Obsessive-compulsive disorder (OCD) causes an estimated 0.25 – 4% of young children and teenagers to live with repetitive, intrusive thoughts or sensations (obsessions) and redundant, time-consuming mental acts or repetitive behavior (compulsions).
While children and adolescents often express some of the same OCD symptoms as adults, there are some distinct differences to be aware of, too. One major difference is that children might have difficulty recognizing that their obsession and compulsions are both illogical and/or excessive.
Read on, as we delve into everything you need to know about obsessive-compulsive disorder in children and teenagers — including signs and symptoms, causes, and tips for how you can best help your young child or teenager live with, and learn to manage, this challenging but treatable condition.
Signs of OCD in Children & Teens
OCD in young people often goes undetected for years before a correct OCD diagnosis is ever made.
All children have periodic questions and worries — it’s normal and even healthy. However, children with OCD are unable to stop worrying or doubting, regardless of how much they may want to change. More often than not, those worries and doubts result in disruptive, repetitive behaviors in very specific ways.
Young children might feel unable to find joy in their life as they can become consumed with navigating the obsessions and compulsions that rule their days. Teens may become self-conscious and work hard to hide their symptoms as it becomes clear to them that not everyone has the same worries and behaviors as they do.
According to the International OCD Foundation (IOCDF), young children and teens experience very similar obsessions and compulsions relative to adults. Specific mental thoughts or images typically vary with age and evolve over time.
A child’s symptoms of OCD might include repetitive thoughts that they or their family is in danger, perhaps from a burglar entering through an unlocked window, the ceiling caving in, or even from a monster hiding in the closet.
The fear and obsessive thought might cause them to develop ritualistic behavior, like repetitively checking every door and window to be sure they’re locked, even while their parents sleep. A child may believe that they inadvertently unlocked a door or window when they were checking it, and then feel compelled to go check again, over, and over.
Unlike teenagers and adults with OCD, young children might not yet be able to recognize that their distressing obsessions are unfounded. Nor are they always able to understand that their compulsive behaviors are without value.
Young children with OCD can often try to involve family members in their ritualistic behavior. For example, they may demand that everyone in the family wash their hands in a particular manner, or that their homework be repeatedly checked for accuracy.
Like older children and adults, young children with OCD may experience contamination obsessions like worrying about being polluted by insects, animals, detergents, chemicals, germs, or dirt.
Children with OCD may also experience common obsessions like:
- Ordering obsessions: Like wanting everything to be very neat, aligned, and balanced.
- Collecting obsessions: Involving saving useless objects, hoarding, or excessive worry over losing valueless items.
- Harming obsessions: Such as worrying about hurting themself or someone else, or being overly concerned with others.
- Doubting obsessions: As in worrying they’ll forget something, already forgot something, or will do something embarrassing.
Although less frequently than teenagers and adults, young children with OCD can also experience religious obsessions including excessive concern about punishment for bad behavior, self-doubt, and impure thoughts.
Keep in mind that the purpose of these compulsive rituals in pediatric obsessive-compulsive disorder is to try and reduce anxiety caused by the obsessive thought, mental images, or feelings. Compulsive behavior can be both mental and physical. An OCD diagnosis requires that compulsions consume at least one hour of a child’s day, every day.
It’s common for children (or teens or adults) to believe something very bad will occur if they don’t engage in their compulsions.
Some examples of compulsive behavior include:
- Checking compulsions: Like ensuring lights are off, windows are locked, shades are pulled, and homework is correct.
- Cleaning compulsions: As in washing hands repetitively, changing clothes several times daily, or avoiding contact with items or other people.
- Counting compulsions: Such as tapping something a certain number of times, counting steps or how many times they swallow, or needing to count items in multiples of a specific number.
- Arranging compulsions: For example, organizing knick-knacks, facing things in the same direction, ensuring that items don’t touch each other, or organizing belongings in a very particular manner.
Other compulsions that a child with OCD may exhibit can include reassurance-seeking, forcing positive thoughts to prevent bad ones from occurring or repeating words, phrases, or numbers to prevent dreaded events from happening.
As a child ages into the teenage years, maturity and understanding develop. While a teen with OCD may not be able to control their compulsive behavior, they often start seeing that their reactions are not positive. Thus, they can begin actively trying to avoid OCD symptoms, though chances are they really won’t be able to understand how to do this on their own.
Teenagers with OCD can experience the same obsessions as young children and adults do, just at unique levels determined by their maturity levels, subjective experiences, life views, and other relevant factors.
Teens can become more obsessed with pollution, hygiene, and life symmetry, whereas younger children might tend to be more obsessive about seeking reassurance or reacting to thoughts and feelings they have about possible harm to themselves or others.
According to the American Academy of Child & Adolescent Psychiatry (AACAP), as a child with OCD moves into their teen years, without effective intervention, they may begin to experience increased impulsivity, aggression, rage, religious fanaticism, excessive eating, or persistent, intense sexual cravings.
What Causes OCD in Children/Teens?
There’s no known cause of obsessive-compulsive disorder. However, scientists believe it has a strong genetic link, as well as various environmental causal factors. In rare cases, it appears that streptococcal infection may cause or worsen OCD symptoms.
People with OCD are known to have deficient levels of a neurotransmitter called serotonin. That’s why selective serotonin reuptake inhibitors (SSRIs) are typically recommended as a first-line drug treatment. In terms of online therapy, cognitive-behavioral therapy (CBT) is highly effective.
“Looking out for any signs or symptoms of OCD in teens and young children is important, and if you notice anything concerning, reach out to a therapist who specializes in OCD. Early intervention can give your children hope for the best outcomes.”Talkspace therapist Kate Rosenblatt, MA, LPC, LMHC
How to Help a Child or Teen with OCD
According to scientists, when OCD in children or teens is left untreated, an OCD symptom may come and go, but it’ll likely worsen over time. OCD can cause significant functional impairment at school, home, and in social circles. Treatment is also important as pediatric OCD is now thought to be linked to an increased risk of additional mental health conditions later in life.
OCD in teens and children can cause embarrassment or shame. They might believe that having OCD means they’re “crazy,” so they can therefore be quite hesitant to speak about their obsessions and compulsions.
Many parents of children with OCD are taken by surprise by a diagnosis. That’s why it’s imperative to ensure effective communication with your child if you’re concerned. Educate yourself about this challenging mental health condition that can leave your child or teen exhausted at the end of the day.
According to the Children’s National Medical Center, “Pediatric OCD is a chronic remitting relapsing condition that often persists into adulthood. Despite the fact that medications have a significant role in treatment, current literature continues to converge in support of CBT as a first line treatment, which has long-term positive outcomes for pediatric OCD.”
“Ask your child’s therapist how you can best support them, as this will look different for everyone. For example, if your child’s OCD made them averse to touching something specific, and in the past you’ve either avoided that specific thing or you dealt with it yourself to reduce your child’s anxiety, your therapist might recommend that you actually not reinforce your child’s obsession or compulsion through avoidance, and instead, encourage them to work through it with the skills they are learning in therapy.”Talkspace therapist Kate Rosenblatt, MA, LPC, LMHC
The Centers for Disease Control and Prevention (CDC) notes that most young children and teenagers with OCD can be effectively treated with the combination of talk therapy (specifically cognitive behavioral therapy) and certain OCD medications, like antidepressants known as selective serotonin reuptake inhibitors (SSRIs), if warranted.
Of course, many parents might prefer non-pharmacological talk therapy for OCD treatment over medication that has potential adverse side effects. However, when necessary, careful use of prescription drugs might help children and teenagers with OCD learn to better manage their symptoms while they’re improving their coping skills through therapy. Rest assured, your child or teen can learn to live with OCD, and you can help them do it.