How to Recognize Obsessive Compulsive Disorder in Children 2022


Obsessive-Compulsive Disorder (OCD) is an anxiety disorder characterized by obsessions and compulsions that disrupt daily life. OCD affects 1%-2% of children and adolescents, often appearing between ages 7 and 12. Sometimes it goes unrecognized, especially when children hide their symptoms or parents don't know what to look for. There are ways to recognize the disorder, even in young children.


Part 1 of 4:Identifying Obsessive-Compulsive Disorder

1Don't jump to conclusions. Remember that children have quirks and often go through phases that may make you wonder whether they are normal. If you're concerned that your child may have any kind of mental disorder, it's best to talk to a pediatrician or a child psychologist before you try to diagnose a disorder on your own. If you have had your child evaluated and are still unsure, don't be afraid to get a second opinion.

2Look out for signs of obsessions. Obsessions can be somewhat difficult to spot, because they are internal thoughts that may or may not have external actions associated with them. Additionally, children may hide their obsessions from adults. The symptoms may be misinterpreted as unnecessarily worrying. The only symptom an adult may see is extended time in the bathroom or bedroom, or being alone. Obsessions are often related to safety. A few common obsessions that often manifest at home include:

Excessive concern about germs, disease, and contamination

Fear that they will hurt someone

Frequent worries about disasters like car crashes, house fires, earthquakes, or tornadoes

Tendency to believe their tasks are never complete

The need to have things around them in a symmetrical, perfect order

The need to perform tasks a specific number of times, or a fixation on a series of numbers

Concern with religious ideas, such as morality, death, or the afterlife

Excessive collecting of meaningless objects

Obsession with sexual thoughts

3Recognize what compulsions look like. Children may enact compulsions differently at home and at school. The symptoms may be misinterpreted as misbehaving. Adults may interpret compulsions or reactions to obsessions as tantrums that occur when things don't go the child's way. Symptoms may vary over time and fluctuate. At home, some compulsions may include:

Cleaning their room over and over again

Washing their hands too much or showering frequently

Checking and rechecking to make sure a door is locked

Arranging and rearranging items over and over again

Saying special words, repeating numbers, or saying phrases before doing things to keep bad things from happening

Always having to do things in a certain order, and becoming very anxious or acting out if something disrupts that order

4Look for hidden signs. Children become used to hiding their obsessions or compulsions. You may never see them engage in any of the above listed activities. There are other ways you can try to determine if your child has OCD if you are concerned. Look for:

Sleeping disorders from staying up too late obsessing

Sore or dry hands from excessive washing

Excessive use of soap

Concern about germs or sickness

Increase in laundry

Avoidance of getting dirty

Decrease in academic performance

Requests for people to repeat words or phrases

Unnecessarily long amounts of time in the shower or getting ready for bed or school

Excessive worry about the safety of family and friends

5Recognize these symptoms at school. Children who have OCD may act differently at school than they do at home. At school, they may hide or suppress their symptoms. Symptoms that do emerge at school may manifest differently than they do at home. At school the child may:

Have difficulty concentrating. Repetitive, obsessive thoughts can hinder a child's concentration. It can affect following directions, starting assignments, completing assignments, and paying attention in class.

Withdraw from their peers

Have low self-esteem

Act out or appear disobedient due to misunderstandings between the child and his peers or the staff. The child may engage in unusual behavior that leads to conflict in school.

Have a learning disorder or cognitive problem that has nothing to do with the OCD

Part 2 of 4:Assessing Specific Behaviors

1Pay attention to fears of contamination. Some children with OCD have obsessions about cleanliness and become afraid of being contaminated, contracting diseases, and becoming ill. They may worry about close person-to-person contact or develop fears of dirt, food, or certain places or things they believe are unsanitary or infectious. Although it can be hard to observe an obsession, you can be on the look out for the compulsions that can result from an obsession with cleanliness:

Your child may avoid certain locations, such as public restrooms, or certain situations, such as social events, because they fear contamination.

Your child may become strangely habitual. For example, they may eat the same food over and over again because it is supposedly contamination-free.

Your child may begin to impose cleansing rituals on you and other members of your family in an attempt to ensure complete sanitation.

Your child may even develop compulsions that seem contrary to an obsession with cleanliness. For example, they may refuse to bathe due to a fear of contamination.

2Note any excessive preoccupation with symmetry, order, and exactness. Some children with OCD develop obsessions with symmetry and order; they need processes to be “done right” and items to be arranged “correctly.” As a result:

Your child may develop very precise ways of handling, arranging, or aligning objects; they may do this in a highly ritualized way.

Your child may become very anxious when items are not arranged correctly; they may panic or believe something terrible will happen.

Your child may have trouble concentrating on schoolwork or other things because they are so preoccupied with these matters, which seem so inessential to you.

3Watch for compulsions to keep loved ones safe. Children with OCD can obsess about themselves or others being harmed. This obsession may manifest itself in a variety of compulsive behaviors:

Your child may become very overprotective toward family members and close friends.

Your child may try to make sure everyone is safe by checking and rechecking that doors are locked, appliances are turned off, and no gas leaks are present.

Your child may devote several hours a day to performing ritualized tasks aimed at making sure that everyone is safe.

4Notice any obsession about causing intentional harm. Children with OCD may have violent intrusive thoughts, and they might become very worried that they will give into these thoughts and hurt themselves or others intentionally. They may begin to hate themselves or believe that they are bad people. As a result:

Your child may be overcome with guilty feelings. They may seek forgiveness, confessing their thoughts to others and seeking reassurances of their love and affection.

Your child may become emotionally exhausted and preoccupied with these thoughts. Though the anxieties may be mostly internal, you can be alert for signs of increased anxiety, depression, or exhaustion.

Your child may draw or write about the violent behaviors over and over.

Part 3 of 4:Understanding Obsessive-Compulsive Disorder

1Familiarize yourself with childhood OCD. More children suffer from OCD than most people realize. According to the director of the Children's Center for OCD and Anxiety in Philadelphia, more than a million children in the US have OCD. That means, 1 in 100 children in America have OCD.

Unlike adults who can recognize they have OCD, children do not understand that they have OCD. Instead, children may view their repetitive thoughts or actions as shameful and feel like they are going crazy. This makes many children too embarrassed to tell an adult of their problems.

The average age that OCD manifests is 10.2

OCD seems to appear equally in boys and girls.

2Know how obsessions work. One part of Obsessive-Compulsive Disorder is a tendency to obsess. Obsessions are persistent or repetitive thoughts, images, ideas, or impulses that rise repeatedly into a person's consciousness. The child cannot shake the thoughts, which become increasingly realistic to him. The unwanted thoughts can be frightening and if unresolved, they can leave your child anxious and distracted, making them appear mentally unbalanced.

These thoughts can cause a lot of doubt.

These thoughts can tell the child something bad is going to happen to someone they care about.

3Understand how compulsions work. The second part of OCD is a tendency toward compulsive behavior. Compulsions are excessively repetitive and rigid behaviors or actions that are performed to reduce anxiety, ward off bad thoughts, or banish something dreaded. The child can do these actions mentally or physically. The actions are often in response to obsessions to help lessen the fear and can seem like strong habits.

In general, compulsions are easier to spot – you don't necessarily know what your child is thinking, but if you pay attention, you'll be able to observe compulsive behavior.

4Understand that OCD isn't just a phase. Some parents believe the symptoms of OCD are just a phase. They also believe their children are acting out to get attention. If your child has OCD, this is not the case. OCD is a neurological disorder.

It is not your fault that the child has OCD, so do not blame yourself.

5Know what other disorders may accompany OCD. Children with OCD may have one or more co-occurring conditions. These include anxiety disorders, depression, bipolar disorder, ADHD, eating disorders, autism, or Tourette Syndrome.

Other disorders share similarities with OCD and can be confused with it. These include body dysmorphic disorder, hoarding disorder, hair-pulling and skin-picking disorder.

Part 4 of 4:Finding Support

1Talk openly with your child. Your child may be unaware of their condition or afraid to come to you, so you need to be the one to start the conversation. Ask questions about your child's behavior in certain situations, and listen carefully.

Remember that your child may open up to you only when they feel safe and secure. Try to approach your child in a non-intimidating manner, with a warm and understanding tone.

For example, you may say, “John, I noticed that you've been washing your hands a lot of times during the day and that they're starting to get red from all of the washing. Would you mind explaining to me why you feel like you need to wash your hands so many times?” or “you've been spending a lot of time in your room arranging your toys. Can you tell me about how they're arranged? I'd like to know why they always need to be in that order.”

2Meet with your child's teachers, friends, and caregivers. Because OCD usually develops in school-aged children, the observations of others will be a valuable source of information. Your child may face different situations when they are away from you and may have different obsessions and compulsions at school and other places.

3Consult with a doctor or therapist. If after looking for these behaviors you believe your child might have OCD, you should see a doctor or therapist as soon as possible for proper diagnosis and treatment. Don't wait for the situation to resolve itself – it may get worse. A doctor can set you on the right path to helping your child.

Discuss with your doctor or psychologist a treatment plan for your child. Also discuss plans for the family to make sure the whole family is being taken care of and supporting each other.

Keep a log of your child's behavior before taking him to the doctor. Make a note of the behaviors, the length of time spent on behaviors, and anything else you think will help the doctor. This can help give a better diagnosis.

4Learn about the available treatments. There is no cure for OCD. However, Cognitive Behavior Therapy (CBT) and medication can reduce the symptoms of OCD. Treating the disease can make it more manageable to live with.

Medications for OCD in children includes SSRIs (selective serotonin reuptake inhibitors) such as fluoxetine, fluvoxamine, paroxetine, citalopram, and sertraline. Another medication that is prescribed for children over 10 is clomipramine, but this medication may have severe side effects for children.

CBT includes helping the child become aware of the behaviors and thoughts. Then, they are helped to find alternate behaviors in those situations. This helps the child change the behavior and develop positive thinking patterns.

School-based therapy may be available to help the child navigate school-related tasks, such as academic demands and social expectations.

5Find a support group for yourself. Helping a child with a serious mental illness can be quite challenging, and finding a group of people in similar situations can help you feel like you're not alone.

It's important to participate in any available parent guidance sessions or family therapy to help parents manage the illness. These sessions also help with parenting skills for these situations, teach families how to deal with the complex feeling surrounding the disorder, and give suggestions on how to function as a family.

Ask your child's mental health counselor about parent support groups or search online for “parent of a child with OCD support group” plus your area.

Check the International OCD Foundation's information for parents and families.