Obsessive-Compulsive Disorder (OCD) in Children

Many of us may have thrown around the term “OCD” casually to describe behaviors such as being neat and organized, but it is so much more than that. Obsessive-compulsive disorder (OCD) is a very real condition that people of all ages experience, and it can be especially distressing in children. Here, we’ll explore what OCD in children is, what the signs are, and how we can move forward with diagnosis and treatment to make your child’s life experience less stressful.

What is OCD in Children?

OCD in children is a condition rooted in anxiety where young individuals experience intrusive, persistent thoughts and compulsions that affect their ability to function normally in daily life. This condition can develop at any age, ranging from preschool to adulthood, but it is most likely to appear in pre-adolescents.

What Causes OCD in Children?

There is no single cause of OCD, but some research suggests that it has something to do with lower levels of serotonin in the brain. Findings suggested that successful treatment of OCD symptoms was associated with greater serotonin levels [*]. While OCD tends to run in families and can be assumed to be genetic, it also occurs in individuals without a family history of the condition.

OCD Symptoms in Children

Several symptoms may point to signs of OCD in children, including the following:

• Fear of germs, dirt, touching surfaces, and contamination from other people
• Doubting household safety, including locking of doors and turning appliances off
• Focusing on presentation, appearance, and organization (e.g., symmetrical arrangements of objects)
• Believing in superstitions that unfortunate things will happen when unrelated behaviors are performed or not performed (e.g., stepping on a crack in a sidewalk or tapping something a number of times)
• Anxiety about accidentally hurting other people

Compulsive behaviors are also symptoms of OCD in kids. These are repetitive rituals done to ease anxiety caused by obsessions and are often excessive, disruptive, and time-consuming. These may include (but are not limited to) the following:

• Excessive cleanliness, including the need to wash, bathe, or change clothing
• Rituals, including the need to touch body parts, move in a certain way, and achieve symmetry in movements
• Being particular about mornings or bedtime
• Repeating words or prayers to keep bad things from happening
• Constantly seeking reassurance from others
• Avoiding situations where they might think “something bad” will occur

How is OCD Diagnosed in Children?

OCD diagnosis starts with raising your concerns with a child psychologist or a mental health expert. They will do interviews as well as a mental health evaluation of your child and determine if the obsessions and compulsions are continuous, severe, disruptive, and harmful to your child’s daily living. According to the Diagnostic and Statistical Manual of Mental Disorders, a diagnosis of OCD “requires the presence of obsessional thoughts and/or compulsions that are time-consuming (more than one hour a day), cause significant distress, and impair work or social functioning [*].”

However, diagnosing OCD is not always straightforward because some children are secretive about their behaviors. OCD also co-occurs with other mental health conditions, such as autism or Tourette’s, so clinicians must determine what is truly OCD and what is related to other disorders.

How is OCD Treated in Children?

Treating OCD in children will depend on each child’s symptoms, age, and general health. It will also depend on the severity of the condition.

OCD treatment is usually a combination of the following:

• Cognitive behavioral therapy (CBT). Cognitive behavioral therapy is widely regarded as the first line of treatment of OCD for mild to moderate cases in children and adolescents [*]. Cognitive methods can help a child identify and understand their fears. It can also teach children new ways to reduce those fears better. Behavioral methods help children and their families make new rules to limit or change behaviors caused by OCD, such as setting a maximum time for a hand washer to wash his or her hands.
• Exposure and response prevention therapy (ERP). ERP is a form of CBT that is used to treat OCD. The goal of ERP is to gradually expose children to their obsessions in a safe and controlled environment. This type of therapy encourages children to face their fears and let obsessive thoughts occur without responding to them with compulsions. As children undergoing ERP learn to handle their obsessions more and more, therapy gradually becomes more intensive.
• Family therapy. Family therapy can provide plenty of support for a child dealing with OCD, and parents play a crucial role in the treatment process. Parents may also opt to have the school get involved with the overall care process.
• Selective serotonin reuptake inhibitors (SSRIs). SSRIs are medications that help regulate and raise serotonin levels in the brain, which can be beneficial for children who have OCD.
• Antibiotics. OCD may be linked to a streptococcal infection [*]. In this case, they will have to take antibiotics.

How to Support a Child with OCD

Supporting your child with OCD is vital to helping them manage the condition. Here are a few ways you can show support:

Talk to your child

Speak to your child in a way that shows you are listening to how they feel. State your observations with love and understanding. You might say something like, “I notice you are washing your hands more often. Having to clean them so much may be causing you a lot of stress.” Tell them that something called “OCD” might be causing the worry they feel. Let your child know that you want to help them feel better.

See a professional

Set an appointment with a child psychologist. Your child’s pediatrician can usually refer you to a mental health professional who can address your concerns. They will spend time talking to you and your child and ask questions about the symptoms your child may be feeling to diagnose OCD correctly. If they conclude that your child has OCD, then they can also explain the treatment.

Be patient

It is important to be patient because overcoming OCD is a process. You can expect many therapy visits, and it is essential that you are present in all of them. Help your child practice the strategies that the therapist shows you, and be sure to praise your child’s efforts. Show them that you are proud and remind them that OCD is not their fault.

Get involved

Get involved in your child’s therapy. This is especially important since it is part of treatment to coach parents on how to respond to a child’s OCD symptoms. Learn everything you can about ways to help and how to support your child’s progress.

Reach out for support

Having a support system is extremely important in the treatment of OCD. Reach out to local community services and even other parents who may be experiencing the same thing.

Frequently Asked Questions

Here are some commonly asked questions about OCD in children.

How prevalent is OCD in children?

The prevalence of OCD in children and adolescents ranges between 1% to 3%, and about 20% of young people with the disorder develop the condition at age 10 or earlier [*].

Are there different types of OCD in children?

There are different types of OCD that children may suffer from. There is fear of contamination, fear of harming others, ordering or arranging objects in specific ways, compulsive checking for completion, and aggressive or violent thoughts. There are also conditions similar to OCD, such as hair pulling and skin picking.

At what age can OCD symptoms first appear in children?

OCD can occur at any age, but generally, it happens between ages eight and 12 and between the late teen years and early adulthood.

The Bottom Line

OCD is a condition that may cause significant distress to your child, but the good news is that it is treatable and can be managed well with the right combination of treatments. It is key to spot it early on so that the appropriate interventions can be implemented. Getting involved is also essential as parents have pivotal roles in the treatment of this condition. When in doubt, reaching out to a mental health professional for an assessment is always the best decision.

References:

1. Lissemore J, Sookman D, Gravel P, et al. Brain serotonin synthesis capacity in obsessive-compulsive disorder: effects of cognitive behavioral therapy and sertraline. 18 April 2018.
2. American Psychiatric Association. What Is Obsessive-Compulsive Disorder? October 2022.
3. Nazeer A, Latif F, Mondal A, et al. Obsessive-compulsive disorder in children and adolescents: epidemiology, diagnosis and management. February 2020.
4. Vogel L. Growing consensus on link between strep and obsessive–compulsive disorder. 22 January 2018.
5. Walitza S, Melfsen S, Jans T, et al. Obsessive-Compulsive Disorder in Children and Adolescents. 18 March 2011.