While OCD is reported to occur in children at a rate of 1%, it seems much more prevalent, particularly if one includes the OCD spectrum disorders mentioned above. These children suffer from the same symptoms as adults, getting preoccupied with germs, bad thoughts (e.g., a parents death), rituals (e.g., perfect handwriting, counting rituals), and as they move into adolescence are more likely to exhibit eating disorders and addictive disorders. It can be quite disturbing and become associated with depression, social withdrawal, and poor grades. Given the immune system issues discussed above, all children with OCD should have a thorough evaluation of their gastrointestinal system, nutrition, and immune system. Excessive doses of stimulants can cause obsessive-compulsive behavior.