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Involuntary thoughts, urges, impulses, worries or ideas run through a child's mind when he or she has obsessive-compulsive disorder. Useless repetitive behaviors also characterize the disorder, and sometimes are linked to the obsessions. These unwanted obsessions and compulsions interfere with normal functioning and are disruptive to everyday life. Some children experience problems with home life, schoolwork and friendships. Symptoms of obsessive-compulsive disorder in children may occur as early as age three or four, but may not be diagnosed until age five or six. Some children are not mature enough to realize their thoughts and actions are outside of the norm. They may not be aware of or understand why they feel that they must perform certain rituals, and, fearing ridicule, may hide them from others.
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Common obsessions in children include a fear of dirt, germs or contamination; a need for symmetry and order; preoccupation with bodily wastes; religious obsessions; fear of illness or harm coming to oneself or relatives; and intrusive sounds or words. Common compulsions include grooming rituals, such as teeth brushing, showering or hand-washing; repetitive rituals such as going in and out of doorways, moving through space in a special way, or rereading, erasing and rewriting; checking rituals to make sure a door is locked or appliance is off; ordering or arranging objects; counting rituals; hoarding or collecting things; and cleaning rituals related to the house or environment.
OCD can be triggered by stress. Normal developmental transitions such as starting school, as well as significant losses or changes, including the death of a loved one or moving to a different town may trigger OCD.
Parents can look for the following symptoms of obsessive-compulsive disorder in children: raw, chapped hands from continual washing; pervasive fear of illness; dramatic increase in laundry; sudden drop in grades; high rate of soap or paper towel usage; an exceptionally long time spent getting ready for bed; a constant fear that something terrible will happen to someone; constantly checking the health of family members; unproductive hours spent on homework; unusual requests for family members to repeat strange phrases or keep answering the same question; and reluctance to leave the house at the same time as other family members.
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Some children have symptoms that look like OCD, but actually are symptoms of other disorders, such as ADHD, autism and Tourette's syndrome. A thorough medical and psychological examination is necessary before a correct diagnosis can be made. Since OCD is an anxiety disorder, symptoms of anxiety in children may change over time. Having OCD symptoms as a child does not necessarily mean they will continue into adulthood. The most important thing parents can do is to institute environmental and behavioral changes to reduce the child's anxiety.