How OCD Manifests in Children and Teens
Obsessive-Compulsive Disorder (OCD) in children and teens can look different from that in adults, and it’s often misunderstood or mistaken for other issues like anxiety, ADHD, or even defiance. Early recognition is important, as effective treatment can greatly improve an adolescent’s functioning and quality of life.
Here’s how OCD typically manifests in children and adolescents:
Core Features of OCD in Kids and Teens
OCD involves:
Obsessions – Unwanted, intrusive thoughts, images, or urges that cause anxiety or distress.
Compulsions – Repetitive behaviors or mental rituals done to reduce the distress or “prevent” something bad from happening.
Children might not always be able to articulate why they do certain things—they may just say it "feels right" or that they “have to.”
Common Obsessions in Kids and Teens
Contamination fears: Your child may be exhibiting fears of getting sick, getting germs on their hands, or a fear of touching dirt.
Fear of harming self or others: If your child is asking themselves or communicating a fear, such as “What if I stab my mom with a knife?”, they may have what is called harm OCD.
Intrusive, violent, or sexual thoughts: If your child is expressing that they are having “bad” thoughts and they are acting on these thoughts through avoidance of spending time with children who are younger than them or avoidance of handling anything that could be seen or perceived as dangerous, then your child may be struggling with OCD. It is important to note that if your child does have OCD and they are having these thoughts, they are fearful about having these thoughts, and they do everything they can to avoid making these thoughts a reality. Therefore, your child is not a danger to themselves or someone else. Individuals who struggle with OCD are less likely to cause harm to others than children and teens who do not have OCD.
Religious or moral obsessions (scrupulosity): This can look like fears that someone will die if they do the wrong thing or praying every night and fearing that if they do not say their nightly prayers, something bad will happen.
Fear of something terrible happening: if they don’t do things a certain way.
Need for symmetry or exactness: If your child needs things to look a certain way or be a specific number, they may have OCD.
Common Compulsions in Kids and Teens
Excessive hand washing or showering
Repeating behaviors (e.g., turning lights on/off a certain number of times)
Checking (e.g., doors, locks, homework, appliances)
Asking for reassurance constantly (e.g., “Are you sure I didn’t hurt someone?”)
Counting, tapping, or ordering things
Mental rituals like repeating words, prayers, or numbers silently
How OCD Appears Differently in Young People
Rituals may seem like habits or games to adults (e.g., needing to walk in a specific pattern)
Increased irritability, tantrums, or emotional meltdowns, especially if rituals are interrupted
Difficulty concentrating at school due to intrusive thoughts
Avoidance behaviors (e.g., avoiding school bathrooms, sharp objects, or certain people)
Poor sleep due to rituals or nighttime checking
Family involvement in rituals (e.g., parents repeating things or helping them check)
Challenges in Diagnosis
Young children might not recognize their thoughts as irrational and believe their fears and thoughts to be true.
Teens may feel embarrassed or secretive, especially if they worry that their thoughts may get them in trouble.
Symptoms may be mistaken for:
ADHD (due to distraction)
Autism (due to repetitive behaviors)
Oppositional Defiant Disorder (due to resistance or meltdowns)
Treatment for Pediatric OCD
Exposure and Response Prevention (ERP) is the gold standard for treatment.
Family involvement is crucial—parents are often coached on how to stop accommodating compulsions.
In moderate to severe cases, medications like SSRIs (e.g., fluoxetine, sertraline) may be used.
Support at school may include accommodations (e.g., extra time, safe space). However, the goal of treatment is to no longer need those accommodations, as they could be enabling the avoidance, which enables the OCD.
What Parents/Teachers Might Hear:
"What if I hurt someone and don’t remember it?"
"Can you check that again? I’m not sure."
"I need to do it just right or something bad will happen."
"It doesn’t feel right—I need to start over."
A Note on PANS and PANDAS:
It is also important to note that two medical conditions present with OCD symptoms. Suppose you noticed a sudden and abrupt change in your child, and they began presenting with OCD symptoms after being sick with a virus or a bacterial infection. In that case, they may have something called PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) or PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections). These are two pediatric conditions that involve the sudden onset of obsessive-compulsive behaviors or severe eating restrictions, often accompanied by a range of other neurological and behavioral symptoms. The only form of treatment for PANS or PANDAS is antibiotics, or in severe cases, treatment includes IVIG (intravenous immunoglobulin) or plasmapheresis to modulate the immune system.
If your child or teen is struggling with OCD, there is hope for recovery. Please reach out to one of our providers to set up a free consultation and begin the treatment process today.
