Hoarding in Children

When we think of hoarders, we visualize an adult who has filled a home with so much stuff — a lot of it worthless — that it’s difficult, if not impossible, to walk, sit down, or, say, cook or eat dinner. But children can be hoarders, too. Sometimes as young as 6 or 7 years old. And while children who hoard don’t have the run of the house in which to stash their compulsively acquired things, as adults do, they fill up their rooms, until functioning is seriously impaired.

When a child is referred over concerns about hoarding, says Jerry Bubrick, PhD, a clinical psychologist at the Child Mind Institute, he asks a series of questions.

• Can you see the floor in your room?
• Can you get clean clothes out of your closet, or is it so packed with stuff that you can’t get in there?
• Can you sleep in your bed, or is your bed temporary storage for everything?
• Can you do your homework at your desk, or is your desk covered with all kinds of stuff?

But it isn’t just the volume of things stashed in a child’s room that differentiates one who’s hoarding from one who’s just disorganized or messy. It’s the way the child feels about the things he saves, and his reaction when someone makes him throw things away. “Parents bring their kids in because the kids are crying when the garbage is collected,” Dr. Bubrick says.

Most kids who have a lot of stuff that’s not well organized don’t get upset if someone occasionally cleans up and puts things away. But children who hoard do. “A hoarder is going to believe, on some level, that either they were violated — how dare someone touch their stuff? — or they feel like they lost a sibling,” Dr. Bubrick explains. “A possession is like a loved one.”

Dr. Bubrick gives an example of a child who saves cardboard tubes from rolls of paper towels. “I’ve seen kids hoard 50 or 100 of those things under the couch. They might think they’re fun to play with or they might think they would use one later. Parents might say, ‘Well, listen. You can keep two, but we’re going to throw away 98.’ Most kids would be okay with that. The kids who are hoarders are going to be devastated.”

Kids who develop hoarding disorder may not only become severely anxious and distressed if things are taken away, they may have tantrums, crying and yelling, or they may even lash out in a panic, kicking or hitting parents or breaking things.

Kids who are hoarders tend to pick up and pocket things on the street – coins and sticks and acorns, etc. — that end up in piles at home. Dr. Bubrick describes the pattern of making piles as “here for now.”

The child, he explains, thinks, “I’m not sure what I’m going to do with it. I don’t know where it goes, so I’ll put it here for now.” Eventually, there may be hundreds of things in those piles.

Part of the reason for keeping things “here for now” is that kids who are hoarders worry that if they put things in a drawer, they’ll forget about them. And that might upset the things, which have feelings, too. “If something is locked up in a drawer,” Dr. Bubrick adds, “it might get lonely and it might miss me or it might miss the other possessions.”

Some objects are cherished because they are reminders of a happy experience. “This rock reminds me of the time I went on the walk in the park with my dad,” Dr. Bubrick notes. Or “This pizza box reminds me of the sleepover I had with my friends. If I throw away the pizza box, it’s like throwing away the memory.”

Experts note that children begin collecting things at a young age — typically things like stuffed animals, stickers, toy cars, dolls, action figures or cards — and collecting can play a positive role in development. It helps children learn to categorize, develop expertise in a subject, practice organizational skills, develop a sense of control and mastery, and build identity. Children who collect show pride in their collections. They like to share them with others, and talk about them.

Children who hoard, on the other hand, do not organize their possessions, and they often feel embarrassed or uncomfortable letting others see or touch their things. Since their ability to purchase things is limited by parental spending limits, they acquire large quantities of things that have no perceived value to other people or are considered waste. And kids who are hoarders often don’t understand why they’re doing it.

Hoarding is related to OCD but, unlike OCD, kids aren’t compelled to hoard in order to alleviate anxiety. “The feeling they have when they pick something up is a sense of desire. That thing looks cool. I really want it. Or I need it. This could help me in some way,” Dr. Bubrick explains. “The anxiety comes when they’re forced to get rid of it. Or when someone moves it around, or touches it without their permission.”

When hoarding, which is an anxiety disorder, appears in children as young as 6 or 7, it’s usually alongside OCD or some other anxiety disorder. Children who develop hoarding disorder alone are usually tweens or older.

It’s not unusual for kids who hoard to be children of hoarders. About 50 percent of individuals who hoard, according to the DSM-5, have a relative who also hoards. When treating children for hoarding, clinicians often find that even if parents may not be diagnosed, they meet the criteria for hoarding.. “Sometimes,” says Dr. Bubrick, “we have to treat parents to help the kids.”

The first-choice treatment for hoarding, as with OCD, is a form of therapy called exposure with response prevention, or ERP. Children bring in things they have been saving (or have collected in their pockets on the way to therapy) and rate them, on a scale from zero to 10, by how much they feel they need them. Then, beginning with the least cherished, they work on letting them go.

In the beginning, Dr. Bubrick suggests that he hold onto the chosen items in his office, and the child tries living without them for a week to see how he will feel. “Most kids, in the beginning, will say, ‘That’s going to be too hard! I can’t do it! No way!’ Then, they do it and it’s hard for a day or two, and then they realize they can do it.”

These exposures help weaken the child’s belief that he can’t live without these things. A reward system gives kids points towards something valuable to them — including an activity they particularly enjoy — if they’re able to discard a certain number of things a day.

The goal is to slow down the acquisition and help kids to understand that an object could be attractive or possibly valuable, but still not something they have to own. “That’s the difference between need and want,” Dr. Bubrick notes. “With hoarders, we have to add on ‘Do I have room for it?’ Sometimes we’ll make deals with kids that if you really believe that you want this thing and/or that you need it, then you have to make room for it by getting rid of something else.”

One important aspect of treatment is that, despite what you see on misleading hoarding shows on television, therapists don’t judge the value (or lack of same) of what patients collect. There is already a lot of shame in hoarding.

“We would never say, ‘What are you holding onto this for? This is ridiculous. Just throw this away,’ ” Dr. Bubrick notes, “because the patients already know that what they believe about their possessions is not what other people believe.” Shaming them further is not going to help.

The end goal of therapy is for the need to hoard to diminish, and for the kids to develop flexibility, to be able to throw things away, limit how much new stuff they acquire, and keep their rooms livable.

But it helps if parents are flexible too, Dr. Bubrick adds, “to give kids some latitude, short of being cluttered and dangerous. After all, we’re not looking to have kids be living in museums.”