Obsessive-Compulsive Disorder in Children

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Obsessive-compulsive disorder (OCD) is characterized by frequent unwanted thoughts known as obsessions. The recurring obsessions then lead to behaviors known as compulsions. For a person with OCD, the obsessions and compulsions are upsetting and interfere with daily life. 

The onset of OCD symptoms can occur at any age, and many people start showing signs in childhood. Knowing the common symptoms can help parents and caregivers identify the mental health disorder early and avoid delays in treatment.

This article will provide an overview of OCD in children, including symptoms, causes, and treatment options. 

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Peter Dazeley

OCD Symptoms in Children

The main symptoms of OCD in children are obsessions, compulsions, or both. Children with OCD often appear tired and stressed because they are fatigued by their frequent compulsive behaviors. It’s helpful to remember that a child’s specific obsessions or compulsions can evolve or change over time. 

Examples of Obsessive Thoughts

Obsessive thoughts that children with OCD may include:

  • Repetitive, unwanted thoughts or images that cause distress
  • Preoccupation with germs, dirt, and staying clean
  • Worries about possible injuries and violence
  • Fear of losing control
  • Superstitions to try to control life outcomes 
  • Inability to make decisions 
  • Concerns related to perfectionism 
  • The belief that rituals keep bad things from happening 

Examples of Compulsive Behaviors

Compulsive behaviors that children with OCD may include:

  • Seeking constant reassurance from a parent
  • Counting while performing a task
  • Checking that the door is locked or that lunch is packed over and over
  • Repeating the same words again and again
  • Excessive handwashing, or excessive showering or bathing
  • Touching or tapping an area at home in a certain way
  • Making up rules that have to be followed 
  • Taking a long time to accomplish tasks like getting ready for school
  • Following rigid routines in the morning and at bedtime 

Causes and Prevalence

For most children with OCD, the exact cause is unknown. Most experts believe that genetic and neurological factors may contribute to a child’s risk. OCD appears to run in families.

Research also shows that children with Tourette's syndrome and other tic disorders may be more likely to be diagnosed with OCD. A child’s risk of OCD may be increased if their mother experienced health problems during pregnancy. 

About 1.2% of American adults have OCD. Of those individuals, about one-third to one-half likely first showed signs of OCD in childhood. Obsessive thoughts and behaviors can begin as early as preschool. 

Diagnosing OCD in Children

Diagnosing OCD in children is not a straightforward process. The process usually involves ruling out other possible causes of the child’s symptoms. 

To get a child diagnosed, parents or caregivers can start by consulting with their child’s healthcare provider or pediatrician when the child’s behaviors seem unusual and out of control. Many children try to hide their compulsions because they recognize that their behaviors are not ordinary. 

To know if your child’s behaviors or habits have become worrisome, observe your child and see if they seem distressed by their thoughts and behaviors. This is a good sign that they need support from a professional. 

If your pediatrician suspects OCD or another mental health disorder, they will likely refer your child to a pediatric psychiatrist or behavioral specialist for an evaluation. Most children with suspected OCD are evaluated for anxiety, depression, and tic disorders before being diagnosed with OCD. 

Treatment for OCD

Children with OCD are usually treated with a combination of therapy and medications. Support for the entire family is also an important aspect of treatment

Therapy

Therapy is usually the first step in treating OCD in children. Research has found that therapy can be as effective as medication in overcoming OCD. Therapy can teach children to think in more helpful ways and reduce their compulsive behaviors. Therapies used to treat OCD include:

Medication

In addition to therapy, many children require medication. Drugs used in treating OCD include serotonin reuptake inhibitors (SRIs) and selective serotonin reuptake inhibitors (SSRIs). These medications can help to reduce OCD symptoms and anxious thoughts. It’s important to remember that they typically take eight to 12 weeks to be effective. 

Medications used to treat OCD in children may include:

The Food and Drug Administration (FDA) has issued a black box warning for the use of antidepressants like SSRIs. Children and adolescents who take antidepressant medications to treat major depressive disorder may have an increased risk of suicidal ideation. Talk with your healthcare provider about the safety of these medications for your child. 

Family Support

When a child has OCD, the entire family is affected. It is helpful for parents and caregivers to participate in their child’s therapy sessions to better understand the obsessions and compulsions. Behavioral specialists can teach a child’s family how to recognize triggers and best respond to the child’s behaviors. 

Parents and caregivers may also benefit from working with a therapist or support group on their own. The  International OCD Foundation has several resources for families affected by OCD.

Summary

Obsessive-compulsive disorder (OCD) involves frequent, repetitive thoughts and behaviors. These unwanted thoughts are known as obsessions, and the resulting behaviors are known as compulsions. It’s estimated that about 1.2% of American adults have OCD. Of those individuals, about one-third to one-half likely first showed signs of OCD in childhood. Obsessive thoughts and behaviors can begin as early as preschool. Treatment options often include therapy, medications, or both. 

A Word From Verywell 

All children have worries and habits. These thoughts and behaviors become concerning when they interfere with your child’s everyday life. OCD symptoms are often distressing for children and their families. Know that you are not alone. Talk with your child’s healthcare provider about family resources like therapy and support groups. 

Frequently Asked Questions

  • Does a mild case of OCD still require treatment?

    A mild case of OCD may require treatment. Talk with your healthcare provider about your symptoms and how severe they are. The first step is to be evaluated by a mental health provider. 

  • Can ERP therapy be done at home?

    Exposure and response prevention (ERP) therapy is most effective when performed in a safe environment with a trained specialist. 

  • What if no progress is made in ERP therapy?

    If ERP therapy does not provide any relief from OCD symptoms, the next step is usually to incorporate medication into the treatment plan.

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7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. Centers for Disease Control and Prevention. Obsessive-compulsive disorder in children.

  3. National Institute of Mental Health. Obsessive-compulsive disorder.

  4. American Academy of Pediatrics. Obsessive-compulsive disorders in children.

  5. Yale Medicine. Obsessive-compulsive disorder in children.

  6. National Institute of Mental Health. Obsessive-compulsive disorder.

  7. Ho D. Antidepressants and the FDA's black-box warning: determining a rational public policy in the absence of sufficient evidence. Virtual Mentor. 2012 Jun 1;14(6):483-8. doi:10.1001/virtualmentor.2012.14.6.pfor2-1206

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