OCD in children

Obsessive-compulsive disorder (OCD) is a mental health condition marked by anxiety-inducing obsessions and energy-sapping compulsions.

Obsessions are intrusive, disruptive thoughts which recur time and time again. Sufferers perform compulsions to soothe the anxiety brought on by the obsessions. These are performed ritualistically as sufferers believe they will somehow prevent negative outcomes and ease the anxiety. ^[1]

If you think your child has OCD, your first step is to book an appointment with your child’s doctor or mental health provider. They will conduct an assessment which will uncover the cause of your child’s symptoms. ^[2]

OCD in Children

OCD can start at any time from preschool to adulthood, but there typically two age ranges where it first occurs: ^[1]

• Between 8 and 12 years of age
• Between late adolescence and early adulthood

OCD is described as ‘childhood-onset’ if obsessions and compulsions begin before puberty, with most cases forming in the 8 to 12 years age range. ^[1]

Childhood-onset OCD affects 1-2% of children and adolescents, with males predominantly diagnosed. ^[3] After puberty, the sex ratio switches, with more women diagnosed with OCD than men. ^[3]

Signs and symptoms of OCD in children

The primary symptoms of OCD are obsessions and compulsions. These will be exhibited differently from child to child, but it’s important for parents and caregivers to have a broad idea of signs and symptoms: ^{[2] [4]}

Obsessions that a child may feel.

• Excessive fear of germs, dirt, or contamination.
• Excessive concern with symmetry and an aversion to things that aren’t arranged ‘just right’.
• Persistent anxiety about hurting a loved one or friend.
• Disturbing or intrusive thoughts that are difficult to control.
• Persistent thoughts about forbidden or taboo topics

Compulsions

Your child may perform compulsions, or rituals, to try and mollify the obsessions. To the child, these rituals seem to quell the negative thoughts and relieve anxiety. However, over time they result in increased stress levels and greater anxiety. Examples include: ^{[2] [4]}

• Frequent handwashing, bathing, or other cleaning rituals.
• Arranging objects in a specific order or pattern.
• A need to repeat phrases or words to prevent unwanted outcomes.
• Difficulty making decisions and constantly seeking assurances from parents or teachers.
• Touching, fidgeting and tapping things in unusual ways.
• Avoidance of situations or places where they believe ‘something bad’ may happen.

Obsessions and compulsions can severely impair a child’s daily functioning, such as schoolwork, socializing, and family life. Obsessions and compulsions can consume a significant amount of a child’s time and cognitive function. The longer they perform compulsions, the more distress they can feel when unable to perform them. ^[2]

Children may involve their parents, unbeknownst to them, in their rituals. For example, a child may insist a parent performs a certain act a set number of times. ^[2] Others may hide their thoughts, fears, and rituals due to feelings of shame and embarrassment. ^[2]

If you suspect your child may have OCD, reach out to a pediatrician, child psychologist, or mental health professional experienced in working with children to receive a proper diagnosis and develop an appropriate treatment plan. Early intervention and treatment can greatly improve the child’s well-being and quality of life.

Treatment for OCD in children

If you are seeking treatment for a child with OCD, the first step is to talk with a medical professional to arrange an evaluation. ^[5]

A medical evaluation will help a doctor determine whether the child’s symptoms result from a separate medical disorder, mental health condition, or other variable. ^[5] They will also be able to identify whether a child with OCD has a current or past tic disorder. ^[5]

If the doctor provides a diagnosis of OCD, they will typically recommend talk therapy, perhaps in the form of cognitive behavior therapy (CBT), and/or medication. ^[2] They will provide a list of suitable child therapists and you can, together with your child, decide between them.

CBT for children with OCD

During CBT, children with OCD learn how to manage their obsessions without performing rituals. This is typically done using a form of CBT called ‘exposure and response prevention’ (ERP). ^[6].

ERP involves gradually exposing children to their fears and encouraging them to abstain from performing the compulsion they use to ease their anxiety. Over time, ERP has been proven to be a successful treatment of childhood-onset OCD. ^[3]

CBT for children with OCD is thought to work best when families and schools participate in the process ^{[2] [5]}, learning how to show support, help children manage their OCD symptoms, and encourage them to not perform rituals in response to obsessions experienced in everyday life.

The Pediatric OCD Treatment Study concluded that CBT was superior to medication as a sole treatment for children ^[3]. Sessions are typically tailored to suit a child’s developmental needs. For example, some therapists provide nicknames, with OCD referred to as the ‘bad guy’ and the child, caregiver, and therapist comprising the ‘good guys’. ^[3]

Child-friendly modifications such as these offset the more abstract concepts of CBT, allowing for a child to benefit fully from the therapy. ^[3]

Medication for children with OCD

Alongside therapy, doctors may prescribe medication for OCD to some children. This decision is made on a case-by-case basis, with therapy being sufficient for many children.

Selective serotonin reuptake inhibitors (SSRIs) are the frontline medication used to treat OCD in children. Examples include Zoloft, Luvox and Prozac. ^[2]

What causes OCD in children?

It is unclear exactly what causes OCD in children. There are several factors that may contribute to a child developing OCD. These include ^{[7] [5]}

• Neurological discrepancies – Some children with OCD have unusually high activity in their brain or low levels of the neurotransmitter, serotonin.
• Genetic disposition – Studies show you’re more likely to develop OCD if a family member has it.
• Environmental factors – OCD may be more common in people who’ve been abused or neglected. It occasionally starts after a seismic life event, such as a bereavement.
• Pregnancy complications – Some studies suggest that a woman’s health complications during a pregnancy can make OCD more likely. ^[5]

How to help your child with OCD

Helping a child with OCD requires patience, love, and understanding. Here are some tips for supporting your child:

1. Empathize with your child

Let them know you’ve observed a ritual they’ve been performing and tell them you understand how much stress they must be feeling.

Gently, let them know that something called OCD could be causing the anxiety. Raise the prospect of a doctor’s appointment and keep the focus on how if you work together, they will feel better. ^[2] These are some of the first steps towards creating a safe and open environment for your child to express their feelings and concerns about OCD.

2. Consult a medical professional

Take your child for an assessment with a doctor. They will ask questions about your child’s symptoms and, if they have OCD, they will provide a diagnosis. Your child’s doctor can then help you find the right therapist for your child.

3. Participate in your child’s therapy

Family participation in a child’s therapy process has proven to be effective in symptom management. ^[3] Parents can learn how to respond to their child’s symptoms and help them resist compulsions in the real world outside the therapist’s office.

4. Educate yourself

Getting informed about OCD, specifically about how it affects children, is a key step to being an effective support to your child.

Moreover, educating yourself about your child’s OCD can help you feel more at ease with the challenges you will face together as a family. You will learn how to better interact with your child and be better placed to help with exposure therapy at home when the time comes.

5. Seek external support

Reach out to local services in your community. Sharing experiences with other parents of children with OCD can feel validating and instructive. There are also online resources, such as the International OCD Foundation, which can be helpful for families dealing with OCD. ^[2]

How common is OCD in children?

Childhood-onset OCD affects 1%-2% of children and teens. Roughly half a million children in the USA suffer from OCD. This equates to one in 200 children, or four to five children per average sized elementary school. ^[8]