I Just Can't Turn my Brain Off! (Dealing with Pediatric OCD)

Renton and his Cars - 1 year, 2 months old

We’ve all seen it or made jokes about it – the person who washes their hands incessantly, the person who has to touch the doorknob three times each time she passes it, the person who has to have only three peas on his plate before he can eat his dinner. Obsessive Compulsive Disorder can appear humorous when viewed from the outside. But when it’s happening to YOUR child, it’s heartbreaking to watch.

Obsessive-Compulsive Disorder is about more than hand washing. It's about thoughts and urges that get stuck in your child's mind, terrifying him, tormenting her. It's about rituals intended to ward off harm. It's about things feeling "not right" to your child. And it's about questions, endless questions -- questions about safety, questions about certainty, questions that drive you crazy, questions that break your heart. (From: What to Do When Your Brain Gets Stuck: A Kid's Guide to Overcoming OCD by Dawn Huebner)

The first time I saw my son, Renton, meticulously line up over fifty of his matchbox cars, nose to end, each assigned to a particular square on the quilt on his bed, I thought to myself, “This is the most adorable thing!” He was barely a year old. We had just moved into what was his fourth home since he was born. Lining things up, especially cars, would become a habit of his for the next several years.

The first time I realized this habit was tied to stress in his life, was an eye-opening experience for me. He was one and a half, we’d just returned from a long trip out to my Grandmother’s in Kansas for the baptism of my daughter Emily (9 weeks old). I had allowed him to bring a handful of cars with him, but we certainly couldn’t bring them all. While we were there, Renton played actively with all the old wooden toys and oatmeal boxes and blocks my grandmother put out for him. He loved them and never showed a moment’s stress about the trip or anything else. He talked a mile a minute (also a trait of his) and continued to take his naps and go potty (yes, he was already potty-trained at this point) on regular intervals like clock-work. Everyone commented on how mature and organized he was. No one, and I mean no one, would have ever suspected that he was also stressed.

When the trip ended, we headed home. The moment we stepped through the door of our house (and mind you it was close to 10pm and we’d been travelling by car, plane and taxi since 5am Kansas time) Renton made a beeline for his room and began pulling out ALL of his cars. He lined them all up, making minute adjustments here and there, examining, changing slightly again, until every single car was precisely in the place his little mind thought it should be. He stepped back, reviewed his work, took a HUGE sigh of relief, then in one sweeping movement, brushed them off the bed, back into their basket, crawled under his covers and fell fast asleep.

I had watched all of this, silently, from the doorway of his room. I was shocked. He had clearly felt this incredible NEED to get the cars lined up before he could feel relaxed. The sigh he made after doing it sounded almost as though he’d been holding his breath for the entire trip. I looked at him, sleeping soundly, chest rising and falling with each steady breath, and I grasped for the first time how desperately he needed to feel in control of his life, even at only a year and a half old.

OCD is a neurobiological problem, and there is nothing you or your child did to cause it. While it appears random and bizarre, it's actually quite common and predictable. OCD is related to certain abnormalities in brain chemistry and function. And although it appears rather tenacious, it is in fact a treatable condition. (From: What to Do When Your Brain Gets Stuck: A Kid's Guide to Overcoming OCD by Dawn Huebner)

So, time has passed and Renton eventually gave up lining up the cars, but his signs of stress have not left. Renton continues having extreme difficulty falling asleep, often explaining, “I just can’t turn my brain off.” He draws INCESSENTLY, and I mean that. We have gone through reams and reams of paper! He draws on the back sides of cereal boxes, inside shoeboxes, magazines, scratch paper, newspapers, you name it. There is not usually any method to his madness, he just feels compelled to draw. Usually extremely detailed pictures with lots of animals and everything is labeled. I have been told this is also an OCD trait, one that helps children assign meaning to the things around them. If they can point out what something is, life becomes more organized and less scary or stressful.

It works for Renton. It has never interfered with his daily routine. His nighttime routine, however, is another matter. Nighttime is when he has the most difficulty “shutting it off.” I will put him to bed around 8pm and come back at 9pm finding him curled up under his nightlight with stacks of at least 20 sheets of paper drawing furiously. I ask him gently to complete one last drawing and get in bed, and he does it without a fuss. But I will come back again around 10pm and then at 11pm, and most nights I will find him once again under the light of his nightlight feverishly scratching away, creating his detailed world of labeled animals engaged in the most animated conversations, all documented to the tiniest detail. It’s like watching a mad scientist at work. He completes one page and tosses it behind him starting in immediately with the next and going and going until something lets him know it’s okay to stop.

When my ex and I divorced when Renton was 5, I took my son to a play therapist just to make sure he had some support in place for all the changes that were about to take place.   Gabrielle Anderson of Lansdowne Family Counselling.  She picked up on the OCD right away. Again, not that it was something terrible or debilitating, just that it was how Renton was dealing with the stress and what was also adding to his stress. (Most people, children included, understand that the obsessive thoughts and compulsive behaviors are somehow not “normal” – feeling powerless to control the thoughts/actions makes them even more stressed.) One of the observation techniques Renton’s therapist used was a sand table in which Renton could play with the hundreds of little plastic animals or human figures she would provide. He could create worlds, have the characters interact, etc. and his therapist would watch his play; talking nonchalantly to him about what he was doing. The therapist explained that Renton habitually categorized, lined up or sectioned off the characters. When he was experiencing greater levels of stress, the categorizing and compartmentalizing became more intense. When she asked him about it, Renton explained that he was “protecting his family.” We were not in physical danger, but the fear (irrational or not) of the presence of danger was strong enough in Renton’s mind that he felt the need to “protect” whatever he could – even if they were only toys. As you can imagine, this is a heartbreaking thing to hear about your child.

So why am I even writing about this? A few months ago I was lying down with Micky (my youngest who is 2-1/2) trying to help him fall asleep. He’d had a particularly rough day that day (anyone who follows my blog knows what that means) and was now having trouble going to sleep. He had brought a little basket of toys into bed with him but hadn’t been playing with them. Suddenly, he sat up, took a toy out of the basket, looked at it, placed it on the bed, took the next toy out, looked at it, placed it on the bed, repeated the entire ritual until every toy was on the bed, then placed them one-at-a-time, back into the basket, repeated the entire process four more times, heaved a hopeful sigh, then just as suddenly plopped back down on the bed and fell fast asleep. It was like watching Renton allover again.

OCD in children is more common than you think. I believe it’s something that as parents we want to normalize or pretend is not happening, maybe it would even annoy you if it were your child.

Once believed to be relatively rare in children and adolescents, OCD now is thought to affect as many as 2-3% of children. Among adolescents with OCD, the literature indicates that very few receive an appropriate and correct diagnosis, and even fewer receive proper treatment. (http://emedicine.medscape.com )

Once I saw the stress connected to Renton’s behaviors and heard him actually say to me, “Mommy, I don’t know why I am thinking these things! I think bad thoughts about you but I LOVE YOU! Why do I think these things?!” (A VERY classic sign of OCD), then saw the behaviors beginning to surface in Micky, I had to get over my own fear and get help. One of the leading causes of death in children with OCD is suicide. SUICIDE! In children! I would not classify my son’s OCD as extreme or severe – but as with everything in life, it doesn’t need to be extreme to cause intense anxiety.

So if you think your child may be suffering from OCD (and please note, many children go through ritualistic phases as a very normal part of growing up – I’m not suggesting that every child who insists on putting the right sock on before the left has OCD – for that you may need to read Raising your Spirited Child) maybe start by checking out the book Renton’s therapist suggested What to Do When Your Brain Gets Stuck. It’s a fantastic book filled with child-centered explanations and activities. It even helped me recognize some of my own OCD traits I’d been battling my whole life. I’m still learning, too, but I can now leave a pillow tilted ever so slightly awry on the bed and IGNORE the thought that that will somehow cause something terrible to happen to me or my children that day.

Note: I originally got the idea for this blog watching the kids play with Legos. Because I was thinking to myself, if anything would appeal to an OCD child, I would think it would be Legos! But, ironically, Renton is completely NOT OCD with Legos – he doesn’t sort them, doesn’t count them, doesn’t line them up, doesn’t care that his and Emily’s are mixed together, creates unique conglomerations with them, doesn’t even care if he builds according to directions. Once more proving that OCD in children is never “straight out of the box.”

Renton with his Legos - 7 yrs old