When OCD begins in childhood, there is a higher likelihood of the child having other disorders as well, such as other anxiety disorders, attention deficit hyperactivity disorder (ADHD), autism spectrum disorders (some children with autism have also been referred to as having Asperger’s disorder), eating disorders, and Tourette’s syndrome (or other tic disorders).
It is important that a mental health professional is aware of all of the needs and challenges a child faces in order to develop an effective and appropriate treatment plan. In some cases, because the symptoms of these disorders can overlap, some conditions are actually confused with OCD or vice versa, which can lead to misdiagnosis. Misdiagnosis then leads to prescribing the wrong treatment plan. For some of these disorders, treatment for one disorder can make the other disorder worse, or it can just be ineffective. Below is a description of some disorders commonly confused with OCD.
Disorders commonly confused with OCD
Pediatric Autoimmune Neuropsychiatric Disorder Associated with Strep (PANDAS) or Pediatric Acute Onset Neuropsychiatric Syndrome (PANS) are actually variations of pediatric OCD.
Children and teens with OCD and PANDAS/PANS both experience typical obsessions (fear of contamination; fear of harm; over responsibility, etc.) and commonly seen compulsions (excessive checking, washing and/or cleaning, reassurance seeking, etc.). However, children with OCD first experience symptoms between 8–12 years old, and symptoms gradually become more severe over time. In PANDAS/PANS, however, children are typically between 4–14 years old, with acute (sudden), dramatic onset of symptoms. Also, children with PANDAS/PANS will show additional symptoms not typically seen in kids with OCD, including:
- Severe separation anxiety
- Anorexia or disordered eating
- Urinary frequency
- Tics and/or purposeless motor movements
- Acute handwriting difficulty
Attention deficit hyperactivity disorder (ADHD)
Children with OCD often experience difficulties maintaining attention, which can sometimes lead to a misdiagnosis of ADHD. However, kids and teens with OCD are very rarely impulsive and do not exhibit risk-taking behavior, two behaviors you see in children with ADHD.
The second thing to consider is that kids and teens with OCD have the ability to perform accurate and repetitive rituals governed by very specific and complex rules, something that children with ADHD will generally struggle with. In fact, attention to detail and the ability to strictly follow attention-demanding tasks are characteristic impairments of ADHD.
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Autism spectrum disorders
Other disorders commonly confused with OCD are the autism spectrum disorders.
Individuals with autism spectrum disorders and people with OCD all may have “stereotyped” behaviors like following rigid routines or show an “obsessive” interest in something. However, kids and teens with autism spectrum disorders usually have thoughts and behaviors that only focus on repeating something (versus thoughts and behaviors that focus on contamination, violent/sexual themes, checking, etc.). Further, kids and teens with autism spectrum disorders don’t try to prevent their thoughts like those with OCD do. Finally, kids and teens with autism spectrum disorders have more severe problems with social interactions
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Tic disorders/Tourette syndrome
People with tics and/or Tourette syndrome and people with OCD both repeat physical behaviors like eye-blinking, touching, or tapping, and in some cases, repeat vocal behaviors like clearing their throat.
People with tics or Tourette syndrome do their tics because they have a sense of discomfort or need to feel “just right,” whereas kids and teens with OCD do their repetitive behaviors in response to an obsession.
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