Assessing Obsessive Compulsive Disorder Ocd in Toddlers

Your little one requires that you read him “Goodnight Moon” three times before bed and he must be tucked in and kissed on the forehead; his door also must be left open or he will simply not be able to sleep. Should you be worried that he’s slipping down the scary slope of a mental illness, namely Obsessive Compulsive Disorder, commonly referred to as OCD?

Experts say probably not. Toddlers and young children thrive on routine. It’s the hallmark of their existence, giving them consistency and a sense of security. Their world is full of new experiences every day, sometimes driving their brains into overload; and their small routines, usually centered around mealtimes, bathing and bed, are the only things that they cling to in their chaotic existence. But there are things that can go too far.

WHAT IS OCD?
OCD is a mental illness that affects about 1 in every 200 children, really only a small fraction of the overall adult population. It is characterized by two separate things: obsessive and distressful thoughts (that’s the obsession part); and rituals and behaviors that are repeated (that’s the compulsive part). It’s easy to see why a toddler who has to have his milk and a graham cracker before bed can be lumped into this category. And, very young children without verbal skills may only exhibit the compulsion category of the disorder, repeating behaviors, sometimes odd ones, over and over again.

WHAT SHOULD YOU LOOK FOR?
Watch for your child to spend long amounts of time, especially increasing amounts of time, on what you would deem unproductive activities. Some children will focus on order, lining up their toys meticulously, and becoming increasingly agitated if they are disarrayed. This will be an especially noticeable behavior if your child doesn’t seem to play with their toys, only arranges them. If you interfere with their routine, which they may have a very organized routine set in their head for, your child will likely become very vocal and agitated.

Watch for especially long toilet routines; this may include your child becoming increasingly obsessed with cleanliness. Children with obsessions may feel that they need to use excessive amounts of soap or toilet paper when using the bathroom. Often, compulsions are related to obsessive thoughts that they are unclean and these toilet routines are related to this.

Look for long, rigid rituals beyond “normal” toddler routines. If it takes hours to put your child to bed, and if deviating from your normal routine causes a meltdown, it may be time to bring it up to your doctor. If you can’t read a different story, or if you tuck your child in a little more loosely than normal, put on different pajamas or select a different tub toy, these may all be indicators of a problem.

Children suffering from OCD may also begin hoarding what you may think are useless objects such as discarded nail clippings or used bandages. They have an obsession that they cannot explain to you, perhaps because of shame or because of poor verbal skills that cause them to want these items. There is a distinct difference between collecting coins, trains, stamps and baseball cards and collecting lint or toenails. If your child is doing this, it is not a phase.

If you notice that your whole family is involved in small routines and rituals that are necessary in order for your child to feel “safe,” there may be a problem. This means that if your child needs six kisses (not five or seven) from every member of the house before they leave for the day, there may be a problem. Or, if everyone is participating in the rituals that your child has eventually fallen into, you may need to evaluate what is going on.

WHAT IS BEHIND IT ALL?
The behaviors are thought to be a function of the obsessions. Obsessive thoughts can run the gamut from very simple to very complex. Adult sufferers often describe their compulsions as functions of irrationality and coincidence. This means that, as people often do, they had a strange thought pop into their head. An example would be the thought of their mother getting into a car accident, while they were writing a note. This sufferer will then tie writing that note with their mother getting into a car accident. They will then feel that they have to rewrite the note over and over again until they can do it without having that same thought. Of course, with the thought in their head, it becomes nearly impossible to do; so, they have to write the note repeatedly.

In older children, you may see long, unproductive hours spent on homework for this same reason as they retrace their steps, erasing and redoing things. They may never explain their actions or give insight into their thoughts. The idea that their thoughts can harm their loved ones is very powerful to sufferers of OCD.

Other explanations are irrational as well, and too often they realize the irrationality of their thoughts but cannot stop them from taking over. For example, they think they will catch malaria from touching the carpet, so they refuse to touch the carpet with their hands. Germs can become a major sticking point for sufferers of OCD.

WHAT’S THE CAUSE?
The cause is unknown at this time, like most mental illnesses. There is some research pointing to pediatric strep infection being an underlying cause; but, research is still preliminary.

IS IT TREATABLE?
In adults and older children, OCD is treatable through talk therapy and medication; however, in younger children and toddlers, it is still very much anyone’s guess. The drugs of choice for treatment: Paxil, Anafranil, Prozac, Zoloft and Luvox are quite dangerous in children. They are antidepressants and can cause children to become manic. About 40% of children become irritable and agitated when taking these medications and they are rarely, if ever, given to toddlers. A new medication, Paroxetine, is being tested on children, ages 8-17, for OCD. But, like other drugs, is still not recommended for toddlers.

WHAT TO DO, THEN?
Watch and wait. Toddlers are quirky creatures and require special care. They all love and crave structure and routine. But, there’s a fine line between demanding to wear his Winnie the Pooh shirt every day because it’s his favorite, and becoming virtually inconsolable because his zipper is not just so, literally to the point of not being able to be distracted.

If your child seems to be a prisoner to his daily routines and seems to be distraught by them, it is something to be brought to the attention of his pediatrician. If his routines seem to distress him or you, and they are interfering with his daily life or his normal development, then it is certainly something to be concerned about. But, if your child just loves to be kissed six times, then kiss him six times every day and remember to savor every day he lets you do it; because before long, he’ll be a teenage and he won’t let your lips near his cheek.

References:
http://www.lifespan.org/services/childhealth/parenting/ocd.htm
http://thomastthomas.com/Obsessive%20Compulsive%20Disorder,%20Thienemann,%20052897.PDF