The symptoms of OCD are generally the same  whether you are an adult or a child, but OCD in childhood can sometimes be more difficult to recognize for a variety of reasons.
At the start, children may not recognize that what they are going through is out of the ordinary and therefore may not think to ask for help. On average, children live with their symptoms for 2.5 years before being assessed by a mental health professional .
Additionally, OCD in children can often be mistaken for behavior and attention issues such as attention-deficit/hyperactivity disorder (ADHD), especially when the symptoms interfere with schoolwork. To learn more about symptoms of OCD and anxiety at school, visit our Anxiety in the Classroom resource.
Kids and teens are likely to involve family members in their compulsive behaviors and rituals. For example, a child may demand that his or her family join in lengthy washing rituals around mealtimes or may refuse to go to bed until a parent joins in a checking ritual. These are called family accommodation behaviors, and research has shown they are associated with more severe OCD symptoms in children . It is believed that family accommodation can make it harder for kids to learn that they don’t need to perform compulsions in order to be safe. Family members may also feel the need to engage in these behaviors out of care and wanting to relieve their child’s distress, without the knowledge that they can reinforce OCD symptoms. Learn more about recognizing and reducing family accommodation.
When OCD begins in childhood, there is also a higher likelihood of the child having other disorders as well, such as tic disorders, ADHD, and other anxiety disorders. In fact, anxiety is one of the most common co-occurring conditions in kids with OCD. Learn more about co-occurring disorders.
Genetics may also play a larger role in OCD if it first appears earlier in childhood, as childhood-onset OCD has been shown to have a generally higher rate of heritability than adult-onset OCD  .
Finally, there are two conditions that result in an acute (sudden) and dramatic onset of symptoms in kids, especially between the ages of 4–14 years old. These are Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections (PANDAS) and Pediatric Acute-Onset Neuropsychiatric Disorder (PANS).
While both result in sudden symptoms of OCD in kids, PANDAS has been linked to a type of strep throat infection, while PANS is associated with other illnesses or with any other rapid onset.
-  Mataix-Cols, D., Nakatani, E., Micali, N., & Heyman, I. (2008). Structure of obsessive-compulsive symptoms in pediatric OCD. Journal of the American Academy of Child & Adolescent Psychiatry, 47(7), 773-778. ↩
-  Geller, D. A. (2006). Obsessive-compulsive and spectrum disorders in children and adolescents. Psychiatric Clinics, 29(2), 353-370. ↩
-  Storch, E. A., Geffken, G. R., Merlo, L. J., Jacob, M. L., Murphy, T. K., Goodman, W. K., ... & Grabill, K. (2007). Family accommodation in pediatric obsessive–compulsive disorder. Journal of Clinical Child and Adolescent Psychology, 36(2), 207-216. ↩
-  Pauls, D.L. (2010). The genetics of obsessive-compulsive disorder: A review. Dialogues in Clinical Neuroscience, 12(2), 149-163. ↩
-  Strom, N.I., Soda, T., Mathews, C.A., & Davis, L.K. (2021). A dimensional perspective on the genetics of obsessive-compulsive disorder. Translational Psychiatry, 11, 401. ↩