With OCD, obsessive intrusion creates the distraction in students that are affected by this condition, placing it with the ILD. Older patients can be very sophisticated in suppressing the symptoms of the condition. The inattention is readily recognized during activities that require increased cognitive functions. The onset can be gradual or sudden, with a waxing and waning pattern, but usually worse under stress. It usually affects boys age 6 to 15 years old, and females, 20 to 29 years old. Compulsive rituals such as checking, cleansing, ordering, and hoarding are the most common signs. For example, it is highly unusual for a 10-year-old boy to keep a well-groomed room, to be washing hands or taking frequently showers.