Our OCD symptoms checklist distinguishes between children and adults because the signs of obsessive-compulsive disorder (OCD) in kids can be different. An estimated 2% to 3% of children suffer from the disability, but many children are still not diagnosed at all or are misdiagnosed.
Obsessive-compulsive disorder in children develops slowly and is almost unrecognizable until the age of about 5. Once the disorder begins, it can last into adulthood.
However, there are rare cases of a sudden onset of OCD in kids that needs immediate attention!
OCD in children can appear “overnight” due to PANDAS or PANS:
Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus (PANDAS) is the abrupt appearance of obsessive-compulsive behavior after the child had a Streptococcus pyogenes (Strep) infection.
Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) displays similar OCD symptoms and occurs after the child had an infection like mycoplasma, mononucleosis, Lyme disease, or the H1N1 flu virus.
Signs and symptoms of PANDAS or PANS in young children:
- A sudden onset of obsessive-compulsive behavior in a young child
- A sudden onset of prolonged and unexplainable screaming
- A sudden onset of bedwetting or frequent urination
- A sudden onset of nighttime fear or anxiety
- Unwillingness to sleep or be alone
- Abrupt new sensitivity to light, sound, clothes,
- A sudden change in motor skills (including drawing, writing, etc.)
- A sudden change in eating behavior and eating skills
- A sudden development of tics
- A sudden change in attentiveness, ability to focus on an object, recalling names
Signs and symptoms of PANDAS or PANS in older children:
- Sudden unexplainable ADHD behavior (hyperactivity, inattention, fidgety)
- Sudden and unexplainable anti-social behavior at school and/or with friends
- Relentlessly asking the same questions over and over again
- Sudden separation anxiety (child is clingy, wants to stay close to parents or caregivers)
- Sudden unexplainable mood changes (sadness, overjoyed, too much laughing or crying, irritability)
- Trouble sleeping
- Frequent urination, unusual sudden nighttime bed wetting
- Changes in motor skills (including handwriting, drawing, etc.)
- Sudden repetitive compulsive routines (relentlessly washing hands, checking doors, etc.)
- Unexplainable joint pain
In OCD, symptoms usually develop gradually, not overnight and abrupt. Current research believes that the sudden onset of the obsessive-compulsive behavior in children is caused during or after an infection when the child’s immune system mistakenly attacks an area in the child’s brain (the basal ganglia) instead of the infection.
Can adults develop sudden OCD due to PANDAS or PANS?
According to the National Institute of Mental Health (NIMH), OCD due to PANDAS or PANS typically only appears in children age 3 to 12. Since NIMH focuses on research with children, it is unknown whether adolescents or adults might have immune-mediated OCD.
Pediatric OCD can also happen after a child experienced psychological or physical stress like a death in a family or a car accident. However, if any of the above OCD symptoms occur, parents should consult a health care professional.
What is OCD?
Obsessive-compulsive disorder (OCD) is considered to be a disorder of the brain that adversely affects behavior and causes intense anxiety in those with the condition.
People with the condition experience obsessions that upset them. Some people may feel the urge to repeat specific rituals in an attempt to control those obsessive thoughts.
OCD definition changes
Obsessive-compulsive disorder used to be regarded as a type of anxiety disorder. In 2013, however, after nearly 20 years, the board of trustees of the American Psychiatric Association (APA) approved major changes to OCD.
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5 or DSM-V), which is used by mental health professionals to diagnose mental disorders, removed OCD from the anxiety disorders section and gave it its own chapter with the title “Obsessive Compulsive and Related Disorders.”
The DSM-V groups together obsessive-compulsive disorder, body dysmorphic disorder, trichotillomania (hair pulling disorder), excoriation (skin picking) disorder, and hoarding disorder.
Other changes in DSM-V include the change from the word “impulse” to “urge,” and the replacement of the word “inappropriate” to “unwanted.”
One of the conditions that was removed from the DSM-IV definition of OCD included the criteria that individuals were required to realize that their obsessions and compulsions are unreasonable or excessive.
By moving obsessive-compulsive disorder as an anxiety subtopic to a topic grouped together with body dysmorphic disorder, trichotillomania, excoriation, and hoarding disorder, DSM-V made an apparent change from a focus of an emotional or psychological disability to a behavioral or physical disability.
In regard to OCD symptoms, experts generally distinguish between obsessive thoughts and common compulsions. As we have done in our ADHD symptoms checklists for children and adults, we distinguish clearly between the psychological or emotional signs of OCD versus its physical or behavioral signs.
The difference between obsessions and compulsions
According to the Centers for Disease Control (CDC), obsessions include recurring and unwanted thoughts, impulses, or images that cause anxiety or stress. Even though an individual might try to make those thoughts go away or ignore them, they are persistent and interfere with everyday life.
Compulsions, on the other hand, are behaviors that a person is doing over and over again even though it is clear that they are unnecessary. Some of the behaviors might not be connected to reality but have to be done in order to relieve stress or fears.
A diagnoses of OCD looks at how much time an individual spends with obsessive and/or compulsive activities (more than one hour a day), how much distress the behavior is causing the person, and how much it affects a person’s life.
OCD symptoms checklist for adults
Obsessive thoughts, fears, and/or worries:
- Aggressive thoughts towards others or self
- Unwanted sexual, religious, harmful thoughts
- Fear of impulsively acting on those unwanted thoughts
- Fear of contamination by body fluids (urine, feces), germs, environmental toxins, dirt
- Fear of disease or a deadly disease
- Fear that something bad will happen if something is not done correctly or is out of order
- Worries that a loved one (person or animal) will die
- Worries about things not being in exact or symmetric order
- Worries about evenness, exactness
- Inability to decide on something (due to excessive thoughts, fears, worries, and a need for perfectionism)
- Excessive and/or repetitive cleaning, wiping, handwashing
- Excessive or compulsive counting
- Excessive or compulsive talking (to others or oneself)
- Excessive changing of clothes in an attempt to look “perfect”
- Excessive, compulsive, and uncontrollable hoarding of items even though they get in the way of one’s social life
- Repeatedly ordering and arranging things in a particular way
- Repeated and excessive body movements (tapping on something, touching an item, blinking)
- Repeatedly checking on things (locked/closed doors, faucet turned off, oven is off, etc.)
- Repeatedly touching light switch (even though it is clear that the light is off or on)
- Repeatedly checking the time, phone messages
By distinguishing between psychological OCD symptoms (obsessive thoughts, fears, worries) and physical OCD symptoms (compulsive behavior), adults might begin to notice the relationship between cause and effect.
Do obsessive thoughts, fears, or worries cause compulsive behavior or does compulsive behavior cause the psychological symptoms?
Obsessive thoughts and compulsive behavior can occur as a vicious cycle
For example, worries (which tend to diminish or block brain function) about an upcoming meeting can result in forgetting to close a door properly and an indoor cat gets out. As a result, the OCD adult will check the door over and over again next time so that the incident will not happen again. However, because of the repeated and excessive behavior of checking the door, the person forgets the time, comes late to an important meeting, and his or her worries were not only justified from the beginning but actually escalate.
While many treatments for OCD in adults focus on recognizing excessive behavior, our experience has shown that realizing how excessive thoughts, fears, and/or worries affect brain function is equally crucial in dealing with the vicious cycle of obsessive (thoughts, fears, worries) –compulsive (behavior) symptoms.
OCD symptoms checklist for children
In contrast to obsessive-compulsive signs in adults, OCD in children goes often unnoticed because children have different excessive thoughts, fears, and/or worries and different ways of dealing with them. Pediatric OCD differs from adult OCD in regard to symptoms and treatment options.
Obsessive thoughts, fears, and/or worries in children:
- Exaggerated thoughts that the child causes others harm (parents, sibling, pet, friends)
- Exaggerated thoughts that the child will hurt himself/herself
- Exaggerated thoughts about having homework or household chores done perfectly
- Fear that contact with other people will cause disease
- Fear that contact with clothes, shoes, schoolbooks cause disease
- Excessive fear of failing in school
- Excessive night time fears
- Worries that parents or a beloved pet will die because the child did something wrong
- Worries about not having followed parents’ directions (closing windows, doors, lights or stove off, etc.)
- Worries about items not being in symmetrical order (because it will cause bad things, chaos)
Compulsive behavior in children:
- Excessive handwashing
- Arranging chairs, toys, books in a specific way
- Excessive talking to or listening to an imaginary voice
- Inability to sleep unless everything is in order
- Changing clothes too often (in an attempt to look perfect)
- Changing clothes not enough (in an attempt to keep everything the same and safe)
- Repeating certain body movements (tapping on something, touching oneself or an item)
- Skipping family gatherings or school (based on above obsessive thoughts, fears, worries)
- Tying shoes over and over again until they look perfect
- Inability to leave home in time because something was not done, is out of order, or needs to be rechecked.
- At school: children might be unable to finish their work in time because they erase, erase, erase
- At school: children might not finish writing because they revise, revise, revise
- At school: children might not finish a math task (even though they know the answer) because they keep changing how numbers or math symbols look
- At school: children might not be able to focus because something in the classroom is not the way it is supposed to be (chairs moved, blackboard not clean, window shade not even, etc.)
- At school: children might ask to go to the bathroom frequently to wash their hands, rearrange their clothes, talk to themselves, be away from others)
It is estimated that 30% of OCD individuals have also experienced some tic order during their lifetime. While the CDC emphasizes that especially boys might experience a tic disorder, we have seen it equally in girls.
Currently, the number of children with OCD is believed to be around ½ million in the United States. However, that number might actually be much higher since many children are not diagnosed at all or are misdiagnosed with ADHD. The number of children diagnosed with ADHD in the United States is about 4 million.
Is OCD a learning disability?
According to the Individuals with Disabilities Education Act (IDEA), obsessive-compulsive disorder is a learning disability since it meets all of the following requirements:
(A) An inability to learn that cannot be explained by intellectual, sensory, or health factors.
(B) An inability to build or maintain satisfactory interpersonal relationships with peers and teachers.
(C) Inappropriate types of behavior or feelings under normal circumstances.
(D) A general pervasive mood of unhappiness or depression.
(E) A tendency to develop physical symptoms or fears associated with personal or school problems.”
IDEA lists OCD under Emotional Disabilities along with Anxiety Disorders, Bipolar Disorder, Conduct Disorder, Psychotic Disorders, and Eating Disorders. Our article Emotional disabilities in children: A silent killer provides an in-depth look at all emotional disabilities.
Adult OCD and the law
Similar to IDEA, which regulates the laws for students with learning disabilities, OCD adults are protected under the Americans with Disabilities Act (ADA). ADA is a Federal civil rights law dating back to 1990, and it protects adults with disabilities (which include mental health impairments) from discrimination at the workplace.
According to ADA, the term “disability” is defined as the following:
- a physical or mental impairment that substantially limits one or more major life activities
- a record of a physical or mental impairment that substantially limits one or more major life activities, or
- being regarded as having a physical or mental impairment that substantially limits one or more major life activities
According to ADA, the term “mental health” describes the following:
- Depression, which affects a person’s mood, concentration, sleep, activity, appetite, social behavior and feelings
- Bipolar disorder (manic depression), which causes a person to experience extreme highs and lows
- Schizophrenia, which affects a person’s ability to think clearly, manage emotions, make decisions and relate to others
- Post-Traumatic Stress Disorder (PTSD), which occurs after exposure to a terrifying event or ordeal
- Obsessive-Compulsive Disorder (OCD), which causes intense recurring unwanted thoughts (obsessions) or rituals (compulsions)
- Panic Disorders, which cause unexpected and repeated episodes of intense fear accompanied by physical symptoms such as chest pain, heart palpitations, shortness of breath, dizziness or abdominal distress
The ADA considers mental health impairments as real and not a sign of personal weakness. Adults that are qualified for a specific job cannot be discriminated against because of a mental health disability like OCD.
Telling one’s employer about a disability is everyone’s personal decision. According to the ADA, an OCD adult does not have to disclose a mental health disorder to an employer unless he or she wants or needs accommodations.
|OCD & Other Mental Health Challenges||Possible Accommodations|
|Maintaining consistent attendance||Flexible leave to attend counseling|
Making up time missed
Schedule a later start time
|Dealing with change||Maintaining open lines of communication with supervisor|
Scheduling regular meetings with supervisor to discuss work-related issues
|Interacting with others||Providing a mentor, a team leader or a buddy to facilitate social and work-related interactions|
Participating in team activities
|Managing time||An electronic calendar marked with meetings and deadlines|
Use E-mail as a time management tool
Daily or weekly performance goals
A partner or a mentor to help with time management
|Organizing information||Assistance in prioritizing tasks|
A written to-do list, which can be reviewed on a regular basis
Dividing large assignments into smaller tasks
A personal data assistant or other electronic organizer
|Handling stress and emotions||Short breaks to walk around the block|
Praise and positive reinforcement
Permission to call or instant message a support person
|Maintaining concentration||A quiet location|
Wearing a headset or ear sets and listening to music or "white noise"
We have included the above information provided by the ADA because these accommodations are not limited to employers but are also provided by schools, colleges, and universities.
Having OCD or any other kind of mental health disorder does not have to impact one’s success in school or in a career.
What can cause OCD?
Our most recent news article OCD causes: New study links Obsessive Compulsive Disorder to genes takes a look at the latest research about obsessive-compulsive behavior and one of its genetic links.
Currently, the main causes for OCD include the following three major components:
Biology: OCD may be a result of changes in a person’s unique natural chemistry or brain functions.
Genetics: OCD may have a genetic component, but specific genes have yet to be identified.
Environment: Some environmental factors such as infections can trigger OCD as seen above in the Pediatric cases of PANDAS or PANS.
What treatment options are there for OCD?
There are several treatment options available for obsessive-compulsive disorder in adults and children. Treatment can occur in individual settings with a therapist, a group setting, or even in a clinic specializing in OCD.
OCD treatments can include any of the following:
- Cognitive-behavioral therapy (CBT) focuses on helping a child turn negative thoughts into positive ones. CBT addresses the vicious cycle of thoughts and behaviors with hands-on and action-oriented solutions.
- Exposure and Response Prevention (ERP) is a form of CBT but focuses on exposing a person intentionally to thoughts or situations that trigger OCD symptoms. ERP can be guided and taught by a therapist so one can apply ERP at home.
- Psychotherapy can include a psychoanalytic method where a therapist looks at the underlying causes for OCD.
- OCD Medications are antidepressants approved by the FDA to treat obsessive-compulsive disorder. They include Clomipramine (Anafranil) for ages 10 and older, Fluoxetine (Prozac) for ages 7 and older, Fluvoxamine for ages 8 and older, Paroxetine (Paxil, Pexeva) for adults only, and Sertraline (Zoloft) for ages 6 and older.
Dr. Sally M. Winston and Dr. Martin N. Seif have written a powerful book about the reasons of persistent OCD thoughts, about the myths that surround those thoughts, and how someone can use CBT to be able to better cope with one’s obsessive-compulsive condition.
OCD at our Academy
While parents and their health care providers focused on working with the children on the symptoms accompanying OCD, we as a school concentrated on providing a safe environment that enabled the child to succeed academically.
In addition to providing all of the support listed in the above table, our OCD students experienced the benefits of playing the piano (tactile exercise), swimming in a heated pool, taking care of goats, therapeutic horseback riding, and learning breathing techniques.
Dr. Jeffrey M. Schwartz reveals via MRI photos how intense the high energy use in the brain of an OCD person looks like. Dr. Schwartz describes a four-step self-treatment method to change one’s OCD brain energy, and we have seen the same brain energy changes in our students.
By redirecting our students’ obsessive-compulsive energy to something meaningful, teaching our students how to handle stress, and by using knowledge about Neuroplasticity (the brain’s ability to change itself), all of our students graduated free of any OCD symptoms.
Living with OCD can be challenging and overwhelming. But just like a surfer learns to ride huge waves, children and adults with the disability can learn to master their “crushing” emotions — and succeed.
Therapeutic horseback riding played a big part in our success:
This is not our school, but the video shows some amazing kids with disabilities:
We highly recommend the following books:
|The book What to Do When Your Brain Gets Stuck: A Kid's Guide to Overcoming OCD (What-to-Do Guides for Kids) guides children and their parents through the cognitive-behavioral techniques used to treat Obsessive Compulsive Disorder. This interactive self-help book contains examples, activities, and step-by-step instructions that help children master the skills needed to break free from the sticky thoughts and urges of OCD||The 2017 book Overcoming Unwanted Intrusive Thoughts: A CBT-Based Guide to Getting Over Frightening, Obsessive, or Disturbing Thoughts teaches readers powerful cognitive behavioral skills to help cope with and move beyond intrusive thoughts, so one can focus on living the life one wants.||In The Power of Neuroplasticity, Shad Helmstetter, Ph.D., presents the scientific discovery that the thoughts we think physically rewire and reshape our brains and change our lives. Dr. Helmstetter shows how to wire your brain to change attitudes, overcome negativity, improve health and fitness, reach personal goals, increase mental sharpness and clarity, improve usable IQ, super-charge your thinking and reshape your life, all by using the latest tools and techniques from the field of neuroscience.||Riding Home:The Power of Horses to Heal is the first and only book to scientifically and experientially explain why horses have the extraordinary ability to emotionally transform the lives of thousands of men, women and children, whether they are horse lovers, or suffering from deep psychological wounds. Please read some of the amazing stories reviewers share on the book's Amazon page. It will change your life!|