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Obsessive-Compulsive Disorder (OCD) in Children and Teens

All kids feel anxious or worried at times. For some, anxious thoughts won't go away. And with these thoughts, your child or teen may feel an intense need to repeat very specific actions. They may not be able to explain why, but often they feel it is to protect themselves or someone they love.

This pattern of recurring thoughts and behaviors can mean a child is struggling with obsessive-compulsive disorder, or OCD. Parents and caregivers are often the first to notice possible signs of OCD in kids. Since getting care early is the key to supporting a child's lifelong health, it's important to take action if you're concerned your child might have OCD.

Here's what you should know about this condition and what to do if you believe your child might need help.

Understanding what OCD is (and isn't)

OCD is an anxiety disorder that affects an estimated 1% to 3% of all children and teens. It often affects kids who have other developmental-behavioral conditions such as ADHD, depression, bipolar disorder or eating disorders.

People sometimes confuse OCD with a personal preference for keeping things neat, clean and organized. But in reality, OCD is a brain-based condition that doesn't leave room for choice.

Kids with OCD live with unwanted (obsessive) thoughts that fill them with fear and anxiety. These thoughts trigger strong urges (compulsions) to do things they believe will protect them or someone they care about, or at least make the bad thoughts go away for a while.

A child with OCD might compulsively check doors and windows to keep loved ones safe or wash their hands again and again, convinced that dirt and germs might harm them. They might count out loud or repeat a series of words, believing that something bad will happen if they don't. Actions like these may not seem logical, but the child's brain is sending them strong signals that are virtually impossible for them to ignore.

A closer look at OCD symptoms

Concerns about OCD often begin when parents, caregivers or teachers notice that a child or teen:

  • Does things over and over again until they are "just right"

  • Orders or arranges objects in a very specific way

  • Questions, judges or criticizes themselves harshly

  • Apologizes constantly or seeks reassurance

  • Has strong emotional reactions to small things

  • Struggles to make choices, even minor ones

Kids with OCD may have trouble sleeping, getting ready for school and other activities on time, or completing homework and everyday chores. Older kids might stay up late, trying to finish tasks they couldn't get done earlier. These patterns can trigger family conflicts, adding to the anxiety that kids, parents and even siblings may feel.

Finding help for your child with OCD

Talk with your pediatrician if you are worried that your child might have OCD. Pediatricians are familiar with anxiety disorders in children and teens and can support you and your family in getting proper screening and care.

Your child's doctor may refer you to a developmental-behavioral health specialist who will look for specific signs that point to an OCD diagnosis.

Generally, OCD is diagnosed when:

  1. A child cannot control their fearful thoughts and compulsive actions

    • They spend at least one hour a day dealing with them

    • Repeated behaviors and rituals don't offer them pleasure or satisfaction (thought they may feel momentary relief)

  2. Symptoms are causing significant struggles at school, home, and in the child's relationships with others

How OCD is treated in children and teens

Finding and treating OCD early can give your child a real advantage in learning new skills that can ease the disorder's impact on everyday life.

Many kids with OCD benefit from a form of cognitive behavioral therapy called exposure and response prevention (ERP). This treatment helps them face their fears without giving in to compulsive responses.

In ERP, a trained professional, such as a psychologist or social worker, may gradually expose a child to a recurring thought in a safe setting, giving them the chance to see that bad things don't happen when they don't automatically launch into their usual behaviors. Gradually, this reduces anxiety and gives kids a greater sense of control over their thoughts and actions.

A subset of children benefit from combining talk therapy with a daily medication to control symptoms and foster healthy adaptations.

Working as a family to support your child (and each other)

There are many things family members can do to create a supportive environment for kids with OCD. Here are some suggestions to consider.

  • Reframe what you see. It helps to remember that kids with OCD have imperfect control over their thoughts and actions. If family members can see fears and compulsions as OCD symptoms, rather than choices the child is making, it will be easier to avoid criticism and blame. This way, you can help your child manage their symptoms rather than hiding them out of shame or fear.

  • Address stress at the family level. OCD symptoms get worse when overall stress and anxiety are high. Embracing family practices like quiet hours, regular mealtimes, soothing bedtime routines and other forms of self-care will benefit kids with OCD.

  • Consider creating a family contract. This is an agreement that outlines concrete ways you can reinforce the positive skills your child learns in therapy while promoting family harmony. Having a contract can ease conflicts that may have built up over time as family routines became overly focused on a child's OCD-driven symptoms or demands. You can map out what family members will and won't do when a child is feeling anxious and ways to offer praise and encouragement for progress.

  • Find support for yourself. Raising a child with OCD can be very challenging. This is why many parents and caregivers seek out support groups where they can speak freely about their concerns and learn what works for other families. Ask your pediatrician for resources that can help you manage your own stress level—a step that will benefit you and your child.

More information

Last Updated
American Academy of Pediatrics Section on Developmental and Behavioral Pediatrics (Copyright © 2023)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
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