When Worry Takes Over: Recognizing the Hidden Signs of Pediatric OCD in San Antonio’s Children and Teens

For many parents in San Antonio, distinguishing between normal childhood behaviors and signs of obsessive-compulsive disorder (OCD) can be challenging. OCD can start at any time from preschool to adulthood, with the disorder generally appearing in two age ranges: between ages 8 and 12, and between the late teen years and early adulthood. Understanding the early warning signs and available treatment options is crucial for ensuring children receive the help they need to thrive.

Understanding Pediatric OCD: More Than Just “Being Organized”

People often use the term OCD casually, to describe someone who is neat and likes to be organized, but that’s a vast understatement. Obsessive-compulsive disorder (OCD) is the diagnosis given when children have intrusive, persistent thoughts and compulsions that interfere with their ability to function. Obsessive compulsive disorder (OCD) is characterized by both obsessions and compulsions. Obsessions are intrusive and unwanted thoughts, images, or urges that occur over and over again and feel outside of the child’s control. These obsessions are unpleasant for the child and typically cause a lot of worry, anxiety, and distress.

OCD affects 1% of children and causes significant impacts to a child’s daily life. Pediatric OCD is more common in boys than in girls, with girls more likely to develop OCD in their teens and 20s. OCD in kids is usually diagnosed between the ages of 7 and 12. Since these are the years when kids naturally feel concerned about fitting in with their friends, the discomfort and stress brought on by OCD can make them feel scared, out of control and alone.

Early Warning Signs Parents Should Watch For

Recognizing OCD symptoms in children can be particularly challenging because some children are secretive about their behaviors, so parents may notice that bedtime rituals have become very prolonged or that, suddenly, there is a lot of extra laundry because a child is showering or changing clothes so often.

Common Obsessions in Children and Teens

The most frequently observed obsessions in pediatric OCD include:

• Worrying about germs, getting sick, or dying. Extreme fears about bad things happening or doing something wrong.
• Worries about unintentionally hurting someone close, like a parent, sibling or friend. Fear of a loved one dying or leaving. Believing that bad things will happen if they don’t perform certain actions, like counting a specific number of times or touching objects in a certain way.
• Disturbing and unwanted thoughts or images about hurting others. Disturbing and unwanted thoughts or images of a sexual nature.

Recognizable Compulsive Behaviors

Children with OCD may exhibit various compulsive behaviors, including:

• Repeated handwashing (often 100 or more times a day) Checking and rechecking many times, such as making sure that a door is locked
• Performing rituals, like moving or touching body parts in a specific way or making sure movements are symmetrical. Arranging items to be “just right” or in a certain grouping or order. Repeating words or sayings to prevent bad things from happening.
• Children with OCD might take an excessive amount of time to complete their homework. This might include children having to read the same line over and over again, having to write each number perfectly for a math problem, or checking homework repeatedly to the point that it takes a very long time to finish

The Impact on Daily Life and Development

When a child has OCD, obsessive thoughts and compulsive rituals can become very frequent and strong. They may interfere with daily living and normal development. OCD often develops slowly over time. With a gradual onset of symptoms, coupled with a parent’s natural tendency to protect and soothe, it might be hard for adults to pick up on a child’s symptoms of OCD when they start appearing. It might be easier to recognize the impact that OCD has on the quality of life in children and those around them.

As OCD symptoms may increase during times of stress or transition (e.g., starting a new school year, feeling sick), parents should watch for symptoms during stressful times. Untreated OCD can contribute to development of other mental health conditions, such as anxiety and depression in adulthood, so early treatment is important.

Evidence-Based Treatment Options

The good news for San Antonio families is that OCD can be very impairing, however, there is treatment available that can significantly reduce symptoms and make them manageable. The best line of treatment for OCD involves medication, prescribed by a psychiatrist, and a specialized type of therapy called Cognitive Behavioral Therapy with Exposure and Response Prevention (CBT with ERP).

Cognitive Behavioral Therapy with Exposure and Response Prevention (ERP)

Pediatric OCD is best treated by a licensed mental health professional using a type of cognitive behavior therapy (CBT) called exposure and response prevention (ERP): In ERP, kids learn to face their fears (exposure) without giving in to compulsions (response prevention). The gold standard treatment for OCD (obsessive-compulsive disorder) is a kind of CBT (cognitive behavioral therapy) called “exposure with response prevention,” or exposure therapy. Instead of avoiding the situation, exposure therapy helps children learn to face their fears in a very structured and safe way. In the process children find that they get used to the anxiety and it fades over time.

For families seeking specialized ocd therapy in San Antonio TX, it’s important to find providers trained specifically in ERP techniques. Cognitive behavioral therapy is a short-term treatment approach, typically offered once a week for about 12 to 20 weeks. Therapy for children with more persistent symptoms may last longer.

Medication Options

When therapy alone isn’t sufficient, medication can play an important role. A specific kind of antidepressants known as serotonin reuptake inhibitors (SRIs) have been found to be helpful in reducing OCD symptoms in children and teens, making ERP easier to do and more effective. Taken together, ERP and medication are considered the “first-line” treatments for OCD.

Selective serotonin reuptake inhibitors (SSRIs) are generally considered the first-line OCD treatment medication for teens. These medications increase serotonin levels in the brain, which can help reduce the intensity of intrusive thoughts and compulsive behaviors. Younger children tend to respond well to the therapy alone. Many children and teens with OCD find that a combination of cognitive behavioral therapy and medication is helpful in overcoming the anxiety related to the condition.

The Importance of Early Intervention

If you notice signs of OCD in your child, you can help by getting an evaluation as soon as possible. Early treatment can ease symptoms and enhance your child’s normal development. It can also improve their quality of life. It’s important for individuals, such as parents, teachers, and athletic coaches, to be able to recognize the potential signs of OCD in children. The sooner you can intervene at the start of a mental health challenge, the better their chance for a successful outcome.

Children will not outgrow OCD on their own. However, with treatment and time, children and parents can learn effective strategies to address OCD symptoms. About 70 percent of people will benefit from ERP and/or medication for their OCD.

Special Considerations: PANDAS and PANS

In some cases, OCD symptoms may appear suddenly and dramatically. In rare cases, symptoms may develop seemingly “overnight” with a rapid change in behavior and mood and sudden appearance of severe anxiety. If this is the presentation, then consider a sub-type of pediatric OCD caused by an infection (e.g., strep throat), which confuses the child’s immune system into attacking the brain instead of the infection. This then causes the child to begin having severe symptoms of OCD, often seemingly all at once, in contrast to the gradual onset seen in most cases of pediatric OCD.

This type of OCD is called Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus (PANDAS) if it is a strep infection, or Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS) if it is any other infection.

Finding Help in San Antonio

For San Antonio families concerned about potential OCD symptoms in their children, the first step is consulting with a pediatrician who can provide referrals to qualified mental health professionals. Your child may get care from a team that may include counselors, therapists, social workers, school psychologists, psychologists, and psychiatrists. Your child’s care team will depend on what your child needs and how serious the OCD is.

When seeking treatment, it’s crucial to find providers specifically trained in pediatric OCD and ERP techniques. Parents and caretakers (and even siblings sometimes) are an important part of a child’s OCD treatment, and should be involved in many ways. The most effective treatment approaches involve the entire family in understanding and supporting the child’s recovery journey.

Remember that treatment can be very helpful for children with OCD, allowing them to lead full and productive lives. With proper identification, evidence-based treatment, and family support, children with OCD can learn to manage their symptoms and thrive in all aspects of their lives.