Here’s what we’ll cover:


What is OCD?

OCD, or obsessive-compulsive disorder, is a mental health condition in which individuals are prone to obsessions and compulsions that are extremely anxiety-provoking. OCD in children is often overwhelming and disruptive to their everyday life as they must navigate the recurring intrusive thoughts (obsessions) and engage in repeated behaviors (compulsions) that the child feels they must do in order to prevent something bad from happening. Many times, kids with OCD experience a combination of both obsessions and compulsions, however, some children experience just one or the other. While OCD can be pervasive, kids with OCD can go on to live happy, fulfilling, successful lives- especially with the right symptom management.

OCD is first characterized by obsessive thoughts. These unwanted thoughts are typically stressful, intrusive, and difficult to control. For example, kids with OCD might worry that they or someone they love will be in harm’s way or even die if they don’t engage in their rituals. Other kids may worry more about everyday problems like making a mistake, germs, or things being out of place. Thoughts and fears are usually irrational but feel extremely real and plausible in the mind of the child.

Along with obsessive thoughts, many kids with OCD are also afflicted by compulsivity. Compulsions, or rituals, can be any kind of repeated behavior or thought done in order to ease anxious feelings. Children with OCD likely feel they have to do certain rituals in order to prevent bad things from happening. Rituals can be things like excessive hand-washing, doing things a certain number of times, or repeating certain words or actions over and over. These can also be cognitive rituals, like engaging in a certain thought pattern or self-talk. When kids are overcome with worry, the compulsions neutralize the anxiety and provide a sense of temporary relief.


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What causes OCD in children?

What causes OCD in children is not yet fully understood. However, genetics and biology are thought to play a role. OCD typically develops during childhood or as a teen, sometimes going unnoticed until later on. Children who have a family member with OCD are more likely to develop the condition. OCD can also come about suddenly following a streptococcal infection (strep) due to a condition called PANDAS (pediatric autoimmune neuropsychiatric disorders). 

Researchers have also found that individuals with OCD appear to have differences in brain activity and structure. Certain areas of the brain, including the prefrontal cortex, basal ganglia, and thalamus, seem to be key players in the condition. More often than not, OCD often occurs alongside other disorders, including but not limited to: anxiety disorders, depression, eating disorders, Tourette’s Syndrome, tic disorders, attention-deficit/hyperactivity disorder, oppositional defiant disorder, panic disorder, and hoarding disorder. While scientists may not fully understand the reason some children develop OCD, there are evidence-based treatment options that help kids to manage symptoms.


Signs of OCD in children

Having a better understanding of the signs and symptoms of OCD can help you identify and seek treatment for the disorder. Thoughts and behaviors that kids with OCD experience, come in all shapes and sizes. They can also change and evolve over time.  For some children, there may be covert signs of OCD, but for others, symptoms can go unnoticed. If children are embarrassed or confused by their OCD, they might try to hide their compulsive behaviors or be hesitant to discuss their anxious thoughts and feelings. Rituals may also be cognitive instead of a physical and therefore can be less likely to see. Regardless of how pronounced symptoms are, when the OCD cycle takes over, parents, caregivers and teachers may notice that engaging in normal daily activities, such as showering or doing schoolwork, become more time-consuming affairs. Here are a few other signs of OCD in children:

  • Fear of yourself or others being harmed, getting sick or dying
  • Fear of dirt, germs, and contamination
  • Obsessive thoughts about order and precision
  • Having special rules for certain tasks
  • Repeated hand washing, showering, or brushing teeth
  • Compulsively checking and rechecking things
  • Repeated actions or words
  • Obsessively counting or touching things
  • Having good/lucky numbers and bad/unlucky numbers


How is OCD diagnosed in children?

Having an accurate diagnosis can lead to appropriate treatment and support for children with this condition. Partnering with a mental health or medical professional that has a background in OCD is the first step in reaching a diagnosis. In order to diagnose OCD, clinicians will utilize the Diagnostic and Statistical Manual of Mental Health Disorders to determine if your child is experiencing obsessions and/or compulsions. They also assess whether or not the behavior is interfering with the child’s daily life. They may utilize interviews and assessments to gather more information from you and your child. The Y-BOCS (Yale-Brown Obsessive Compulsive Scale) is commonly used when determining the severity of a child’s OCD or how they are progressing with treatment. Clinicians may also obtain a family history to better understand what may be causing or contributing to the OCD.

Finding a professional that has a background in OCD can help ensure an appropriate diagnosis and treatment plan is made. The CDC has helpful finder tools that allow you to search for professionals in the fields of psychology, adolescent psychiatry, and cognitive behavior therapy.  Find out more by visiting their website.


Treatment options for children with OCD

Treatment options for children with OCD are typically cognitive, pharmacological, or a combination of both depending on the severity of their symptoms. When selecting the best treatment option, parents should consider how symptoms are impacting their child’s ability to function in different areas of their life. Some children experience OCD alongside other disorders that should also be considered when developing an effective plan.

Cognitive interventions include psychotherapy and counseling. CBT, or cognitive behavioral therapy, is a popular and effective treatment approach for OCD. CBT helps kids learn more about how their thoughts affect their feelings and behavior. Therapists then work with children to rework unhelpful thought parents and replace them with healthier ways of thinking and behaving. 

ERP, or exposure and response prevention, is a CBT strategy commonly utilized as part of the treatment process. During ERP, children are exposed to their triggers or anxiety-producing thoughts, and then practice not reacting to them with a compulsion. Over time, as kids actively choose not to engage in repetitive behaviors or compulsive rituals, anxiety lessens. The process is gradual and done under the careful direction of a therapist. 

Pharmacological interventions may be used in addition to therapy for more extreme cases of OCD or to help with the effectiveness of difficult cognitive interventions. SSRIs (selective serotonin reuptake inhibitors), including medicines like Zoloft or Prozac, may be prescribed. To learn more about different treatment options for your child, speak with a mental health professional or healthcare provider. 

The path to your child feeling better may be challenging at times. Fortunately, there are many types of support available to parents and children alike, from support groups to family counseling. Visit the International OCD Foundation website for additional resources and information.