Open Mind

My 3-year old daughter has a great personality, her development is right on target, but she has some behaviors that cause concern. She is extremely precise about the tiniest of details: her bedroom door must be ajar 6 inches when she goes to bed, her clothes cannot have wrinkles, the sheets must be perfectly stretched on her bed, and other details that children her age don’t even notice. Now that she’s talking better, she can tell us what distresses her, but some of this was going on when she was barely 2 years old. What makes a child this young so picky and how can we minimize it?

Repetitive behaviors are normal in early childhood, providing order and predictability for young children who have little control or understanding. Many want things” just so” or insist on elaborative bedtime rituals. Rituals peak at about two to four years of age. As children get older, their need to rely on ritualistic behavior decreases. Your daughter is exhibiting compulsive behaviors, characteristic of a disorder called Obsessive-Compulsive Disorder (OCD). Obsessions are distressing, unwanted thoughts. Compulsions are repetitive behaviors performed to relieve the dreaded thoughts. One or both may be present in OCD. This disorder usually begins in childhood, occurring in about 1 in 200 children. The distinction between developmentally normal ritualistic behaviors and OCD involves the time and energy it takes to perform compulsions and how much the obsessions and/or compulsions upset or interfere with the child’s daily life. Very young children will perform these rituals in the presence of others. Older children become embarrassed and may deny symptoms of OCD. Regardless of whether this child has or will develop OCD, you need to allow her to perform the rituals without shaming her. At this time, or when the behaviors increase in frequency or intensity, the child should be evaluated by a mental health professional that specializes in children. OCD in children responds well to cognitive-behavioral therapy (CBT) or a combination of CBT and medication.

Sherri G. Harris, MSW, LCSW
Child and Adolescent Psychotherapist
1750 South Brentwood Blvd.
St. Louis, MO
314-968-2111

Children often have certain ways they like things to be, but your description crosses from organized to excessive, and suggests that she gets upset or has a tantrum if wrinkles or messes occur and things aren’t her way. If severe and long-standing enough to cause stress in the family, it’s time to choose a behavior management approach. Her growing communication and language can help teach coping skills that young children understand. You’ll need to first decide which preferences are OK enough to tolerate, and which ones to extinguish using a behavioral plan. Techniques may include rewarding specific flexible behaviors, reminding her it’s OK to make little mistakes, and using storytelling or puppet play to reinforce themes of flexibility and tolerating changes in routine. You might also consider how orderly you are, as children often model behaviors they see in parents, and then take good habits to extremes. Also consider whether there are biological relatives with anxiety or Obsessive Compulsive Disorder (OCD). While your daughter is extremely young for these diagnoses, that possibility should be monitored as she grows. Several types of mental health professionals might be consulted in this case, including a child psychologist for evaluation and a behavioral plan, or a pediatric neurologist for evaluation from a medical/developmental perspective and possible medication.

Karen Hampton, Ph.D.
Licensed Psychologist
Creve Coeur, MO  63141
314-432-5036

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