tapes such as The Touching Tree can help diminish a child’s sense of isolation. Please refer to the reference list for books that concentrate on children. To help increase awareness and understanding of a child’s lonely struggle with OCD, The Touching Tree, a video based on personal experience, has been produced by the Internaltional OCD Foundation. It may help children with OCD come forth to seek help, and it is an educational tool for parents and educators.