Childhood OCD: Why constantly reassuring your child could be strengthening their anxiety

A ten-year-old washes her hands, then asks her mother if they are clean. The mother says yes. Ten minutes later, the same question. Another yes. By bedtime, the answer has been given twenty times, and nobody in the house thinks anything of it. That is love at work, not neglect. It is also one of the most common ways OCD gets stronger in children.

Clinicians call it family accommodation. It means changing how the household runs to keep a child's fear quiet. Studies suggest it shows up in most families where a child has OCD, and the more of it there is, the more severe the symptoms tend to be. Children in those homes also tend to respond more slowly to treatment.

The reason is simple. When a parent responds to a worry, the child feels better for a few minutes. The brain takes note. That fear was real, and an adult had to step in. The next worry arrives sooner and asks for more.

Accommodation does not look like a problem many a times. Common examples could be answering the same question over and over again, like "Are you sure I'm not sick?" Maybe opening doors so the child does not have to touch the handle. It can also be washing a school bag or uniform a second time. Or something as simple as buying extra soap or notebooks without asking if it's needed.

Any one of these is easy to excuse. Together they can bend the daily routine around the fear. Mornings stretch by an hour. Bedtimes drag. Parents get worn down and snappy, then feel guilty about it.

Many Indian homes treat cleanliness as a virtue. A child who bathes multiple times in a day or washes their hands many times may be praised for it. Onset in children is often between ages 10 and 14. This is exactly when exam pressure rises. Hence, a child rewriting answers for hours looks hardworking. In joint families, one parent may try to hold back while a grandparent steps in to stop the crying. Here the child learns which adult will give in.

Parents did not cause this. Recent genetic research points to differences in how the brain handles habits and doubt. But not to poor parenting. Blame only gets in the way. A few steps tend to work better for parents to not catalyse this behaviour in their children:

-Parents should not give reassurance. When the child asks if something is clean or if something bad will happen, saying "yes" again and again feels like the right thing. But the child asks again. The OCD gets stronger. Tell the child you understand they are anxious, and politely refuse to answer the same question again.

-Parents also should not join in the rituals. No washing things for the child or checking things for them. Don't change how the house runs just because of the fear. Even a small favour keeps the habit alive.

-Don't force the child to take treatment. If the child is not ready, pushing only brings more resistance. Parents can wait till the child is open to help. Till then, they can seek guidance for themselves.

-Once you pick a specialist, stick to them. If you keep consulting different specialists, the whole process is repeated again.

-Find out how their treatment works. Ask the specialist what each stage is and what the parents have to do at home. If you know the plan, you can support it. Otherwise, you may end up going against it without realising.

-Have patience, but ask about goals. It takes time, and the child's distress can escalate before it comes down. So ask the doctor to set some goals at the start and keep evaluating the progress.

-Check the qualifications of the specialist who works with children. Degrees and a long list of qualifications may not be able to tell you if the person can treat children as well as adults. Ask how many children they have treated. Also, ask what the results were like and how they involve parents.

-Don't make sudden changes to the child's routine. Implement the changes one step at a time after consulting an expert.

Finally, the child, the doctor and the parents are all working for the same recovery. OCD is the problem. The child never is. Distress usually rises before it falls. Hence, a rough first week does not mean the plan is failing.

Not every child will agree to see a therapist, and pushing one who isn't ready tends to make them dig in. Parents can go to the specialist on their own first. They tell the specialist what daily life looks like. They can also ask what to try. In many homes, the child ends up willing to go once things settle a bit.

Here are a few things that are worth asking before choosing an expert. Has the specialist worked with children? What does a session actually involve? What are parents supposed to do at home? How long will it take? Qualifications are important, no doubt. But what is more important is the experience with kids. Once the choice is made, they should give it time. Changing specialists every few weeks usually means starting over. Do note that a child who has to repeat their story again and again gets tired of it. Any worries should be raised with the specialist directly.

(The author is the founder & OCD specialist at Emotion of Life)

The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.