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While it is natural for children to worry, sometimes these worries
can take over a child's life, leading to severe levels of fear, anxiety
and stress.

For some children and adolescents, this persistent
anxiety can turn into an obsession, which a child may then try to
relieve by performing certain behaviors repeatedly, which is known as a
compulsion. More than one million children in the United States are
diagnosed with this psychological condition, known as
obsessive-compulsive disorder (OCD).

Just as in adults, OCD
symptoms often appear in kids in such behaviors as prolonged
hand-washing, repeated checking of locked doors and needing to have
personal items neatly arranged in an exact, unchanging order.

Phoebe
Moore, Ph.D., assistant clinical professor at the Duke Child and Family
Studies Center, said OCD can make life highly stressful for a child.

"We've
all had the child who needs a bedtime story read three times in a row,"
she said. "Usually that's normal. It's when it starts causing distress,
when if you don't read the story three times in a row, there's a huge
meltdown.

"They might wash their hands until their hands are
raw," she continued. "Long stints in the bathroom are very common in
OCD kids. Checking again and again to make sure doors are locked. There
are prayer rituals, when the child has to say a special prayer a
certain number of times. And making things even, like if you touch the
left side you have to touch the right side.

"The key always with
childhood mental illness or disorders of thought or feeling is
impairment," Moore said. "School grades begin falling or getting to
school becomes more difficult. A child has less interest in friends.
Family relationships are affected, there are problems at home, you
can't get the chores done, can't get the table set for dinner because
you're too busy washing in the bathroom. OCD starts to really interfere
with the quality of life."

Moore has seen parents become
frustrated and angry at a child with OCD, believing the child should
simply "turn off" the obsessions and cease the constant repetitive
behaviors. But she said getting angry may only make the condition more
difficult to control.

"One of the hallmarks of OCD is that it is
irrational," she explained. "We all know that you don't have to wash
your hands for two hours to get rid of the germs, but OCD is telling
the kid, 'Yes, I do need to wash that much.' So parents get very upset
and may exhort the child to stop or even physically prevent the child
from ritualizing. This makes things more frightening for the child. It
can make rituals more likely to happen or stronger because the anxiety
level has gone up.

"We think the number-one thing to do if you
have a child with OCD is to find a therapist who is trained in CBT, or
cognitive behavior therapy, for obsessive-compulsive disorder," Moore
said. "It's a really effective treatment and teamed with medication,
it's even better."