How is OCD treated in children?

DEAR DOCTOR K:

I think my 9-year-old son may have OCD. How is this condition treated in children?

DEAR READER:

Before discussing treatment for OCD, it’s important to describe what it is. You know, of course, but other readers may not.

Children (and adults) with obsessive compulsive disorder (OCD) are troubled by repeated, intrusive, distressing thoughts (obsessions). These obsessions cause great anxiety. As a result, people with OCD often have a strong urge to repeat certain behaviors (compulsions) in order to reduce the anxiety. For example, people who have obsessive thoughts about germs may repeatedly wash their hands.

OCD usually starts in childhood or adolescence; symptoms may appear as early as age 3. A young child with OCD may insist on bedtime routines done without variation, night after night. He or she may insist that toys be arranged in exactly the same way every day.

Many children like a sense of order and routine. But in a child with OCD, these beliefs or behaviors become all-consuming. They interfere with school, home life and recreational activities. Even young children often know that their obsessions are senseless — but they may be helpless to stop themselves.

Treatment may help to reduce symptoms and improve a child’s ability to function. Many experts recommend trying a type of talk therapy called cognitive behavioral therapy (CBT) first, before turning to medication. If you decide to try CBT, look for a clinician experienced at working with children and teens.

A version of CBT known as exposure and response prevention is typically used in treating OCD in patients of all ages. During therapy, a clinician exposes patients — either physically or through the imagination — to the things, places and circumstances that provoke their obsessions. Patients are then prevented from performing the usual compulsive ritual.

For example, if your child is obsessed with germs, he may be asked to touch a “dirty” shoe. Then he will be told to wait before washing his hands. The waiting time before hand washing will increase over time. Eventually, if all goes well, he will learn to tolerate the anxiety, making the compulsive behaviors unnecessary.

Medication can also help children better manage OCD. Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac) and sertraline (Zoloft), are the drugs most often prescribed and studied in children with OCD. These drugs are normally taken to treat depression. SSRIs are prescribed at higher doses and for longer periods of time to treat OCD than to treat depression.

A combination of CBT and medication often gives a child the best chance of relief.

What causes OCD? For many years, it was regarded as a purely psychological problem. That meant (to many of those who believed it) that there was no alteration in the anatomy or chemistry of the brain. It also implied that people with OCD simply had some kind of character flaw.

Today, however, we know that a tendency to OCD is inherited — and that there are particular brain circuits and chemistry that are different in people with OCD.