How to cope when your child has OCD

About 21 per cent of cases emerge before age 10, he says. There's a wave at about age seven, when kids start full days at school, with another wave at about age 12, when puberty sets in – both potential periods of upheaval. The disorder occurs at the same rate in boys and girls, with a slightly earlier onset in boys.

The earlier symptoms appear, the greater the likelihood that the disorder is inherited. Heredity is very much on Sara's mind these days; she can't help but analyze the behaviour of her five-year-old daughter. "When she was a baby, I would listen to her crying in her crib, and I would think she was experiencing the terror and emptiness I felt alone in my bed as a child."

Parents and OCD
It's difficult for parents to know if their child's behaviours are simply quirks that will pass, or signs of OCD. His or her behaviours might be age-appropriate – for example, a five-year-old's fussiness around eating, or a nine-year-old's setting and resetting a table for a perfect pretend tea party. The key here is that the behaviour fades away as the child matures out of a particular developmental stage.
 
Some parents might question whether a certain behaviour, like avoiding stepping on a crack on the sidewalk, is a sign of OCD or merely a passing superstition. Mendlowitz explains the differences:

"Superstitions are culturally bound, and held by a group of people; obsessions are above and beyond what is expected in your culture. If a child is thought to be engaging in excessive prayer (another common compulsion) then the family and their spiritual or religious leader would know what is excessive within their religious belief system."

Dealing with your child's rituals
Many parents unwittingly aid and abet their child's rituals. I played along with Tessa's parting ritual and bought more comforters for her bed than a set of quintuplets would need. "It's a tough situation because a parent doesn't want their child to be in distress, so they help as an altruistic reaction," says Mendlowitz. "But the helping is never enough, and it actually serves to worsen the OCD," she says. "Parental overinvolvement, even though it's meant to help alleviate anxiety, just negatively reinforces the problem," says Mendlowitz. "The child will think, If my dad goes along with it, then it must be true. If it wasn't really a problem, why would he help?"

If you suspect, as I did, that your child's anxieties are outside the realm of normal, ask your family doctor for a referral to get an assessment. You may get such an assessment at a hospital, a mental health facility, a clinic or a private office. Both physicians and psychologists can make a diagnosis. A proper assessment should include a thorough physical exam to rule out any other possible causes of the odd behaviour, and oral and written questions that both you and your child answer. You'll be asked, for example, about behaviour, mood, school, social ties and activities, as much to rule out things as to assess their role. As Mendlowitz explains, a child can be late for school because of his OCD rituals, or because he is scared of an older schoolyard bully.

To be diagnosed with OCD, either obsessive thoughts or compulsive behaviours must be present and impair daily functioning. The general rule of thumb is that if either obsessions or compulsions are consuming an hour or more each day, the child likely has OCD. When they were bad, Tessa's rituals could destroy up to eight hours of her day.

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