A new trial at the South London and Maudsley NHS Foundation Trust (SlaM), one of the UK's leading treatment centres for mental health, is attempting to find the best-possible treatment for children with obsessive compulsive disorder (OCD).
Childhood (or pediatric) OCD is thought to affect around 300,000 under-16s in the UK and can be extremely upsetting, not only for the child, but also for their parents and family.
People with OCD suffer from obsessions, which are intrusive or unwanted thoughts, ideas, urges, impulses or worries that are often alarming or unpleasant. These may include worries about dirt or germs, fears that certain activities haven't been completed properly, even after countless repetitions, a need for certain objects (or people) to be in 'correct' positions or places, repetitive counting or having lucky/unlucky numbers.
Compulsions – also known as rituals – are repeated behaviours that are performed to reduce the anxiety generated by obsessive thoughts. They include excessive hand-washing or bathing, avoiding 'contaminated' or 'dangerous' objects or substances, repeatedly checking windows, cupboards and doors, or entering or leaving the home or car in a certain way.
Children don't understand
Benedetta Monzani, a member of SlaM's Obsessive Compulsive Disorder Service for children and adolescents, says that although childhood and adult OCD are similar, there are some key differences.
"Young people with OCD may be unable to describe their obsessions/worries and often report that they don't know why they have to do rituals," she says.
The first-choice treatment for anyone with OCD is cognitive-behavioural therapy (CBT), which helps people learn how to gradually face their fears and stop the compulsive behaviour. But although many young people do improve after CBT, some don't respond or make a full recovery.
So the new trial is investigating whether CBT can be enhanced when combined with a new drug, D-Cycloserine, which has been shown to speed up the treatment process in adults.
Signs of childhood OCD
If you are worried that some of your child's behaviour may be unusual, it's important to distinguish between normal childhood fears and preoccupations with signs of OCD or another disorder.
"Rituals like stepping over cracks in the pavement are part of normal childhood development and should not be confused with OCD," explains Monzani. "These rituals are most common between the ages of two and seven, and parents should only be concerned if they are becoming more prolonged or distressing."
If the obsessions or rituals seem to upset your child, or interfere with their everyday life, speak to your GP. If they think it's necessary they will then refer them to a local child and adolescent mental health professional who can assess them and, if necessary, provide treatment.
As with any kind of illness that might affect your child, knowledge is power. So it's worth reading up on the subject if you are concerned. There are plenty of good books on the subject, including Breaking Free From OCD: A CBT Guide for Young People and Their Families, by Jo Derisley.
Early treatment is key
If children do have OCD, it's very important to diagnose and treat it as early as possible – the sooner it's diagnosed, the easier it is to treat.
"Without treatment, OCD can persist into adulthood and negatively impact on all areas of a young person's life," says Monzani. "This might include education, peer relationships, family and personal development. Early detection will help them avoid this, so it's important to make a diagnosis and start treatment as soon as possible."
One last point: parents of children with OCD often blame themselves, but like many other mental health problems it's nobody's fault.
They may well have a genetic predisposition to the disorder (caused by one or more faulty genes). This can be activated by a trigger like puberty, exam stress or problems with friends.
"We still don't know the precise causes of OCD, but what is clear is that it's nobody's fault," says Monzani. "Many parents are worried they have done something wrong, but we know this is unlikely to cause OCD. And it's important to stress that there are very good treatments available and that most people with OCD can be helped to lead a normal life."
•OCD Action: 0845 390 6232; www.ocdaction.org.uk
•Anxiety UK: 08444 775774; www.anxietyuk.org.uk
•South London and Maudsley NHS Foundation: www.slam.nhs.uk