Obsessive-compulsive disorder (OCD) may develop during childhood. But OCD in children may be challenging to recognize because their behaviors may be mistaken for a part of typical development.

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Obsessive-compulsive disorder (OCD) is a mental health condition featuring obsessions (involuntary distressing thoughts, urges, and mental imagery) and compulsions (repetitive, rigid behaviors).

Obsessions cause intense negative emotions like anxiety, fear, or dread. Compulsions act as a coping mechanism for obsessions. They’re rituals or actions you feel you have to perform to prevent an undesired outcome.

OCD in children involves intrusive thoughts and protective actions, just as it does in adults. In children, however, symptoms of OCD can be difficult to distinguish from typical developmental behaviors.

Learn about OCD.

OCD at any age is characterized by obsessions, compulsions, or both. The specific symptoms you experience often have to do with your OCD’s theme, which is the focus point behind thoughts and behaviors.

According to diagnostic criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR), themes of obsessions and compulsions in OCD determine the related symptoms.

Common themes include:

  • Cleaning: contamination obsessions and cleaning compulsions
  • Symmetry: symmetry obsessions and repeating, ordering, or counting compulsions
  • Harm: fearful obsessions about causing harm and reassurance or checking compulsions
  • Taboo: aggressive, sexual, or religious obsessions and related compulsions

Other themes in OCD also exist, and it’s possible to experience multiple types of intrusive thoughts. According to the DSM-5-TR, children and adolescents are more likely to experience harm obsessions than adults.

Depending on the themes in OCD, signs can include behaviors such as:

  • excessively checking and rechecking
  • needing to do things the same way every time
  • having rituals that interfere with daily life
  • repeating lucky words or numbers
  • seeking constant reassurance
  • insisting items be organized in a certain way
  • feeling uncomfortable when things aren’t “just so”
  • repeating actions until you feel they’re perfect
  • repetitive praying, reciting, or mental reviewing
  • excessive cleaning or washing
  • hoarding behaviors

The DSM-5-TR indicates children have the same rate of obsessions and compulsions as adults. In children, however, behavior patterns are less stable, and they may not be able to put into words how they feel or why they behave a certain way.

Children naturally go through developmental stages where behaviors are unpredictable. It can be challenging to tell the difference between compulsions and natural processes of creating routines and exploring the environment.

Compulsions in children, for example, could be mistaken as rebellious behavior if a child performs them even after being told not to.

The exact cause of OCD in children and adults is unknown. Structural and functional changes in the brain, genetics, temperament, and environmental factors may all play a role.

OCD in children and adults is typically treated with a type of cognitive behavioral therapy (CBT) called exposure and response prevention (ERP).

In ERP, children are gradually exposed to underlying fears in a safe, controlled setting and are instructed to not engage in a compulsion. This helps them learn that fears are exaggerated and that negative emotions pass without compulsions.

Medications, like antidepressants, might be recommended when CBT is not effective enough or symptoms are severe.

Children may also benefit from:

  • family therapy
  • support groups
  • relaxation training
  • community and school support programs
  • psychoeducation

While the exact causes of OCD aren’t clear, certain factors may increase a child’s risk, including:

  • having a parent or sibling living with OCD
  • experiencing childhood trauma
  • having a naturally reserved temperament
  • displaying a tendency to experience negative emotions, anxiety, or depression
  • having structural differences in areas of the brain associated with behavior and emotion management
  • living with a tic disorder

A cohort study from 2020 notes that a child’s OCD risk may also increase due to maternal factors during pregnancy, such as the birthing parent’s age, psychiatric history, and use of cigarettes while pregnant.

What about PANDAS and PANS?

For some children, infection can be a risk factor for certain types of OCD.

Pediatric autoimmune neuropsychiatric disorder associated with streptococcus (PANDAS) and pediatric acute-onset neuropsychiatric syndrome (PANS) are unique forms of OCD that develop as the result of infection.

Children between the ages of 3 and 14 years are the most affected. They can develop OCD-like symptoms rapidly and often require antibiotics and intravenous (IV) therapies as a part of treatment.

Infectious agents associated with PANDAS/PAN include:

Because the underlying causes of OCD appear to be complex and may be unique for each individual, experts can’t say for certain whether you can take steps to prevent it.

Some evidence suggests that preventing factors, like maternal health during pregnancy and traumatic experiences for children, can help reduce the risk a child may develop OCD.

OCD isn’t curable, but it is treatable. According to the International OCD Foundation (IOCDF), as many as 70% of people experience improvement through ERP, medication, or both.

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What does OCD in kids look like?

OCD in children and adults features obsessions, compulsions, or both. Children may be less likely to communicate about obsessions, however, and they are more likely than adults to experience harm-themed thoughts and behaviors.

How do you discipline a child with OCD?

You can still enforce boundaries with children when they live with OCD. The goal is to discipline only for behaviors within a child’s control, not behaviors related to OCD.

When can a child be diagnosed with OCD?

Under DSM-5-TR guidelines, healthcare professionals can diagnose OCD in children and adults of any age. Onset in children typically occurs during two age ranges: between 8 and 12 years and in the late teens to early adulthood.

What should you not say to a child with OCD?

The IOCDF recommends avoiding statements that criticize and minimize a child’s experiences in OCD, like saying “just snap out of it” in response to a compulsion. The foundation also suggests not debating or rationalizing with children to “convince” them an obsession or compulsion is unnecessary.

The symptoms of OCD — obsessions and compulsions — are the same in children and adults, though the developmental stages of childhood can make early recognition more challenging.

While there’s no cure for OCD, effective support can help children learn to manage their symptoms and break the cycle of obsessions and compulsions.