The need for constant hand washing in schools could lead to Generation OCD

Rigorous handwashing throughout the day, only entering classrooms through one door, walking down school corridors in one direction...at any other time in history, alarm bells might ring if a child was displaying obsessive or rigid and repetitive behaviours.

But as children settle into the new term with essential COVID rules in place, these are sensible precautions to follow. But as a result, could we be storing up another pandemic for our children – that of obsessive compulsive disorder (OCD)? Clinical psychologist Dr Melanie Smart says the number of clients coming to her with symptoms of OCD has risen by 30 per cent in recent weeks. 

"Post-lockdown it’s perhaps understandable that I’m seeing more children not just with OCD but overall anxiety,’ Dr Smart says. ‘It’s important to note that if a child hasn’t got pre-existing anxiety or had a trauma, chances are, all the handwashing and germ avoidance at school is likely to be experienced at benign, normal levels. But for some, the Covid lockdown fits the criteria for trauma, particularly if the child has suffered a bereavement.

"All children will have experienced some form of loss over lockdown – whether it’s the loss of friends or freedom or disruption - therefore parents and teachers need to be on the lookout for any repetitive behaviours and they need to be monitored closely."

Obsessive compulsive disorder involves a person having thoughts or images that are recurrent, persistent, intrusive and unwanted – ie obsessions. 

‘Every single one of us, every day will experience an intrusive thought such as when someone tells you not to touch something hot and a voice says “Go on, touch it!” says Dr Smart. ‘But those with OCD feel a need to act upon those thoughts to prevent something from they fear from happening – compulsions - and the behaviours might be totally unconnected to the feared event. 

‘For example, hand-washing is a rational precaution to prevent the virus. But for someone suffering from OCD, repeating a phrase in the belief that this might stop a loved one catching the virus seems just as rational.’

Children under 12 can particularly vulnerable to the condition. "In the teen years, the frontal lobe of the brain comes online and children develop more abstract reasoning," says Dr Smart. "So older children have a more nuanced understanding about blame and responsibility. But younger children don’t have that ability yet and think in a much more concrete, cause and effect way. They might have a death or a trauma in the family and somehow think that It was something they ‘did’. "

What can you do?

If parents are worried about their child, it may be that they are seeing behaviours around repeating, checking, reassurance seeking, hoarding and arranging. But Dr Smart warns not to panic. "With teenagers you can be direct and ask what’s worrying them, why they feel the need to do something a certain way. With younger children, it’s often good to ask: ‘Why is your brain telling you to do that?’ because that externalises the problem so it’s the ‘brain’ not the ‘child’ doing the behaviour." 

The urge to stop your child from performing their ritual might be overwhelming but it’s not the answer. 

"This will only increase the anxiety," she says. "If they can’t perform the neutralising ‘ritual’ they may just develop a new one. Instead, keep conversation open and playful about anxiety. Tell them that YOU are worried too about the virus but you’re only going to wash your hands once because that’s enough.

"Mess with it a bit if it doesn’t cause distress. Delay the ritual, do extra (four times instead of three), do it backwards etc. This can sometimes prove the futility of it to the child. The key is tolerating uncertainty rather than feeling in control and waiting for anxiety to pass – a big ask for all of us at present!"

However, if there is an impact on functioning and the child won’t go to school or to bed as a result of their compulsive behaviour for example, it’s time to seek professional help. "The NHS can help but waiting lists are long so if you have the means, self-funded support is available," says Dr Smart. "Early intervention is usually successful and can be vital before issues become entrenched."