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EspañolChildren's OCD symptoms: What are the early signs of children's OCD?
Overview: What does children's OCD look like?
As in adults, pediatric obsessive-compulsive disorder (OCD) involves intrusive, unwanted, and obsessive thoughts that cause distress and anxiety. They may involve germs, cleanliness, security, or fears of doing something bad. To suppress these intrusive thoughts, the child adopts rigid, repetitious behaviors like repeated washing, changing clothes, organizing objects, praying, counting, avoiding places or things, or constantly seeking reassurance.
A child can develop OCD symptoms gradually, or they can appear rapidly in a day or two. Rapid onset of OCD symptoms happens only in young children. When the symptoms come on gradually, it’s easy to mistake obsessions and compulsions for anxiety, worry, fear, or inattention. Eventually, obsessions and compulsions will seriously interfere with daily life to the point where a child can’t function. On average, people with OCD have symptoms for 11 years before they’re diagnosed and treated.
Key takeaways:
Children's OCD is a health condition that can affect anyone regardless of age, sex, race, or ethnicity. Find updated OCD statistics here.
Early signs of children's OCD include intrusive thoughts, repeated behaviors, continual reassurance-seeking, and highly focused worries.
Serious symptoms of children's OCD such as severe distress, self-harm, risky behaviors, or talking about suicide may require immediate medical attention.
Children's OCD is associated with many factors but seems to be mostly caused by genetics. The immune system is also a significant factor in the development of pediatric OCD. A child may be at risk for developing children's OCD symptoms if that child has a family relative with OCD and especially if there’s a family history of early onset OCD. Other risk factors include a streptococcus infection or other type of infection.
Children's OCD usually requires a medical diagnosis.
Children's OCD generally requires treatment. A child’s OCD symptoms typically improve with treatment but not in every case.
Treatment of children's OCD may include cognitive behavioral therapy, selective serotonin reuptake inhibitors (SSRIs), and additional prescription medications if SSRIs aren’t completely effective. Read more about children's OCD treatments here.
Untreated children's OCD could result in complications like severe disability, low quality of life, academic underachievement, and suicide.
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What are the early signs of children's OCD?
The early signs of children’s OCD may be hard to spot. The defining symptom is intrusive thoughts called obsessions, but it may look like worry, fear, or an anxiety disorder. Common obsessions or fears include:
Worries about germs, infection, or dirt
Fear of disorder or disorganization
Safety fears: whether doors are locked, or appliances are turned off
Fears about doing bad things or doing something wrong
Worries about sin or religion
Concerns about unimportant details
Superstitions
The child may engage in ritualized or illogical behaviors that help them manage or control these thoughts. Called compulsions, these might include:
Repeated handwashing
Repeated showers or baths
Continual changes of clothes
Continually ordering or arranging objects
Continually seeking reassurance
Using rigid rules to perform daily tasks
Counting and recounting
Cleaning
Touching and tapping
Hoarding
Praying
Many other neurological conditions, such as anxiety and autism can cause intrusive thoughts and compulsions. People with eating disorders may have eating obsessions or rituals. Stress can also cause intrusive thoughts. The difference is this: with OCD, intrusive thoughts and compulsions are often bizarre, or they’re so oppressive that the child can’t function.
A child’s symptoms might also include:
Frequent angry outbursts or panic over trivial matters or unimportant details
Coercive behaviors about unimportant issues
Children as young as four can develop OCD, but the usual age of onset is between the ages of eight and 12 and in the late teens and early 20s.
Some children gradually develop symptoms, but other children may develop full-blown OCD in a day or two, a condition called Pediatric Autoimmune Disorder Associated with Streptococcal Infections (PANDAS) if the symptoms appear while the child has a streptococcus infection or Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) if the symptoms are brought on by a different type of infection or immune response.
RELATED: OCD symptoms: what are the early signs of OCD?
Other children's OCD symptoms
OCD is the presence of obsessions, compulsions, or both. They must be severe enough to cause distress and take up a significant part of a person’s day. The thoughts and compulsions must significantly impair a child’s ability to function at school, at home, and with friends.
Children's OCD vs. ADHD symptoms
Both OCD and attention-deficit/hyperactivity disorder (ADHD) often appear in childhood and cause children to function poorly in school, at home, and with their peers. They both may be characterized by an inability to focus, pay attention, or complete tasks. Still, experienced and careful clinicians do not usually misdiagnose one for the other. That’s because they are very different medical conditions with distinctive symptoms.
In short, ADHD causes inattention or hyperactivity because the part of the brain that is responsible for attention, focus, and controlling behaviors is not as neurologically active as it is in other kids. In other words, attention problems are symptoms of ADHD.
OCD causes inattention and poor functioning because the child is preoccupied or overloaded with obsessions and compulsions. The obsessive thoughts overwhelm other concerns like listening in class, remembering instructions, or completing work. In other words, attention problems in kids with OCD are a consequence of their symptoms. The presence of time-consuming obsessions and compulsions is the defining feature of OCD and what separates OCD from ADHD.
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RELATED: Is your child being misdiagnosed with ADHD?
Types of children's OCD: How can I tell which one I have?
There is only one type of OCD though the content of a child’s obsessions or nature of their compulsions can vary. However, the Diagnostic and Statistical Manual of Mental Disorders, (DSM-5), the diagnostic manual for psychiatric disorders, requires mental health professionals to specify the child’s awareness of their obsessive-compulsive beliefs, so a child can be diagnosed with:
OCD with good insight. The child is aware that the obsessive-compulsive beliefs are not true
OCD with poor insight. The child thinks their beliefs are probably true and their compulsive behaviors reasonable
OCD with absent insight. The child is convinced the obsessive-compulsive beliefs are true
When to see a doctor for children's OCD symptoms
Talk to a healthcare provider if the child has unusual symptoms or behaviors. The critical issue is how much their thoughts or behaviors interfere with daily life. If children are struggling in school, at home, or socially, then talk to the child’s pediatrician or other healthcare provider. The doctor may give the child an OCD screening test, but will probably refer the child to a child psychiatrist, clinical psychologist, or other mental health professional.
A mental health professional will diagnose the child’s OCD based on the symptoms, medical history, and a thorough history of the symptoms. The clinician will carefully interview the child, the parents, and possibly others, including family members and teachers. The clinician may also use a structured questionnaire called the Children’s Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) to quantify symptoms, their severity, and how much they interfere with daily life. The clinician will also evaluate the child for other conditions that are commonly found with OCD, including ADHD, autism, and tic disorders such as Tourette syndrome.
RELATED: Finding the right medication for your mental health starts with finding the right doctor
Complications of children's OCD
Left untreated, OCD can significantly interfere with a child’s ability to function and, as an adult, have a job and take care of themselves. Complications of untreated OCD include:
Worsening of the OCD symptoms
Functional disability
Academic underachievement
Low quality of life
Substance abuse
Suicidal thoughts and behaviors
How to treat children's OCD symptoms
OCD is considered a lifelong condition, but treatment of OCD can be highly successful. About 70% of young children, teens, and adults who are treated will experience some easing or significant remission of their symptoms.
OCD in both children and adults is primarily treated with cognitive behavioral therapy (CBT) with exposure and response prevention (ERP). Clinicians may also use high-dose selective serotonin reuptake inhibitors (SSRIs). SSRIs change the chemistry of the brain to allow children to better regulate their thoughts and mood. Cognitive behavioral therapy teaches children skills to test the reality of their thoughts, stop unwanted thoughts, and control compulsions. ERP is a component of CBT and involves exposing the child to situations that provoke obsessions and compulsions. The child then has to engage with the situation and its uncertainties without using compulsive behaviors.
If CBT and SSRIs don’t work at relieving symptoms, a mental health professional may add other medications or treatment options.
Living with children's OCD
An integral part of treating pediatric OCD is training parents, caregivers, and family members about OCD and how to work with the child. It is a very different job than raising a child without OCD, so it involves learning new skills. Living with and raising a child with OCD is a long-term and complicated process, but here are the basics:
Criticizing the child doesn’t usually help, but positive feedback and encouragement do help
Learn about OCD and its treatments—parents achieve the greatest success when they employ CBT with ERP treatment strategies at home
Celebrate small gains—every step forward is a win
Make sure that the child takes all medications as instructed and that all therapy sessions are attended
The CBT specialist may prescribe “homework” between sessions, so help the child with this
Keep a log of all symptoms and possible triggers—share this log with the therapist and other members of the treatment team
Try not to measure the child’s progress by comparing that child with other children—a child with OCD or any other mental illness or disability is on a different learning curve with different goals and timelines than other children
Decrease the family’s engagement with the child’s obsessions and compulsions—do not over-explain, do not react emotionally, and above all, minimize your participation in the compulsions
Decrease the amount of stress and chaos in the family
Most importantly, see a healthcare professional
Always remember that the critical part of mental health issues is how well a child is functioning. Once symptoms are noticeable, OCD can seriously interfere with a child’s ability to get through the day: school, home life, and being with other people. OCD is not about children obsessing about things. Healthy children do that, too. It’s that they obsess about things that aren't normal to obsess about, and they do it too much of the time. It isn’t that they have ritualized or repetitive behaviors. Again, healthy children do that, too. It’s that these ritualized behaviors are bizarre, time-consuming, and interfere with daily life. If a child is struggling, no matter what the symptoms, then talk to the child’s pediatrician or another healthcare professional. It may not be OCD, but it could be another problem that is fixable such as stress, fractured home life, or a medical condition.
What’s next? Additional resources for people with children's OCD symptoms
Test and diagnostics
Obsessive-compulsive disorder, StatPearls
Obsessive-compulsive disorder: diagnosis and management, American Family Physician (2015)
Obsessive-compulsive disorder in children and adolescents: epidemiology, diagnosis and management, Translational Pediatrics (2020)
Signs & symptoms of pediatric OCD, International OCD Foundation
Treatments
Exposure and response prevention (ERP), International OCD Foundation
Medications for OCD, International OCD Foundation
Obsessive-compulsive disorder, StatPearls
Obsessive-compulsive disorder in children and adolescents: epidemiology, diagnosis and management, Translational Pediatrics (2020)
Scientific studies and clinical trials
Don’t judge a book by its cover: ADHD-like symptoms in obsessive-compulsive disorder, Journal of Obsessive-Compulsive and Related Disorders (2013)