By Krista Reed, LSCSW
In all the years that I have been treating obsessive compulsive disorder (OCD) in children and adolescents, one question comes up with every single case.
“What causes OCD in children?”
I would LOVE for the answer to "what causes OCD in children?" to be simple.
“Well Mrs. Sanders, your son has OCD because a spider bit him and now he has super abilities.” Wait. That’s Spiderman.
“Mr. Blake, your daughter was born with a rare genetic mutation and now she controls the weather.” Hold up. That is Storm, from the X-Men.
The truth is, there is not some simplistic answer to why someone’s brain is wired in this fashion. Instead, OCD comes from a combination of factors, much like a recipe.
The recipe for OCD
Let’s pretend that I am a famous chef on The Food Network, and I am cooking up a complicated dish for you all. Today’s dish is something that will affect roughly one out of 200 children between the ages 8-12.
With a dash of genetics, a cup of brain abnormalities, and top it off with the environment that the child is raised in ... VOILA!!! We have OCD!!! (Audience cheers).
That recipe is about as simple as me watching The Great British Baking Show and thinking I can replicate a Schichttorte (look it up, it is amazing!).
The beginnings of OCD
Is there a specific OCD “gene?” The short answer is no. However, there are multiple research studies that highlight significant relations to genetic factors with OCD.
One particular study showcases genetics with twins and determined that the heritability (genetic risk) for OCD is around 48% percent. This means that about half of the cause for OCD is genetic (Browne, H. A., 2014).
Even though the typical onset is between ages 8-12, and sometimes in later teens, children as young as three can struggle with OCD. But diagnosis at that age is very challenging even for a top pediatric OCD specialist. Early detection is key, and treatment is necessary with a professional who is trained to treat OCD. Not all pediatric therapists are trained to treat OCD.
Let's discuss one of the ingredients of OCD: environment. I am not referring to the cleanliness of the household, as stereotypes might have you believe. Instead, I mean environmental risk factors.
These can include health factors like low birth weight, maternal stress during the pregnancy, and parental psychopathology. In addition, trauma like childhood sexual abuse and emotional abuse, although continuing to be researched, is a factor in some individuals who have been diagnosed with OCD as adults.
However, research is ongoing to define this area, as not every individual with OCD has a history of trauma or other health-related factors.
What does OCD look like in kids?
Unfortunately, OCD can be very difficult to spot in kids. This is due to the complexities of the mind and the fact that a child’s brain is still "under construction."
Obsessions include and are not limited to fears of germs, fear of dying (self, others, and even animals), perfectionism/needing things to be "just right," fear of bad situations occurring, religious/moral themes, fear of becoming ill, or even thoughts of a sexual nature (typically seen in older children/adolescence if it occurs).
Compulsions, meanwhile, include and are not limited to washing/cleaning repeatedly or in a ritualistic way, repeating behaviors, re-reading/re-writing, seeking reassurance (from self or asking others the same questions repeatedly), avoiding things that may be contaminated/dirty, tapping/touching, and even ordering.
Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus (PANDAS) is another onset that may cause OCD symptoms in a child. PANDAS is a sudden onset of OCD symptoms that is brought on by a Strep infection. If you are a parent wondering if your child might have OCD related to a Strep infection, get your child tested.
If your child does test positive for Strep AND is experiencing OCD symptoms, use antibiotics to treat the infection. Also, be sure to seek out an OCD treatment provider who is trained in working with children and can guide you through this process.
Treatment is possible. Yes, you may have to wait a few weeks or months to get in with someone who is trained in this area. The wait is worth it. Trust me. Your child can and will get better with someone who treats pediatric OCD. Your child will not get better, however, with a therapist who just has the “sooner available appointment.”
A behavioral health specialist is like a doctor who specializes in a particular treatment. If you would not go to a cardiologist to have your baby delivered, then don’t go to a general therapist to have your child’s OCD treated.
To learn more about what causes OCD in children, keep up with the IOCDF for more information on research. Attending the Annual OCD Conference or the Online OCD Conference is a great way to stay up to date with research.
Check out the resource directory for a therapist who is trained in treating pediatric OCD with exposure and response prevention therapy (ERP.)
Browne, H. A., Gair, S. L., Scharf, J. M., & Grice, D. E. (2014). Genetics of obsessive-compulsive disorder and related disorders. The Psychiatric clinics of North America, 37(3), 319–335. https://doi.org/10.1016/j.psc.2014.06.002