All kids have worries. When a child or teen continues to have big worries or seem stuck in a cycle of thought, in spite of talking it through and attempts to stop, you should seek help. One mental health condition that causes big worries and repetitive behaviors is obsessive-compulsive disorder.

What is OCD?

Obsessive-compulsive disorder (OCD) causes excessive worrying or intrusive thoughts (obsessions) that often leads to rituals (compulsive behaviors). These repeated behaviors help the child feel like they are keeping bad things, or negative thoughts, from happening. These obsessions and rituals often impact children at home, at school and in other parts of their life.

What are the signs and symptoms of OCD?

OCD in kids is usually diagnosed between the ages of 7 and 12 years old. It’s possible for kids to have obsessive thoughts without compulsive behaviors. It’s also possible for compulsive behaviors to be invisible to a parent or caregiver, such as the child counting to a specific number in their head.

Here’s how to look out for the most common signs of OCD in children and teens.

For kids and teens with OCD, common obsessions are:

  • Fear of dirt or germs (they may feel contaminated by people or touching certain objects)
  • Intense focus on faith, spirituality or religious rules or practices (disrupting life)
  • Talking about/worrying over body wastes
  • Sexual or violent thoughts
  • Worries about sickness, accidents or injuries happening to themselves or relatives
  • Strongly desiring things to be orderly, precise or lined up
  • Preoccupation with household items
  • Intrusive sounds or words
  • Lucky and unlucky numbers

These compulsions are the most common among kids and teens:

  • Spending time cleaning their bodies, such as brushing their teeth, bathing/showering or washing their hands
  • Counting repeatedly out loud or silently
  • Touching certain objects or items a certain number of times before moving on
  • Checking rituals like making sure that homework is done and put away multiple times or looking over and over to see if a door is locked
  • Collecting items or objects of little value and being defensive about them being changed, moved or removed
  • Performing rituals to prevent harm to themselves or to others or to “undo” contact with a “contaminated” person or object
  • Repeatedly cleaning certain areas of the house or certain items and having to do it in a certain way or at certain times
  • Arranging objects in a particular way or order and getting very upset when that order is “messed up” or changed
  • Repeating behaviors, like only going through a room in a certain direction; reading then rereading or writing, erasing and writing again; or having to touch the doorframe before moving through a doorway

Rituals may initially seem to help your child feel better about their obsessive thoughts. But rituals and compulsions can expand and build on each other over time, taking up a lot of your child’s energy and preventing them from doing the things they want to do.

What should I do if I’m worried?

  • Talk to your child in a loving way about the behaviors you’re noticing. You might say something like “I’ve noticed that you flip the light switch many times each night before bedtime. It seems stressful to you when I turn the light off instead.”
  • Tell your child that you’re going to make an appointment with a doctor to talk about it. Reassure your child that there are treatments that can help them feel better.
  • Talk to your pediatrician or make an appointment with a pediatric mental health provider. While OCD can be impairing, treatment is available that can significantly reduce symptoms and make them manageable.

What is the best treatment for OCD?

The best line of treatment for OCD involves medication, prescribed by a psychiatrist, and a specialized type of therapy called Cognitive Behavioral Therapy with Exposure and Response Prevention (CBT with ERP).

ERP involves gradually exposing a child with OCD to the thing that makes them anxious while providing them with the skills to cope with their anxiety and limiting their access to their rituals. Over time, they experience less anxiety and can cope better.

Plan to attend therapy sessions with your child. OCD behaviors are not “fixed” overnight. It takes therapy, time, practice, treatment and help for children to improve.