As adults, we remember our childhood days of avoiding stepping on cracks to not “break our mother’s back” or insisting that dad check under the bed every night to ensure the absence of monsters. Repetitive play, superstitions, and ritualistic games are normal parts of childhood. But parents are faced with the question of when do these superstitious and ritualistic behaviors cross the line into more worrisome behavior. What questions should you ask yourself to determine if your child’s fears and ritualistic behavior are normal or whether seeking consultation from a mental health professional would be helpful?
What is Obsessive Compulsive Disorder?
One type of problem characterized by fears and ritualistic behavior is called Obsessive-compulsive disorder (OCD). OCD is characterized by intrusive, troubling thoughts (called obsessions), and repetitive, ritualistic behaviors (called compulsions). Ritualistic behaviors are aimed at reducing anxiety brought on by unwanted, intrusive obsessional thinking. Individuals with OCD usually have obsessions and compulsions, which take more than 1 hour per day, significantly interfere with life, or causes significant distress.
Childhood Superstitions, Rituals, and Fears
Superstitions are ideas and related practices that may resemble obsessions and compulsions seen in OCD, but are generally not considered problematic. Generally, most people have superstitions such as keeping a four-leaf clover for good luck, or avoiding opening an umbrella indoors. Common childhood rituals and superstitious behavior include checking under the bed before going to sleep, touching walls ritualistically while walking, avoid stepping on sidewalk cracks, or repetitively asking “Are we there yet?” on car trips. Similarly, many children experience developmentally normal fears including fears of strangers, the dark, monsters or animals.
Certain superstitions are normal at certain ages. Common rituals at two years old include rigid routines around eating, bathing, and bedtime. At 3-5, children will often engage in repetitive themes during solitary play activities (like lining up cars repeatedly). At 5-6 years, children will often engage in elaborate rules and rhymes associated with games. Children aged 6-11 may participate in superstitious games. Finally, older children may be preoccupied with popular activities or famous people, and rituals related to sports.
How do I know if my child’s fears and behaviors are a problem?
Extreme amounts of ritualistic activities may be obsessive-compulsive behavior. To determine what is problematic, you can ask yourself how often your child engages in the behavior, how much the behavior disrupts life, and how distressed your child becomes when the ritualistic behavior is interrupted or prevented. In terms of emotional responses, children with OCD are usually upset by their fears and rituals whereas children without OCD tend to feel neutral or positive about their ritualistic-like behavior. However, there may be exceptions to this and it is important to consider how much time the child spends doing the ritualistic behavior, as well as how distressing it is when this behavior is prevented.
Childhood rituals are very common, but in some instances, can be problematic and signal a larger problem that warrants clinical attention. In determining if your child’s behaviors may be indicative of more serious problems versus simply age-appropriate developmental behavior, you may wish to ask yourself how often your child engages in the behavior, how much the behavior disrupts you or your child’s daily routine, and how distressed your child becomes when the ritualistic behavior is interrupted or prevented. If your responses suggest that this is a troubling aspect of your child’s life, you may wish to contact a psychologist or psychiatrist trained in OCD treatment for further assessment. There are very effective treatments available for OCD including cognitive-behavioral therapy and medication. Cognitive-behavioral therapy, either alone or with medication, is considered the most effective single treatment for OCD in children or adults.
Eric A. Storch, PhD, is a University of South Florida Health Morsani College of Medicine professor and clinical director of Rogers Behavioral Health–Tampa Bay. For more information on OCD or anxiety, contact Rogers Behavioral Health at www.rogersbh.org or call 844-220-4411.