Earlier OCD care can start with you.
Nearly 3% of children and adolescents are estimated to have obsessive compulsive disorder (OCD), a mental health disorder that causes significant impairment to a child’s day-to-day functioning, including relationships, school, health, and cognition. That's nearly 2 million youth in the United States alone.
Pediatricians and other medical providers are often among the first professionals families turn to when something doesn’t seem right. Recognizing the signs of OCD, including the less obvious ways it can present, can help children get the right diagnosis and connect with effective treatment sooner.
That isn’t always easy. OCD can look like anxiety, behavioral challenges, attention problems, school avoidance, or physical complaints. Children may not have the words to explain what they’re experiencing, may believe their fears are real, or may hide intrusive thoughts and compulsions because they feel embarrassed, ashamed, or afraid of what they mean.
But the good news is that OCD is treatable, and these children and youth don't need to suffer endlessly with their symptoms.
For pediatricians, knowing what to look for, what to ask, and what to do next can make a critical difference.
Professional Referrals
Visit IOCDF's Find Help Directory to find pediatric clinicians near you who specialize in the treatment of OCD and related disorders.
Recognizing Pediatric OCD
OCD is characterized by a cycle of obsessions and compulsions and is diagnosed when obsessions or compulsions become so time-consuming that they interfere with daily functioning, including school, social activities, and self-care.
Obsessions are intrusive and unwanted thoughts, images, or urges that occur repeatedly and feel outside of the child’s control. These obsessions are unpleasant and typically cause worry, anxiety, or distress.
Common obsessions may include:
- Worrying about germs, illness, or dying
- Extreme fears about something bad happening or doing something wrong
- Feeling that things must be “just right”
- Disturbing and unwanted thoughts or images about hurting others
- Disturbing and unwanted thoughts or images of a sexual nature
Compulsions, also called rituals, are behaviors a child feels they must perform to get rid of the upsetting feelings caused by an obsession. A child may also believe that completing a compulsion will prevent something bad from happening.
Common compulsions may include:
- Excessive checking
- Excessive washing or cleaning
- Repeating actions or starting over until something feels “just right”
- Ordering or arranging
- Mental compulsions, including excessive praying or mental reviewing
- Frequent confessing or apologizing
- Saying lucky words or numbers
- Excessive reassurance seeking
Although symptoms are generally similar in children and adults, several factors can make pediatric OCD harder to recognize:
- Children may not recognize that their experiences are unusual.
- OCD may be mistaken for behavior or attention problems, particularly when symptoms interfere with schoolwork.
- Children and teens may involve family members in their compulsions and rituals.
- Children may hide symptoms, particularly “bad thoughts” or aggressive or sexual obsessions.
- Younger children may have difficulty describing what they are experiencing.
- Tic disorders, ADHD, other anxiety disorders, depression, eating disorders, and other conditions may occur alongside OCD.
Family accommodation is especially important to recognize. A child may demand that family members participate in washing or checking rituals, provide repeated reassurance, or change household routines. Although family members participate because they want to reduce the child’s distress, accommodation can reinforce OCD symptoms.
Most pediatric OCD symptoms develop gradually over several weeks or months. In rare cases, symptoms may appear seemingly overnight, accompanied by rapid changes in behavior or mood and the sudden onset of severe anxiety or OCD symptoms. This type of sudden onset may warrant further evaluation of PANS/PANDAS.
Connecting families with treatment and support
Effective treatment is available for pediatric OCD. Exposure and response prevention (ERP), a specialized form of cognitive behavioral therapy (CBT), is the leading psychosocial treatment for OCD. Medication, particularly serotonin reuptake inhibitors (SRIs), is also an evidence-based treatment option for children and adolescents and may be used alongside ERP. Connecting families with providers who understand pediatric OCD and its evidence-based treatments can help children get the specialized care they need.
Treatment is only one part of supporting a child with OCD. Children and their caregivers can also benefit from education, community, and support along the way. The IOCDF offers resources designed to help families understand OCD, navigate treatment, and connect with others who understand what they’re going through. These include:
- Supporting Our Families livestream (third Thursday of each month, 7-8pm ET)
- Online OCD Camp(opens in new tab) for kids and families (late January / early February)
- Our Anxiety in the Classroom resources to educate school professionals and support the child's educational journey