Children can have OCD, too, but it’s sometimes harder to spot the signs. With the right support, children can better manage their symptoms.
Obsessive-compulsive disorder (OCD) is mental health condition that causes uncontrollable, recurring thoughts (obsessions) and/or behaviors (compulsions) that someone repeats over and over again.
The disorder is often mislabeled or misunderstood because people associate it with traits like perfectionism or tidiness, which is sometimes how OCD is incorrectly depicted in popular culture, movies, TV, and more.
Many people aren’t aware that children can have the condition — which can mean that people miss the signs. In fact, OCD often begins in childhood or adolescence. Around one-third of adults living with OCD developed the condition in childhood.
The American Academy of Child and Adolescent Psychiatry (AACAP) reports that OCD affects as many as 1 in 200 children and adolescents in the United States today.
Even if parents know their child has OCD, it’s easy to feel powerless or unsure of how to help when faced with behaviors they don’t fully understand. The good news is that help is available.
OCD looks relatively similar in children and adults. The disorder has two main characteristics: obsessions and compulsions. To meet the criteria for diagnosis, the obsessions and/or compulsions must be time consuming and interfere with daily life.
Obsessions are intrusive, unwanted, and reoccurring thoughts, worries, or ruminations. These thoughts tend to spiral and feed off each other, which is why someone with OCD finds it difficult to stop thinking about them.
For example, Dr. Eric Hollander, director of the Autism and Obsessive-Compulsive Spectrum Program at Montefiore Medical Center, says, “Younger children may focus on perfectionism; want things to be symmetrical, just-so, or in place; and worry about contamination, including excessive fears of COVID.”
Other children with obsessive thoughts might be preoccupied with worries about doing something wrong or failing at school, worries about bad things happening to them or their families, or thoughts of death and dying.
Some might also have very disturbing thoughts or images swirling in their head, including thoughts of hurting others or sexual images.
Compulsions are defined in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition as repetitive mental or physical acts. For people with OCD, compulsions are often ritualistic and experienced as strong urges to do something in response to obsessive thoughts, and they may not always feel logical.
For example, a child who is worried about an intruder harming them or their family might compulsively check that the windows and doors of their home are locked in order to relieve the discomfort of such obsessive thoughts.
A child who is afraid of COVID-19 might develop rituals that involve repeatedly washing their hands and wiping down their desk at school.
A teen with obsessions about being “perfect” and doing something “just right” might erase or rewrite the same or similar answers over and over on a test, and this may prevent them from completing the exam.
Compulsions often act to manage the anxiety and discomfort that come with obsessive thoughts. Some other examples of compulsions are:
- seeking reassurance or asking the same question over and over again
- confessing or apologizing over and over again
- hoarding things
- saying lucky words or numbers
- arranging and rearranging things
Effects on a child’s life
Together or on their own, obsessions and compulsions can start to interfere with your child’s ability to do their day-to-day activities.
As your child gets older, these behaviors can change as their understanding of the world changes. For example, children in preschool might have compulsions related to meals or bedtime, while school-aged children might develop compulsions around school. Teens, meanwhile, might struggle with completing homework.
But no matter how the condition manifests, by definition, OCD symptoms will interfere with a child’s functioning.
“It takes a lot of their time,” explains psychologist Shagoon Maurya. “It is difficult for them to concentrate on other things, like school, academics, and family. It can be extremely stressful for them.”
OCD in children and adolescents is usually treated with cognitive behavioral therapy (CBT). CBT helps children learn and understand the connections between their thoughts, feelings, and behaviors and develop skills to deal with unhelpful patterns that cause distress.
Treatment for OCD might involve a specific type of CBT called exposure response prevention (ERP). ERP works by carefully and gradually exposing a person to a trigger that often causes obsessions in a safe, controlled environment.
ERP then supports the person in building skills to cope with their distress rather than engaging in compulsions by showing them they’re safe even when they don’t perform the rituals associated with their obsessive thoughts.
“Children can view the OCD as a ‘bully’ and stand up to the OCD by facing their fears and resist doing their rituals,” explains Hollander. Then, over time, “if they resist the compulsions, the anxiety and discomfort will eventually go away on their own.”
For children with OCD, family involvement is critically important, and treatment can sometimes include family therapy so that everyone can be involved in the child’s care and help them improve.
If your child receives an OCD diagnosis, it’s understandable to want to help — in fact, it’s highly beneficial for you to get involved in your child’s treatment. Here are some tips for how to do that effectively:
1. Keep the lines of communication open
Children can sometimes feel ashamed or embarrassed by their OCD symptoms, which can make them shut down, pull away from friends, and stop asking for help from teachers or parents.
It can be really helpful if you try to create a set time to speak in a supportive way and listen to your child about what they’re thinking and feeling. Consider sharing that you’ve noticed certain behaviors and let them know you’re always there to support them without judgment and listen if they want to talk.
2. Be involved in therapy
As mentioned above, your child’s treatment will involve therapy — and parents play a big role in that. Your child’s therapist will be working with your child directly, but they’ll also likely go over how you can practice, reinforce, and support what they’re doing in sessions at home.
3. Try to have patience for the process
Treatment for any mental health condition takes time. The therapeutic process isn’t necessarily fast, and improvement will be incremental but gradual. You may sometimes worry that it’s not working.
It can be helpful to remember that by getting your child CBT with a professional, you’re already doing a lot to help them, even if it doesn’t always feel like it.
4. Try not to enable
As a parent, it’s natural to want to protect your child from things that bring them pain or stress. So if your child is afraid of something, your instinct might be to help.
For example, if your child tends to have obsessions around germs or getting sick, they might ask you to open the door so they don’t have to touch it — and you might be tempted to do that. However, doing so also means you’re participating in their compulsions and rituals and inadvertently reinforcing their OCD.
5. Make sure everyone follows the rules
Your child needs consistent messages when it comes to learning to cope with OCD. It’s important to speak with the whole family, as well as teachers and other caregivers, about your child’s diagnosis so everyone can be on the same page about how best to support your child.
6. Remind yourself it’s going to get better
There will be times when managing your child’s OCD is challenging for both of you.
In fact, it’s almost a guarantee — especially in the beginning — that staying firm and not accommodating will make things worse before they get better. Your child might lash out, feel more distressed, or have a meltdown. This is when being consistent and resisting making accommodations for your child is important.
For example, it might make you late for work or cause a squabble between siblings. It will likely test your patience and even, at times, make you angry.
But whatever happens, try to remember two things: First, your child is not defying you on purpose. They’re doing their best to manage distress, and it’s their mental health condition that is causing them to seem oppositional. And second, it’s normal for you to feel things too. Whether that’s frustration, worry, or guilt, try to give yourself a little grace.
7. It’s OK to get support for yourself too
Some parents find it helpful to seek therapy for themselves because OCD affects the whole family. If you think it might help, consider reaching out to a therapist or support group.
If you’re looking for a therapist but not sure where to start, you can find helpful information at Psych Central’s Find a Therapist resource page.
The good news is that OCD is treatable. There are a lot of resources out there to help you and your child learn more about OCD and how to cope with it.
Consider asking your pediatrician or therapist about OCD support groups or looking for resources, such as: