Key Takeaways Key Takeaways
  • Early-onset Obsessive Compulsive Disorder (OCD) is a common mental illness among children and adolescents, affecting 1% to 3% of this population, often diagnosed after a delay.

  • OCD symptoms in children involve intrusive thoughts, fears of harm, perfectionism, and compulsive behaviors like checking or washing. Behavioral signs may include avoidance, reassurance-seeking, and rituals.

  • The causes of childhood OCD are multifaceted, involving genetic, neurological, and environmental factors. Testing for OCD in children involves assessments by mental health professionals, considering symptoms, family history, and potential contributing factors.

What Parents Should Know About Children and OCD

This content has been updated from the previous article on June 17, 2021.

While popular media would have people believe that OCD exclusively affects adults, children can develop the condition. In fact, early-onset OCD is one of the more common mental illnesses of children and adolescents, with a prevalence of 1% to 3%. It impairs the quality of life of the affected young people but is often diagnosed only after a delay.

Researchers have found that COVID-19 has worsened OCD symptoms in children and teens with the disorder. Furthermore, it appears that some people are developing OCD in response to COVID-19 trauma, even when they did not live with the disorder before. Parents who know about this disorder’s symptoms, causes, and treatment options can look out for signs of OCD in children and help their kids if the problem ever arises.

Symptoms of OCD in Children

In both children and adults, the symptoms of OCD can be categorized into two types: obsessions and compulsions. Obsessions are things that the patient thinks about constantly, even when the thoughts cause distress. The child may have these thoughts at inappropriate times and may even know that the thoughts are illogical.

Children with OCD may have obsessive thoughts about:

  • Being “good enough” or avoiding doing anything bad
  • Their own health and safety
  • The health and safety of the people they love
  • Cleanliness and germs
  • Keeping things in perfect order

These obsessive thoughts often cause or go hand-in-hand with compulsive behaviors. Often, a child believes that performing the compulsions will stop something bad from happening.

For example, a child who obsesses over cleanliness and germs may feel compelled to wash his hand four times after using the restroom. Even when a child knows the compulsion is illogical, failing to complete it causes severe anxiety.

Some common OCD symptoms in children include:

Obsessions:

  • Intrusive Thoughts: Persistent and unwanted thoughts or images that cause anxiety or distress.
  • Fear of Harm: Excessive fears of harm coming to oneself or others.
  • Perfectionism: An intense need for things to be symmetrical or “just right.”
  • Unpleasant Religious or Sexual Thoughts: Disturbing thoughts related to religious beliefs or sexuality.

Compulsions:

  • Excessive Checking: Repeatedly checking things, such as locks or switches, to alleviate anxiety.
  • Counting: Engaging in counting rituals, often associated with avoiding perceived harm.
  • Cleaning and Washing: Compulsions related to cleanliness, often driven by fear of contamination.
  • Ordering and Arranging: Needing things to be arranged in a specific way.

Other Behavioral Signs:

  • Avoidance: Children may avoid situations or activities that trigger their obsessions.
  • Reassurance-Seeking: Constantly seeking reassurance from caregivers to alleviate anxiety.
  • Rituals and Routines: Developing strict rituals or routines that must be followed.

Causes of Childhood OCD

When children show signs of OCD, some parents feel guilty and ashamed. While there is no single known cause of OCD, researchers agree that parents should not feel as though they did something wrong. The exact cause of OCD in children is not well-understood, and it likely involves a combination of genetic, neurological, behavioral, cognitive, and environmental factors.

In some rare cases, an infection can cause pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections, or PANDAS for short. This can cause OCD in children after having strep throat. While this diagnosis is rare and controversial, it’s important for parents to know about the possibility.

How Doctors Test for OCD in Children

If you notice symptoms of OCD in your child, you should know that you do not have to go about this alone. Using a variety of testing and evaluation methods, mental health care professionals can help you determine if your child does have OCD or if something else is going on.  Based on these assessments, you can find a treatment plan that works for your family.

In an effort to find the correct diagnosis, the mental health professional will talk to you and your child about symptoms. They will use your answers to fill out assessments that help determine if your child has OCD. If the child has this disorder, your initial reaction may be fear. However, many families come to feel like getting the diagnosis was a relief and the first step in getting help.

Treating OCD in Children

In treating your child’s OCD, the professional team may recommend medication, individual therapy, and/or family therapy. You do not have to consent to anything that you do not feel comfortable doing, and compassionate professionals will help you find a treatment plan that you feel good about.

The most common medications for OCD in children are SSRIs, including Zoloft. Many therapists recommend Cognitive Behavioral Therapy (CBT) for children with OCD. They learn to recognize negative thoughts, turn them around, and rely on healthy coping mechanisms. Family therapy can also help you and your loved ones learn how to best support your child with OCD.

If a child with Obsessive Compulsive Disorder (OCD) doesn’t receive help, their symptoms may persist and worsen, leading to significant disruptions in daily life. Untreated OCD can adversely impact academic performance, social relationships, and overall well-being.

Compulsive behaviors may become more time-consuming and interfere with normal activities, contributing to heightened anxiety and distress. Left untreated, OCD can lead to increased isolation, depression, and impaired functioning. Early intervention is crucial for effective management, and seeking professional help, such as cognitive-behavioral therapy and, if necessary, medication, can significantly improve outcomes for children with OCD.

Authored By 

LifeStance Health
LifeStance Health

LifeStance is a mental healthcare company focused on providing evidence-based, medically driven treatment services for children, adolescents, and adults suffering from a variety of mental health issues in an outpatient care setting, both in-person and through its digital health telemedicine offering.


Reviewed By

Nicholette Leanza, LPCC-S
Nicholette Leanza, LPCC-S

Nicholette is a faculty member at John Carroll University’s Clinical Counseling program, and she is also the host of the LifeStance podcast, Convos from the Couch.