Young children often rely on rituals — but when those rituals are upsetting instead of comforting, it could be a sign of childhood OCD.
If you have a toddler or preschooler, you likely depend on a few rituals to get through the day. Your child might eat the same breakfast every day at the same time, put on the same shoe first, and require a story, a glass of water, and a trip to the bathroom every night before bed.
But when rituals become obsessions instead of comforts, and if they impair your child’s daily functioning, something else might be at play, such as obsessive-compulsive disorder (OCD).
According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR), the mean age for OCD to develop is 19.5 years. Around 25% of cases begin before the person is 14 years old. Men have an earlier onset than women, with almost 25% of men developing symptoms before age 10.
The main features of OCD are obsessions and compulsions. Obsessions are intrusive, anxiety-inducing thoughts and compulsions are behaviors (e.g. tapping) or mental acts (e.g., counting or repeating words) the child does to relieve anxiety related to those thoughts.
Some symptoms of OCD in a toddler or preschooler may include:
- an obsession with cleanliness, such as frequent handwashing or fear of germs
- a fear that something bad will happen
- repeated doubts related to the fear of something bad happening, like whether a door was locked or a stove was left on
- the need to check things, like locks or stoves, compulsively
- preoccupation with order or symmetry
Your child may be very upset by these obsessions and compulsions. They aren’t comforting in the way a bedtime ritual might be. They can be chronic and disruptive, and your child may voice their discomfort to you.
According to the DSM-5-TR, up to 30% of people with OCD will have a tic disorder in their lifetime, which is most common in men with childhood-onset OCD.
Blinking or breathing rituals
Blinking or breathing rituals, such as blinking a certain number of times or breathing in a certain way, may be more common in children diagnosed with OCD
These are examples of sensorimotor symptoms, where the obsession and compulsion focus on a bodily function.
- reacting violently to change in the household, such as new furniture or a new car
- responding with rage to certain behaviors, like screaming and crying if the TV is turned on
- forbidding certain behaviors entirely, such as demanding the TV be turned off in their presence
- experiencing intrusive thoughts about hurting themselves or others, known as harm OCD
- impulsive behaviors
Young children might have more frequent contamination obsessions than older children and adults, such as:
- becoming upset by mess or disorder
- imposing strict cleanliness rules on other members of the household
- forbidding certain actions, like coughing, by other members of the household for fear of contamination
Younger children often have more frequent tapping, touching, and rubbing compulsions than older children or adults. These compulsions may resemble tics.
Compulsions may include:
- touching certain objects over and over
- counting over and over while tapping on something
- a preoccupation with patterns of noises
The diagnostic criteria for pediatric OCD are similar to those for adult-onset OCD.
Toddlers and preschoolers often rely on routines, rituals, and structure in their daily lives, so particular attention must be paid to whether those rituals and behaviors are time-consuming (take more than 1 hour a day) and disruptive to their lives.
To receive a diagnosis, obsessions (unwanted, intrusive thoughts or impulses) or compulsions (ritualistic, repetitive actions that a child undertakes rigidly) must be present on most days in a 2-week period.
The obsessions and compulsions are unwanted, distressing to the child (not comforting), and disabling — they are getting in the way of things the child wants to do, like play or school activities.
During the diagnostic process, the mental health professional will ask about:
- a detailed history of obsessions and compulsions
- how much time the obsessions and compulsions take up
- how distressing the symptoms are
- how much the symptoms interfere with the child and caregivers’ lives
- the child’s developmental history
Pediatric OCD is a treatable mental health disorder. Treatment typically involves a combination of psychotherapy and, in some cases, medication.
With ERP, a therapist will safely and gently guide your child toward gradually confronting the things that set off their obsessions and compulsions. An example would be touching something dirty without being able to wash their hands immediately afterward. Over time, the anxiety response tends to lessen.
A 2014 review suggests that CBT is an effective option for treating OCD in children and may reduce symptoms by 40%–65%. It can be effective for children as young as 3 years old.
A more recent
In more severe cases of pediatric OCD, doctors may recommend combining a serotonin selective reuptake inhibitor (SSRI) with therapy.
Only a doctor or psychiatrist can prescribe medication for OCD. If a doctor prescribes your child medication, it’s important to follow guidelines on taking it.
Pediatric OCD is a treatable mental health condition. But if left untreated, the disorder can worsen as a child gets older and enters adolescence and adulthood.
If you think your child may have OCD, consider talking with a pediatrician or therapist. They can help you find the best treatment plan. Treatment often consists of therapy and, in more severe cases, prescription medication.
If you’re ready to get help but don’t know where to begin, consider Psych Central’s guide to finding mental health support.