Identifying OCD in children during the lockdown

Have you noticed your child repeatedly performing purposeful and meaningful actions in a very rigid and structured routine during the lockdown? Clinical psychologist Marise Swart explains how and why COVID-19 and the lockdown can lead to OCD in children.

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The COVID-19 pandemic has changed life as we know it. Countries and continents have come to a complete standstill and the “normality” of daily life has transformed in a matter of weeks. The uncertainty and novelty of this new virus has created an unprecedented level of anxiety for most of us, including our children.

As parents try navigate the uncertainties of the nationwide lockdown, they’re finding themselves in unchartered territory. Concerns around income, lack of productivity and changing routines can cause anxiety levels to soar and panic to spread. While anxiety is a normal reaction to uncertainty and change, you need to know that children might find this time especially scary and distressing. The reason for this is because they primarily take their cues from you: if you are anxious, distressed or constantly angry, your children will find it hard to stay calm.

As a parent, you are essential in helping your children regulate their emotions. Children seek comfort and security from their parents or their environment. The ability to anticipate change provides them with a sense of certainty and control in uncertain times.

Understandably, some children may find it especially hard to tolerate worry during this time as the world around them echoes messages of death, infection, contamination, and social isolation. Some, with existing anxiety symptoms or other mental disorders, can be particularly at risk of developing more severe anxiety symptoms. In an attempt to safeguard themselves against germs, like the new cornonavirus, children may become hyper-focused on the possible factors that may threaten their safety and wellbeing. This hyper-focus or preoccupation is very different from what is developmentally expected in that it produces clinically significant levels of distress and impairment in functioning.

As children grow, rituals and obsessive thoughts normally happen with a purpose and focus. Pre-schoolers often have rituals and routines around meals, bathing, and bedtime. These rituals bring structure and predictability to their world. Rituals are also part of learning and underpin play, team sports, and cultural activities. These rituals help children to socialise and learn to deal with anxiety. However, if these rituals are excessive or carry on beyond developmentally-appropriate periods, it might be indicative of Obsessive Compulsive Disorder (OCD).

What is OCD?

OCD is a common mental disorder characterised by obsessions and compulsions. Obsessions are intrusive unwanted recurring thoughts, urges, or images. It can range from the fear of contamination, fear of causing harm, fear of dying, ridged thinking and the fear of things not being in order. Thoughts about contamination might be even more concentrated during this time and children may respond to these fears by obsessively washing their hands, avoiding people or situations and religiously wearing gloves or a mask. These actions are known as compulsions. Compulsions involve repeatedly performing purposeful and meaningful actions in a very rigid and structured routine, specifically in relation to the obsessional thoughts. Children may believe that engaging in these compulsions will somehow prevent bad things from happening.

Common compulsions may involve:

  • Frequent confessing or apologising
  • Saying lucky words or numbers
  • Excessive checking and re-checking
  • Excessive washing and/or cleaning
  • Repeating actions until they are “just right”
  • Repeatedly ordering or arranging things.
  • Mental actions like excessive praying, mental reviewing or counting.

Preoccupations or obsessions are hard to identify in young children as they may not be able to articulate the reasons for their repetitive behaviours or thoughts. In contrast, compulsions are quite plain to see. Boys are more affected by OCD in childhood and have an earlier onset than girls.

In very rare cases, symptoms may develop suddenly with a rapid change in behaviour and mood and the abrupt appearance of severe anxiety. If this is the case, it is that the child has a sub-type of paediatric OCD caused by an infection such as strep throat.

Strep throat is a bacterial infection that is characterised by a sore and scratchy throat. This infection can confuse the child’s immune system into attacking the brain instead of the infection. When this happens, the child begins having severe symptoms of OCD, often seemingly all at once, in contrast to the gradual onset seen in most cases of paediatric OCD.

This rare type of OCD due to a strep infection is called Paediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus (PANDAS). If it’s caused by another infection, it’s called Paediatric Acute-Onset Neuropsychiatric Syndrome (PANS).

Treating OCD

Overall OCD is treatable, but overcoming it isn’t a quick or easy process. Children diagnosed with OCD usually need to work with a therapist and take medicines to help manage their behaviours and the accompanying thoughts and feelings. However, parents are invaluable in supporting their children during this pandemic. One way you can help your child diagnosed with OCD is to stay informed. Knowing the facts surrounding Covid-19 can help reduce stress. If your child is frightened of getting sick, you can remind them that people are staying home to prevent the spread of Covid-19. By reframing the situation, you can bring more certainty to an uncertain situation.

ALSO SEE: How to talk to your kids about the coronavirus and the lockdown

Routine is very important

Similarly, you can create more structure and predictability at home by establishing a daily routine. Write out a plan for each day and notify your children of the plan. Ideally, you need to keep their routine as close as possible to what it was before COVID-19. Have your children wake up, get dressed and eat breakfast at the same time they would for school to help create a sense of “normality”. ​Use the school schedule as a template but switch activities every 30-40 minutes or so. At “lunchtime”, eat lunch together. Also, try to encourage healthy eating during the day as it helps manage their energy levels. They should also be getting enough sleep and engage in physical exercise. You may want to think about the types of activities that helped relax your child when they experienced other stressful events in the past. Activities that soothe and promote self-care should be at the heart of the daily routine.

ALSO SEE: 16 fun and simple at-home activities for kids

Help your kids stay connected with friends

Social interaction and connection are vital and children might feel sad or angry that they can’t see their friends or family. To prevent children from feeling alone help them stay connected with others in new ways. Use technology like Skype, Zoom, Facetime or other apps to set up “virtual playdates”. They can watch a show with their friend or have a picnic via Zoom or Skype. If that’s not possible, set up regular times for your children to talk with their friends on the phone.

Get help if you suspect your child may have OCD

If you suspect that your child may have OCD or is presenting with OCD symptoms, reach out to a health care professional. You can consult your general practitioner during the lockdown period and request a referral to a psychiatrist or specialist paediatrician. In addition, you can contact a psychologist in your area to set up an online consultation during the lockdown or an in-person consultation for after the lockdown. You can also contact the South African Depression and Anxiety Group on 0800 205026 for a list of mental health professionals. I am also available to assist during this lockdown period via online therapy. To schedule an appointment during lockdown phone 076 500 0303 or email info@marise.co.za.

More about the expert:

Marise Swart is a clinical psychologist in private practice in Pretoria. She is also a certified Somatic Experiencing Practitioner®, a certified Brainspotting Therapist and the only Brainspotting trainer in Africa. Marise is also trained in Eye Movement Desensitization and Reprocessing (EMDR), Ego-State Therapy, Interactional Pattern Analysis and BrainWorking Recursive Therapy® (BWRT). She has attended numerous international workshops and trainings and is currently working on her PhD in Psychology at the University of Johannesburg. Learn more about Marise Swart here.

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