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James had always been perfectionistic. He couldn't stand not doing things right the first time. His mother tried to get him involved in team sports, but his first episode on the basketball court was a disaster. When he missed a shot, he collapsed onto the court in tears at his failure. His mother had to carry him off. He also tried karate, but when he couldn't master one move on the first try, he quit in frustration. Even small failures were more than he could handle.

James's mother thought that some of his problems were associated with his failure to comprehend time. When he wanted something, he couldn't tolerate waiting. He couldn't even bear to wait the ten seconds it took the computer to boot up. His mother had to give him a toy to distract him until the computer was ready. "He's the most 'I can't wait' person in the world," his mother said. He also had a hard time with the idea of forever. Things seemed to fall into two categories for James: things that would be gone shortly and things that would last forever. Things that would begone shortly included mostly trash and routine garbage. Things that would stick around longer he incorporated into his own sense of permanence.

When someone moved his things, his mother couldn't console him, nor could he console himself. Although she reported that he was a little better now than he had been a year earlier, a minor infringement on the sanctity of his things could still cost James a whole day. His mother kept bags full of broken toys, fearful of his reaction to her discarding them. He seemed somewhat comforted by his stuffed animals, so she often sent two or three of them with him to school in case he had an episode. This caused some trouble at school, however. The teachers complained that he was distracted by the things he brought, so they eventually limited what he could bring to school. Otherwise, James would cram his backpack with toys he couldn't bear to be away from—more of the "just in case" phenomena we've seen in adults.

According to his mother, James bonded with things, especially things in his collections. His favorite collections were his stuffed animals and his Star Wars objects. But he also bonded with anything he could incorporate into his imaginary play. Once a thing was included in his fantasy world, it was hard for him to let it go. From his mother's perspective, these things seemed as important to him as human beings. He talked to them as if they were alive and often assigned them human qualities. Once he picked up one of his Star Wars soldiers and told his mother, "He has a sense of humor." On another occasion, he said of a stuffed animal, "He feels sad." Although this degree of personification is not all that unusual in children, James extended it to a surprising range of objects. One day he started to cry when he spilled his fruit drink on the driveway because he thought it was getting burned on the hot pavement. At one point, he stopped eating for a time because he thought eating would hurt the food's feelings. He couldn't articulate much more than the distress he felt, but his mother observed that these things seemed to have become like parts of his body: they felt pain, and he empathized. We've seen this in other child hoarding cases and also in adults. For example, one young girl believed that her toys would die or feel betrayed if given away or discarded. Another child described his toys as having personalities and opinions. One middle-aged woman feared that the dishes on the lower level of the dishwasher would feel upset because they weren't on top.

James bonded not only with things he owned but also with things he touched. Once when a friend lent him a toy light saber, his mother had to buy the friend a new one because James wouldn't part with the one he'd been loaned.

Even taking James to the grocery store was an ordeal. One day he touched a robot he wanted for his collection and became inconsolable for the rest of the day when his mother refused to buy it. He went through a grieving process even though he had never owned the item.

As in other cases we've seen, there was a history of hoarding in James's family. His paternal grandmother hoarded things for most of her life. Now, at age eighty, she was unabashed about it. James's mother said, "She's the curmudgeonliest person I've ever met." She had strong opinions about everything and wasn't shy about expressing them. Brought up in the Depression, she attributed her saving to frugality and considered it a virtue. She had canned foods from the 1940s and multiple freezers full of food in her basement. Her house was cluttered with newspapers, magazines, and whatever else she could collect. Small pathways cut through the clutter. Several years ago, she added on a room to accommodate all her stuff, but it quickly filled up, and her house was worse than ever. The family had recognized her eccentricity for years and often joked about it, but now they were worried. Even though the conditions in her home bordered on dangerous, no one dared bring up the topic with her.

James's extreme attachment to his things, his family history of hoarding, and his perfectionism fit a pattern repeated again and again among children who hoard. Like Eric and Amy, he felt intensely emotional about objects and sought to control his environment with an unusual ferocity. More recently, his mother began to notice a shift in James. He had an easier time managing his emotions and tolerating other people having control over his things.

At the age of seven, Julian broke his arm while on a hike with some friends. His ordeal involved trips to several emergency rooms over a thirty-six-hour period, and the bones had to be reset multiple times. Through it all, Julian never cried. His father marveled at that. But shortly thereafter, the hoarding started.

His parents first noticed an odd reaction from Julian about some of his Valentine's Day candy. He refused to eat or even unwrap the special red Hershey's Kisses. He asked, "What if they don't come out with [them] again?" Before long, his concerns spread to virtually everything he touched: papers from school, empty milk cartons, napkins, paper plates, paper towels from the bathroom at school, and even empty potato chip bags. When his parents insisted that he throw some of these things away, he began to hide them under his dresser or in his pockets. His teacher noticed this problem as well. After completing a project that produced scraps of paper to be discarded, he would walk up to the trash can and have a hard time throwing his scraps away. On a bad day, Julian could not even part with lint he found on his clothes.

When his parents tried to talk to him about it, he came unglued. The stoic young man who did not cry when his arm was shattered dissolved into a flood of tears when faced with the prospect of parting with the paper towels stuffed in his pants pockets. Before the accident, his mother had noticed some reluctance to get rid of things. It wasn't so much that stuff collected in his room, she said, but that he hesitated before throwing things away. "Broken toys were always an issue," she said. Still, it was no cause for alarm. This new reaction, however, caused them enough concern that they contacted a psychologist for help.

The psychologist asked Julian to draw a picture on a piece of paper. When he finished, the therapist asked him how hard it would be to throw it away. Julian's eyes filled with tears before he answered. He rated the difficulty as 7 on a scale of 1 to 10. The doctor asked him how hard it would be to throw away a blank piece of paper. Julian rated that as 4. Most things the therapist could think of gave him some trouble, the lone exception being used toilet paper.

Julian could offer little in the way of an explanation for his behavior. Initially, he told the psychologist, "I don't know why I have to save things. I just can't throw them away." To his parents, who were good at getting him to talk, he described "that sadness feeling" when he had to throw something out or when he recalled something he had thrown out. At night the feeling kept him awake. "I worry about stuff I might have forgotten about, stuff I didn't save and I think I might need to use. I try to close my eyes and not think about it. I try to think about country music."

Julian's father thought that his son's major worry was waste. Julian seemed obsessed with making sure nothing he handled got wasted, even things such as used napkins. He took personal responsibility for all the materials he used, as well as those his family used. Julian often asked about saving napkins and paper plates after meals. His concern also extended to food. He insisted on finishing the food on his plate, and if other family members didn't finish theirs, he had to eat it, too. In contrast to the other child hoarders we have seen, he had no trouble sharing his toys with others or even giving away or selling old ones. In his mind, they were not being wasted but going to someone who would use them.

Talking with the psychologist seemed to help Julian. His father observed that it didn't make the problem go away, but Julian did accept getting rid of things more easily. After the first session, he asked his parents to throw things away for him when it was just too hard for him to do so.

By the second session with the psychologist, Julian was able to throw some things away himself. But at the end of the session, he told the psychologist he was sad about the things he had discarded. After a few more sessions, things quieted down for Julian, and it looked like the problem was abating. The cast came off his arm, and Julian resumed the more active life he was accustomed to. The hoarding faded into the background, and he was able to throw things away in a normal fashion. His father noticed, however, that he sometimes put things that he knew needed to be discarded, such as empty potato chip bags, on the edge of the trash can rather than inside it. When asked about this, Julian admitted that he didn't want to get rid of them completely.

About six months later, Julian's parents called the psychologist again. Julian had told them that he was having "that sadness feeling" again when throwing things away. His biggest worry was that he would start to cry in math class about the things he had to throw away. Julian had just been moved up to an advanced math class where speedy problem solving, something that had always caused him trouble, was emphasized. Fear that he might fail at this new challenge seemed to have triggered the latest episode of hoarding. After a few weeks in the class, when it was clear to him that he could handle the work, his worries disappeared, and so did "that sadness feeling." The hoarding faded again, though he occasionally asked his parents if they could wash and save their used paper plates and napkins. In contrast to his earlier state, however, he accepted their insistence that the items be thrown away. His father thought it ironic that the day before our interview, Julian was given the class citizenship award for insisting that everyone in the class, including his teacher, recycle water bottles instead of discarding them.

Julian had always been an anxious child with a "nervous stomach," afraid to take risks. His parents had also seen signs of indecisiveness, particularly when it came to spending money. He struggled with what to order at a restaurant or what to buy if he had some money. He showed some attention problems in the first grade and sometimes had to stay in at recess to finish the work he couldn't complete during class. His father described his style as deliberate, like his grandfather's. He wanted things done just right and was careful and meticulous in his work. Despite this tendency, Julian didn't seem perfectionistic in other ways. The only OCD-like rituals Julian displayed were his rigid rules for saying goodbye to his parents. He showered them with multiple hugs and kisses before he felt comfortable parting. If his father did not wave to him at the window, Julian would complain to him later in the day.

In contrast to the other child hoarding cases we've seen, Julian had no family history of OCD or hoarding. His problems with saving seemed closely tied to his general fearfulness and to traumatic events. Small, irrational concerns or habits can spin out of control when people are very fearful. Although Julian's hoarding had ceased to be a problem, his father was cautious: "My intuition ... is that we're not done with this."

The diversity of hoarding behaviors in these children mirrors what we see in adult hoarders. Worries about waste drive some child hoarders. For others, their identities fuse with possessions so that getting rid of something feels like losing a piece of themselves. Most experience an intense need to maintain control over their possessions, and they become extraordinarily upset, even aggressive, when their control is challenged. Most of the parents we interviewed found that getting their children to understand the difficulties their behavior created was a real challenge as well.

Hoarding in children may be more closely related to OCD obsessions and rituals than it is in adults. Two of the cases discussed in this chapter had significant OCD symptoms in addition to hoarding. What little research exists on this topic suggests that up to half of children with OCD hoard. Among adults, somewhere between 25 and 33 percent of OCD patients have hoarding problems. Dr. Eric Storch and his colleagues at the University of Florida found that certain kinds of OCD symptoms, including magical thinking and ordering and arranging compulsions, occur in hoarding children, though not in any of the children described here. This reflects some research on adult hoarders showing an association with symmetry obsessions and ordering and arranging compulsions, like those of Debra in chapter 5.

Outside the OCD sphere, some genetic disorders are associated with hoarding. Hoarding occurs in more than 50 percent of children with Prader-Willi syndrome, a genetic condition associated with the absence of paternal contribution to chromosome 15. Prader-Willi patients typically suffer from mild mental retardation and problems with satiety, resulting in obesity. A high frequency of hoarding in children with autism spectrum disorders has also been reported. Among the cases we reviewed here, only James may have had a mild form of autism. Whether the causes of hoarding are the same for children with developmental disabilities as for those without such problems remains to be seen. Foster care workers have long been aware of hoarding in the children they serve, but no studies have been done to document hoarding among foster children.