What is OCD in children?

OCD causes children to have obsessive thoughts or compulsions in an attempt to minimize distress from intrusive thoughts (obsessions).

While many children experience intrusive thoughts or habitual behaviors from time to time, these behaviors are cause for concern when they begin to cause distress for children and their families.

For instance, a child might perform behaviors to minimize distress, like avoiding going to certain places to prevent obsessive worries all together. These behaviors or avoidance tactics can unintentionally result in children being excluded in social situations and cause difficulties at home or school.

What are the signs of OCD in children?

Here are some behaviors that suggest a child may have OCD.

Obsessive thoughts:

• Constant checking to make sure things are safe, such as whether doors are locked, windows are shut, appliances are off or homework is completed.
• Fear of germs or contamination from people or surfaces.
• Worries about unintentionally hurting someone close, like a parent, sibling or friend.
• Fear of a loved one dying or leaving.
• Believing that bad things will happen if they don’t perform certain actions, like counting a specific number of times or touching objects in a certain way.

Compulsive behaviors:

• Performing rituals, like moving or touching body parts in a specific way or making sure movements are symmetrical.
• Arranging items to be “just right” or in a certain grouping or order.
• Repeating words or sayings to prevent bad things from happening.
• An excessive need to wash, shower, or change clothes to stay clean.
• Constantly seeking reassurance from parents, teachers or others.

Children with OCD may display these behaviors on a regular basis, especially when they are unable to perform rituals. Their mood may be:

• worried
• frustrated
• irritable
• sad
• tired

How is OCD diagnosed in a child?

If your child displays these behaviors regularly, check with your pediatrician about next steps. They may suggest talking to your child about their behaviors or, for more severe cases, suggest speaking to a psychologist, psychiatrist or other mental health professional with OCD expertise. OCD affects 1% of children and causes significant impacts to a child’s daily life. Pediatric OCD is more common in boys than in girls, with girls more likely to develop OCD in their teens and 20s.

What causes OCD in a child?

The cause of OCD in children is unknown, but there are several factors that could influence the development of this condition.

Genetic: OCD tends to run in families, and there is research linking genetics to the occurrence of OCD. However, many children who develop OCD do not have a familial history of OCD.

Neurobiological: There are specific brain regions and neural circuits that are associated with OCD symptoms and severity.

Learning: The routines, rules and rigid behaviors associated with OCD serve to reduce distress caused by intrusive obsessions, and these routines can be reinforced and become learned behavior patterns.

How is OCD treated in a child?

Cognitive Behavioral Therapy (CBT)

Cognitive behavior therapy teaches children and parents therapeutic skills to target OCD symptoms in a step-by-step manner. First, children and parents learn information about OCD and the cognitive-behavioral treatment approach. Next, children and parents work together to identify current OCD symptoms to develop a road map for treatment. Afterward, children and parents practice new cognitive and behavioral strategies in situations that mimic OCD-related distress — without engaging in compulsive behaviors or avoidance. Over time and with repeated practice, the OCD-related distress caused by these situations lessens. CBT is recommended as the front-line treatment approach for pediatric OCD, and has demonstrated considerable therapeutic benefit in randomized clinical trials.

Medication

Medications called serotonin reuptake inhibitors (SRIs) have been shown to reduce OCD symptoms and severity. Your health care practitioner may prescribe medication along with CBT to help your child overcome OCD symptoms.

Can children grow out of OCD?

Children will not outgrow OCD on their own. However, with treatment and time, children and parents can learn effective strategies to address OCD symptoms. As OCD symptoms may increase during times of stress or transition (e.g., starting a new school year, feeling sick), parents should watch for symptoms during stressful times. Untreated OCD can contribute to development of other mental health conditions, such as anxiety and depression in adulthood, so early treatment is important.

How can I help my child with OCD tendencies?

Listen. Let your child tell you what is wrong and what they fear.

Seek help. Talk to your pediatrician about your child’s symptoms, and see what the doctor recommends.

Reassure. Most importantly, reassure your child that while these thoughts and behaviors are distressing, there are proven treatments to help them get better.

Reinforce. Help your child review and strengthen skills learned in therapy.