Purpose: To inform people on the changes that might occur when transitioning from childhood to

adulthood with OCD

Thesis: There are trends that arise with childhood-onset and adult-onset OCD, as children have a
more juvenile mindset that influences their symptoms, treatments, repercussions, and associated
disorders.
i.

ii.

Introduction
a. Defining OCD
i. Anxiety disorder
ii. Obsessions unwanted ideas, thoughts, images or urges that are
unpleasant and may cause worry, guilt or shame
iii. Compulsions/rituals behaviors that one feels that he or she must
perform repeatedly to reduce the upsetting feelings or prevent something
bad from happening
b. Defining childhood-onset and adult-onset
i. Childhood-onset OCD is when symptoms present themselves prior to
puberty
ii. Adult OCD is after puberty
iii. Children differ from adults cognitively, developmentally, and
physiologically.
c. Statistics
i. Half a million children in the US have OCD (1 in 200 children)
ii. 1/3 of adults with OCD developed the disorder when they were children
iii. 1 out of 40 people will be diagnosed with OCD (2% of the US population)
d. Causes
i. Areas of the brain do not respond normally to serotonin
ii. Genetics can play a part if a parent or sibling has OCD then there is a
25% chance that another immediate family member will have it
e. Prognosis
i. Three factors found to affect the chance of persistence into adulthood
were age of OCD onset, necessity of in-patient care, and duration of
disease.
ii. Findings from a recent study on pediatric OCD suggest that the prognosis
of children with poor insight is worse than that of children with good
insight.
f. Thesis
Symptoms
a. Background
i. Children and adults can experience the same obsessions and compulsions
ii. People might know that their thoughts are not rational, but that knowledge
does not help them to stop the thoughts
iii. Symptoms often start anywhere from childhood and young adulthood
iv. In order to be considered OCD the intrusive thoughts and obsessive
behaviors need to last generally more than an hour each day and need to
interfere with daily life

iii.

v. Examples of obsessions
1. Harming or having harmed someone
2. Worries about turning off the stove or locking the door
3. Unpleasant sexual images
4. Worries about yelling inappropriate things in public
vi. Examples of compulsions
1. Excessive hand washing
2. Counting money
3. Checking locked door and turned off stove
4. Mental checking
vii. Between 30% and 50% of adults with OCD reported that their symptoms
started during or before mid-adolescence.
b. Children
i. Children often require their family members to perform certain rituals as
well (specific hand washing)
ii. Common feeling is that they have to do things perfectly
iii. Sometimes children can have thoughts about hurting others or sex
iv. Some common rituals for children include washing and cleaning,
repeating actions until they are just right, starting things over again, doing
things evenly, erasing, rewriting, asking the same question over and over
again, confessing or apologizing, saying lucky words or numbers,
checking, touching, tapping, counting, praying, ordering, arranging and
hoarding.
v. Symmetry is often important to children
vi. In 1997, Leckman and colleagues used the just-right characteristic and
other behaviors to identify four phenomenological subtypes of childhoodonset OCD based on the childs symptoms: obsessions and checking;
symmetry and ordering; cleanliness and washing; and hoarding.
vii. Young children often lack insight into the irrationality of their actions.
1. About 33% of adults and about 40% of children with OCD deny
that their compulsions are driven by obsessive thoughts
viii. Children are more likely to have their symptoms presented by simple ticlike compulsions
ix. Children often have specific obsessions about the death of their parents
x. Children with OCD might hoard more than adults with OCD
c. Adults
i. An adult generally is at least intermittently aware that the obsessions or
compulsions are unrealistic.However some children, particularly young
ones, may not have the cognitive capacity to understand the nature of the
obsessions or compulsions.
ii. Most common adult obsessions are fears of contamination and of harming
oneself or others
iii. Most common adult compulsions are checking and cleaning
Treatments
a. Background

i. No cure for OCD

ii. CBT is agreed to be the best treatment for children with OCD and should
be tried before medication is tried
iii. Treatment tends to include both therapy and medication
iv. There is the Yale-Brown obsessive-compulsive scale (Y-BOCS) and the
childrens Y-BOCS (CY-BOCS)
1. Provides a specific measure of the severity of the symptoms
regardless of the type of OCD behaviors
2. Helps to determine the course of treatment
3. Scales are quite similar and only vary slightly with different
obsessions and compulsions categories
4. Parents and children usually fill out the YBOCS
5. CY-BOCS scale has the same questions are the Y-BOCS, but they
are broken down into three categories
a. Magical thoughts/superstitious obsessions
b. Excessive game playing/superstitious behavior (stepping
over certain spots on the floor to avoid something bad)
c. Miscellaneous obsessions and compulsions
v. Children and adolescents with OCD should be treated first with CBT
alone or with an SSRI and CBT in combination.
vi. Research suggests that parental involvement is a strong predictor of
treatment success [with children].
vii. Relaxation and mental self-monitoring techniques are useful
b. Cognitive Behavioral Therapy
i. The main objectives of CBT are identifying the triggers of obsessions and
compulsions and designing personalized exposure and response
prevention strategies that can be practiced outside the therapy sessions.
ii. Strategies
1. Exposure and Response Prevention (ERP)
a. Children with OCD can learn that they are in charge, not
OCD.
b. Children learn to do the opposite of what their OCD tells
them to do by facing fears (exposure) and not giving into
the rituals (response prevention)
c. Helps children to realize that their fears do use not come
true when they do not give into the OCD
d. Child needs to be instrumental in deciding how quickly to
progress through this process because it tends to produce a
lot of anxiety
iii. Studies have shown that group CBT is as effective as individual CBT in
children and adolescents with OCD, as long as the family is involved in
the treatment approach.
iv. With children, CBT is usually more effective than medication

iv.

1. Essential to use age-appropriate terms to make it more accessible

and engaging to the child (worry monster, good guys, bad
guys)
2. Family context is important
v. Even young children can benefit by having a basic understand of what is
going on in their brain (doctor often allows young children to color a
repetitive circle in the brain to show them how their thoughts get stuck and
go around and around in their brain; also uses Brain Lock by Jeffrey
Schwartz, MD.)
1. Another good book is Blink, Blink, Clop, Clop, Why Do We Do
Things We Cant Stop? by Moritz and Jablonsky
a. The OCD is characterized by OC Flea and is an
unattractive, silly but non-threatening creature. This helps
kids visualize what they are dealing with in a relatable way
c. Medication
i. Background
1. Antidepressants called selective serotonin reuptake inhibitors
a. Drugs that inhibit the reuptake of the neurotransmitter
serotonin by presynaptic cells and therefore increase the
concentration of serotonin in the synapse have been
successfully used to treat individuals with childhood-onset
OCD.
2. Only should be used when symptoms are moderate to severe
3. Medicines affect each child differently
4. Symptoms can return when discontinuing medication
5. Only 50%-60% of adults with OCD respond positively to the
initial SSRI that they try and 70%-80% respond to at least one
a. Few younger patients experience complete symptom
relief
ii. Other medications like Risperidone and Clonazepam can be effective
when paired with an SSRI for adult-onset OCD
iii. The childs cognitive development necessitates some changes in the
psychotherapeutic approach. If medications are used, the physician must
consider the childs smaller size and different metabolism.
Repercussions
a. Background
i. OCD can be long-term disorder if it is not treated, but some peoples
symptoms can increase and decrease over time while others gets
increasingly worse
b. Children
i. Rituals can often make children late for school and other activities, which
can cause arguments in the family
ii. OCD can cause children to spend less time with their friends because they
are busy doing their rituals

v.

iii. At school the OCD can affect attention and focus, completion of tasks
and school attendance
iv. As children get older they might think that they are crazy so they try to
hide their OCD from others
v. Children often have extensive bedtime routines that can cause them to go
to bed late and be tired during the day, which can cause feelings of
sadness, anger, and explosiveness
vi. OCD in children can cause the parents to feel fear, frustration, anger, guilt,
and sadness
vii. OCD can cause children to not pay attention during school or to never
finish assignments because they constantly erase and rewrite their work
viii. OCD can lead to anxiety and low self-esteem in children
ix. Childhood-onset OCDseems to signal a higher risk of genetic
transmission of OCD, tic disorders and attention deficit hyperactivity
disorder.
c. Adults
i. Many of the repercussions that impact children can also impact adults, just
in a different way. Instead of being distracted at school, adults can have
similar consequences at their job, etc.
ii. Both adults and children might get to the point where they cannot even
leave their house because they spend an extensive amount of time
completing their rituals
Associated Disorders
a. Body Dysmorphic Disorder
i. Obsession with physical appearance
ii. Can lead to bodily injury (infection caused by skin picking, excessive
exercise, unnecessary surgical procedures)
b. Hoarding Disorder
i. Drive to collect a large amount of useless or valueless items, coupled
with extreme distress at the idea of throwing anything away
ii. Can negatively impact the person emotionally, physically, socially, and
financially
iii. Leads to distress and disability
iv. Hard for the person to see that their actions are harmful to them
c. Trichotillomania
i. Compulsive urge to pull out (an possibly eat) your own hair, including
eyelashes and eyebrows
ii. Can lead to serious injuries (repetitive motion injury of the arm or hand,
formation of hairballs in the stomach)
d. Excoriation Disorder
i. Compulsive urge to scratch or pick at the skin
e. OCD can mimic agoraphobia, hypochondria, or depression
f. Children
i. Comorbidity is more common in children with OCD, as about 2/3rds have
comorbid tics and 20%-80% with Tourette Syndrome also have OCD
symptoms

ii. Children and adolescents with OCD are more likely to also have Attention
Deficit Disorder, learning disorders, oppositional behavior, separation
anxiety disorder, and other anxiety disorders (trichotillomania, body
dysmorphic disorder, and habit disorders)
g. Adults
i. Adulthood-onset OCD is more commonly accompanied by depression and
anxiety