OCD in Children: Signs, Symptoms, & Treatments

What Is Obsessive Compulsive Disorder?

Obsessive compulsive disorder (OCD) is a mental health condition where a person experiences repetitive, intrusive thoughts called obsessions. These obsessions lead someone to act on their urges, causing compulsive or repetitive behavior. The goal of doing these actions is to reduce the stress and anxiety that comes with these thoughts.^1,2

How Common Is OCD in Children?

Childhood OCD affects around 3% of children and teens.¹ Children with OCD believe that performing compulsions will prevent bad things or reduce anxiety. While these behaviors may temporarily alleviate anxiety, obsessive thoughts eventually return, resulting in a vicious OCD cycle.

If you notice your child expressing intrusive thoughts or engaging in compulsive behaviors, you might start to worry that they have OCD; however, it is important to note that OCD is more than just double-checking or occasional anxious thoughts and odd rituals. Many people who don’t have OCD experience mild intrusive thoughts or urges to do compulsive acts at times, but it doesn’t interfere with their quality of life. For a person with OCD, obsessive thoughts and compulsions are overwhelming, time-consuming, and hard to control.²

OCD Symptoms in Children

OCD involves obsessions and compulsions that are beyond mild worry or checking. They take up significant time, occur regularly, and affect several areas of a child’s life. While children, teens, and adults can all experience OCD, the type of obsessions and compulsions that are commonly experienced by children and teens with OCD may be different than adults.

Childhood OCD Obsessions

Obsessions are intrusive ideas, thoughts, images, or impulses.³ They’re difficult to control and cause significant anxiety. The content of people’s obsessions vary and can change over time. Some people with good insight may be aware that their obsessions are irrational and untrue, while others may not have this awareness.

Common obsessions in children with OCD include:^3,4

• Fear of germs or contamination
• Worry about harming themselves or others
• Need for symmetry or order, like having objects lined up perfectly (often a sign of symmetry OCD or “just right” OCD)
• Fear that something bad will happen if things aren’t done right, such as having to touch a doorknob three times every time they leave the house
• Intrusive thoughts related to religion, such as excessive worry about sinning (called scrupulosity OCD)

Childhood OCD Compulsions

Compulsions are repetitive behaviors or acts that a person does to help alleviate the anxiety caused by obsessions.³ A child with OCD may get some short-term relief from their anxiety after doing the compulsive act, but the anxiety eventually returns. This causes an ongoing cycle of obsessions and compulsions.

Common compulsions in kids with OCD include:^3,4

• Excessive hand washing or cleaning
• Checking objects, like making sure a doorknob is locked numerous times
• Avoiding certain things, like cracks in a sidewalk
• Repeating a word or phrase
• Doing a task a certain number of times
• Doing tasks in a specific order
• Hoarding

Avoidance

Avoidance behaviors are common for children with OCD. It helps them have control and manage their feelings when they are able to avoid things that may cause them distress.

Common avoidance themes include:

• Social situations
• Communication with other children
• Playing with common toys
• Things that can make them dirty
• Things that can make them stand out

Other Feelings Related to Childhood OCD

Children with OCD often experience a range of other emotions in relation to their symptoms, including:

• Being anxious about bad things happening
• Feeling tired all the time
• Getting upset when they can’t perform a ritual
• Constantly seeking reassurance
• Feeling like things have to be “just right”
• Feeling ashamed, guilty, or insecure in social situations due to compulsions

Signs of OCD in Children

Children with OCD might be embarrassed by and try to hide their obsessions and compulsions.¹ This can make it difficult to detect whether or not your child is struggling with OCD symptoms. If you notice an increase in anxiety and new behaviors or rituals, then it’s possible; however, a diagnosis from a healthcare professional is the only way to know for sure.

Parents or caregivers who are concerned about OCD in their child should look for:¹

• Excessive worry and anxiety
• Changes in the child’s habits
• Difficulty concentrating
• Hard time making decisions
• Decrease in school performance
• Less interest in activities or hobbies that they once enjoyed
• Spending less time with friends and family

Signs of OCD in a School Setting

Teachers and school staff might notice signs of OCD in a child’s behavior at school. Here are a few indicators of OCD in a school setting:¹⁰

• Constantly going to the bathroom
• Excessive reassurance-seeking about assignment instructions
• Getting stuck on tasks
• Constant erasing
• Tapping or touching symmetrically (e.g., if someone touches the left side of their desk, they have to touch the right side)
• Rough, dry, red, or cracked hands that may indicate excessive hand-washing
• Inability to choose an answer
• Repeatedly asking the same questions

Childhood OCD Vs. Common Childhood Routines

It is normal for children to have routines around bedtime, mealtimes, or getting ready for the day. In fact, research has long suggested that routines are helpful for children to gain a sense of predictability and order.¹¹ Most children outgrow many of these routines.

However, if a child carries these routines past the typical age, or they become distressing, it might be indicative of OCD. According to the American Psychiatric Association, rituals related to OCD interfere with daily functioning.¹² If a routine is related to washing, symmetry, order, repeating, or checking, it is more likely to stem from OCD.

What Causes Childhood OCD?

Causes of childhood OCD aren’t fully understood, but professionals believe it’s influenced by a combination of biological, environmental, and psychological factors.¹

Brain Differences

Children and adults with OCD display differences in certain parts of the brain, like the frontal cortex, when compared to people without OCD. But more research needs to be conducted to fully understand how brain structure and functioning affect OCD development.⁵

Genetics

Genetics plays a role in OCD development, as people who have a first-degree relative, like a parent, child, or sibling with OCD are more likely to develop it themselves.

Environmental Factors

Environmental and psychological factors are believed to influence the development of OCD in children, too. Some studies have found a connection between childhood trauma and abuse and OCD.⁶ Again, more research is needed to fully understand the connection.

Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS)

In rare cases, children can develop symptoms of OCD after contracting streptococcal infections.¹ This condition is called pediatric acute-onset neuropsychiatric syndrome (PANDAS). When this happens, symptoms tend to come on gradually over a period of months or years. The treatment for PANDAS is the same as OCD that is caused by other factors.

Can Childhood OCD Be Prevented?

While OCD can’t be cured, it can be managed and proactively prevented to a degree if caught early. Exposure and response therapy is a great way to help children learn how to manage their feelings while being exposed to the stimuli that is triggering distressing feelings. It gives kids a safe space to face these feelings and learn coping skills.

How Is Childhood OCD Diagnosed?

If you’re concerned that your child may have OCD, start by speaking to your child’s pediatrician. They’ll be able to evaluate your child and determine whether they should be referred to a mental health professional for further assessment. Keep in mind that the average age that children begin experiencing symptoms of OCD is 10, but children as young as four or five can also develop OCD.⁶

The following people can diagnose OCD in children:

• Psychiatrist or psychiatric nurse practitioner
• Psychologist
• Social worker
• Mental health counselor
• Licensed therapist

To establish a diagnosis of OCD, a mental health provider will conduct a thorough assessment. This may take place over one or more appointments. The provider will ask you and your child questions and may ask to speak with other people who know them well, like your child’s teacher or school guidance counselor. If they determine that your child does have OCD, they will talk to you about the types of treatments available and what they recommend specifically.

OCD Treatment for Children

Treatment for OCD in children may involve therapy, medication, or both.⁷ Child and teen therapy for OCD can help them learn how to tolerate the anxiety caused by their obsessions without engaging in compulsions.

Exposure & Response Prevention

ERP for OCD is the gold standard treatment option.⁸ During an ERP therapy session for OCD, a therapist exposes a child to situations that may trigger their obsessive thoughts. The therapist helps them cope with their anxiety without resorting to compulsive behaviors.

For example, if a child is struggling with obsessive thoughts about feeling dirty, the therapist will coach them through how to manage their anxiety without washing their hands. The goal of therapy for childhood OCD is to reduce children’s obsessive thoughts and need to engage in compulsive behaviors, so they can live a more comfortable and satisfying life.

Medication

Medication for OCD is typically the most effective when combined with therapy. Certain antidepressants, like sertraline and clomipramine, have been found to be effective.⁹ A psychiatrist or psychiatric nurse practitioner who specializes in working with children would be able to discuss the pros and cons of medication and help you determine whether it should be added to your child’s treatment.

Family Therapy

Children interact with many people on a regular basis, so involving these people in treatment through family therapy can be helpful. A therapist may coordinate with your child’s pediatrician, school counselor, and teacher to provide better care. As a parent or primary caregiver, you also play a crucial role in your child’s recovery from OCD, so a therapist will usually request that you participate in family therapy sessions.

How to Help a Child With OCD at Home

As a parent, you play a significant role in helping your child cope with OCD. In conjunction with therapy and medication, you can take steps to help your child work through their anxiety and reduce their obsessions and compulsions.

Here are six ways to help your child cope with OCD:

1. Avoid Going Along With or Accommodating Your Child’s Rituals

When a child has OCD, it’s common for their compulsions to involve the family. Though accommodating these compulsions will lessen your child’s anxiety in the short-term, it will only make things worse. With the guidance of a mental health professional, work on stopping your participation in your child’s compulsions either gradually or cold turkey.

2. Educate Yourselves on Coping Skills

You and your child can benefit from learning tools for coping with OCD and anxiety, like deep breathing and mindfulness. Consider taking a yoga or art class, or find another positive coping activity that you can both do together.

3. Model Good Coping

Your child looks to you as a role model, so be sure that you are modeling how to deal with your own anxiety. If you’re feeling stressed, use the coping skills that you learned together so they can see them working in action.

4. Get Professional Treatment for Your Child

If your child is experiencing OCD and unable to improve with your help, don’t hesitate to find a therapist. Therapy can help them manage their anxiety and cope with their obsessions and compulsions.

5. Seek Help for Yourself

If you’re feeling sad, worried, or overwhelmed by your child’s OCD, you can benefit from getting help, too. Therapy can provide an opportunity to learn ways to cope with your child’s anxiety and support them while also caring for yourself. This also models good habits for your child. You can also join an online support group through an online OCD resource.

6. Be Patient

Treating OCD can be a long process that requires patience and determination. Weekly treatment sessions for 12-15 weeks is the general timeframe in which many children experience improvement, though it varies depending on the individual. Take heart – research shows that over half of children treated for OCD achieve remission, and that overall, remission of symptoms is more common in children than adults.¹³ Getting your child help as early as possible will increase their likelihood of success in treatment.