Attention Deficit Hyperactivity Disorder (ADHD) and Obsessive-Compulsive Disorder (OCD) are two of the most common mental health conditions in the United States. ADHD is a neurodevelopmental disorder characterised by problems with focus, hyperactivity, and impulsiveness. OCD is a chronic condition marked by unwanted and intrusive thoughts, emotions, or impulses that lead to repetitive behaviours or compulsions. Roughly 30% of people with OCD have ADHD.
While they have some similarities, they are also two very different disorders. I decided to write this post to explore the link between ADHD and OCD, as well as the symptoms and treatments available for each condition. The ADHD journey for our children is never easy, is it?
What is OCD?
OCD is a neurological disorder characterised by intrusive, unwanted thoughts, obsessions, and repetitive behaviours or compulsions. The thoughts and behaviours are typically unpleasant and can cause significant distress and impairment in daily functioning.
Approximately 2-3 % of all adults are affected by OCD, with 80% of these showing symptoms before the age of 18, in both males and females. According to the International OCD Foundation (IOCDF), 1 in 200 children suffer from it, with a quarter presenting by 14 years old. OCD occurs due to insufficient levels of the neurotransmitter, serotonin and over-activity in the brain.
The most common type is contamination OCD. This type involves unwanted and intrusive thoughts about germs, bacteria, or dirt. These thoughts can lead to compulsive behaviours such as excessive hand-washing, cleaning, or checking.
Other common types of OCD include hoarding OCD, where people have obsessive thoughts about acquiring and saving items; symmetry OCD, where people have obsessive thoughts about arranging things in a particular way; and order OCD, where people have obsessive thoughts about making sure everything is perfect.
People with OCD often perform these compulsions in an effort to relieve the anxiety caused by the obsessions. However, the compulsions only serve to temporarily relieve the anxiety and are not actually effective in solving the underlying problem. OCD can be a very debilitating condition that can interfere with all aspects of a person’s life.
What are the symptoms of OCD?
The symptoms of ADHD and OCD can overlap somewhat, but there are some key differences between the two disorders. The main difference is that ADHD is characterized by problems with focus, hyperactivity, and impulsiveness, while OCD is characterized by unwanted and intrusive thoughts. Another difference is that people with OCD usually know that their thoughts are not rational, while people with ADHD may not realize that their behaviour is disruptive.
The symptoms of OCD can vary from person to person. However, some common symptoms include:
- Obsessions/Intrusive thoughts
Intrusive thoughts are thoughts or images that occur against a person’s will and are often disturbing or upsetting. Intrusive thoughts are not just everyday worries or concerns. The person may know that the thoughts are untrue and illogical, yet they cannot stop them from invading their thoughts.
Compulsions are repetitive behaviours or mental acts that a person feels compelled to perform in order to relieve the anxiety caused by their obsessions. This causes anxiety. Anxiety is a feeling of fear or dread that is usually accompanied by physical symptoms such as sweating, heart palpitations, and dizziness. A person suffering from OCD will often know that their behaviour is not rational and can leave them feeling full of shame and depression. Depression is a feeling of sadness and hopelessness that can lead to changes in behaviour, sleep, and appetite.
ADHD and OCD
People with ADHD may be more likely to have obsessive thoughts about tasks they need to start or complete, yet can’t quite start. Individuals with OCD are more likely to engage in compulsive behaviours, such as checking things over and over again or lining up objects in a certain way.
An individual with ADHD and OCD often have difficulty controlling their thoughts and behaviours. They may feel like they are out of control. This can lead to a great deal of distress and anxiety.
It is important to note that ADHD is a constant in everyday life, whereas OCD is very specific with regard to obsessive thoughts and compulsions.
ADHD and OCD in children
Both ADHD and OCD can occur in children, but they are not always recognised or diagnosed properly. ADHD is often mistaken for bad behaviour or laziness, while OCD symptoms can be mistaken for typical childhood worries and fears. Children as young as five can be shown to have symptoms of OCD. It is important to get a proper diagnosis if you think your child may have either of these conditions, as early treatment can be crucial for success.
Common Obsessions in children include:
- Germs, becoming sick and dying
- Getting unwell and physically being sick
- Loved ones dying, failing a test, manmade disasters occurring etc all unless the compulsions/specific behaviours are completed
Common Compulsions in children:
- Counting and repeating
- Checking over and over
- Hair twisting/Eyelash pulling
- Organising and arranging things a certain way
- Hoarding and not allowing things to be thrown
- Cleaning/washing in an exact pattern or ritual
- Food aversions, having to eat in a certain order; food touching another food; texture
Some compulsions may result in the child being in actual physical pain from over-cleaning and washing; nail-biting; hair twisting and/or pulling; eyelash pulling; picking at dry skin or scabs. I knew a child who would constantly spit on his arm if he got a bad taste in his mouth because he thought he had ‘caught a germ’. His arms would be soaked by the end of the day.
Many children like to arrange their toys a certain way and will get cross with you should you move them. I know my brother use to line up all his toy soldiers and woe betide anyone that knocked one over. However, it becomes a problem if you notice your child doing things for more than an hour a day and it is adversely affecting your child. Oh, and just because your child’s room is a mess does not mean they can’t have OCD. OCD can be neat obsessed and organised or hoarding and not allowing things to be taken away.
There are a number of symptoms that are common to both ADHD and OCD. These include:
– Difficulty concentrating
– Obsessive thoughts
– Compulsive behaviours
While these symptoms may be similar, they are not always indicative of the same disorder. For example, someone with ADHD may sit organising their desk in a certain way because they are procrastinating and cannot actually start the task they have been given. This could also be because they need some order so they are not overwhelmed by all the bits and bobs on their desk. However, someone with OCD may be organising their desk because they need it just right before they start the task.
Because children with OCD tend to overfocus on a small part of a task, needing perfection, and children with ADHD under focus or have difficulty focusing, they both have a hard time finishing the task. But for different reasons. It is so important to understand the reasoning or motivation behind the behaviour so that a correct diagnosis can be made.
Visiting your GP will be the initial starting point. They will need to rule out any other problems that may be causing the symptoms. Be sure to keep a diary and have a history of all things you have noticed about your child’s behaviours as this will help your doctor.
Like ADHD, it can be hard to diagnose OCD due to all the overlaps with other comorbidities. Also, like ADHD, no two individuals will present the same. With ADHD, there is the stereotype of a ‘naughty’ boy bouncing off the walls, and OCD has the stereotype of someone handwashing repeatedly. Let’s remember how differently all our children present!
OCD will be diagnosed if:
- your child spends over an hour per day focusing on obsessive or compulsive thoughts and/or behaviours
- they cannot control these thoughts and behaviours, even though they know they are not rational
- your child doesn’t enjoy these obsessions and compulsions, despite feeling some relief when completed
- they negatively impact your child’s life.
Treatment for ADHD and OCD
There are a variety of treatments available for both ADHD and OCD.
Stimulant medications are often prescribed for ADHD, and they can be effective in reducing symptoms, and improving focus and concentration. However, stimulant medication may worsen the symptoms of OCD, allowing them to focus on obsessions more. If you were in doubt that your child had both ADHD and OCD, this will be a significant indication. If your child does have both conditions, treating OCD appears to be the best way forward. Once these behaviours are under control then medicating the ADHD can commence.
For OCD, a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI) is often used. This medication can help to reduce the intensity of obsessions and compulsions, and it is generally considered to be safe and well-tolerated. Antipsychotics may also be prescribed depending on the severity. Medication for OCD does not appear to make ADHD any worse. In fact, some SSRIs are often used to treat ADHD and depression.
Exposure and response prevention (ERP) therapy is often recommended for OCD. This type of therapy involves gradually exposing yourself to your fears and learning how to cope with the anxiety that comes with them. Confronting their fears and preventing them from carrying out the rituals that follow, or reducing them, is often very successful.
For OCD and ADHD, treatment may include cognitive-behavioural therapy (CBT), medication, or a combination of the two. CBT is a type of therapy that helps people understand and change their thought patterns, beliefs and behaviours. Often this will include family therapy as both these disorders can impact your entire family unit. Gaining the understanding of all members of your family can help. Both ADHD and OCD can really affect a child’s self-esteem. Treating ADHD and OCD as a whole unit can be so beneficial.
For OCD and ADHD, treatment may include therapy, medication, or a combination of the two.
Your GP can direct you to psychological therapies available in your area.
I must admit before looking into this comorbidity I had no idea of the extent and intensity of it. ADHD and OCD both have deficiencies in neurotransmitters, both have a genetic link and both can be debilitating. If you think your child may be struggling with ADHD or OCD, it is important to talk to a doctor or mental health professional. A mental health professional can diagnose and treat these conditions effectively. With the right treatment, children with ADHD and OCD can lead happy and successful lives. I found this link for teens with OCD that I thought I would share too.
I have started a private support group on Facebook for parents and carers who need support with their child with ADHD. It’s a friendly place to chat with others. Please do click this link ADHDinchildren to join. And for anyone on Instagram, I’m there too ADHD Mum.