Imagine a 12-year-old who takes 20 minutes to get ready for school because they need to check the front door three times, pack their backpack in a specific order, and start over if something doesn’t feel right. At first, their parents might think they’re being overly careful or that it’s just a phase. But as the routine gets longer, the family starts leaving the house late, homework takes twice as long, and the child keeps asking the same questions because they need reassurance that nothing bad will happen.
What may look like a habit or preference can sometimes be a sign of obsessive-compulsive disorder (OCD). OCD involves unwanted, intrusive thoughts, images, or urges called obsessions and repetitive behaviors or mental acts called compulsions. These thoughts and behaviors can become distressing, time-consuming, and disruptive to everyday life.
OCD Can Look Different From What You Expect
Many people associate OCD with excessive handwashing or a need to keep things perfectly organized. While those can be symptoms of OCD, OCD can involve many different fears and patterns. A child may worry about germs, illness, making a mistake, safety, harming someone, or something bad happening to a loved one. They may also feel that something has to be done a certain number of times or in a particular order to prevent a feared outcome.
Some common signs and symptoms of OCD in children and teens can include:
- Repeated fears or intrusive thoughts that cause significant distress
- Excessive checking of doors, homework, appliances, or other things
- Frequent handwashing, cleaning, counting, or arranging
- Repeating words, phrases, or actions
- Needing things to feel “just right” before moving on
- Asking the same questions or seeking reassurance repeatedly
- Avoiding certain people, places, objects, or activities because of intense fears
- Spending so much time on routines or rituals that school, sleep, relationships, or other daily activities are affected
The OCD compulsions that follow an obsession aren’t always visible. A child might silently repeat a phrase, mentally review an event, or try to “undo” a thought in their head.
Children and teens may also hide their symptoms because they’re embarrassed, afraid others won’t understand, or unsure how to explain what’s happening. This can make OCD harder for parents, teachers, and other adults to recognize.
When Does a Routine Become a Concern?
Children naturally have routines and rituals, so wanting to wear a favorite shirt or follow a particular bedtime routine doesn’t automatically mean a child has OCD. The bigger question is whether unwanted thoughts or repetitive behaviors are becoming difficult to control and interfering with everyday life.
Parents and caregivers may notice that a child:
- Takes an unusually long time to get dressed, eat, complete homework, or leave the house
- Becomes extremely distressed when a routine is interrupted
- Repeatedly asks for reassurance about the same fear
- Avoids activities because of intense worries
- Needs family members to participate in rituals or repeatedly check things
- Has difficulty concentrating because of intrusive thoughts or mental rituals
These behaviors don’t automatically mean a child has OCD. Symptoms can overlap with other mental health or developmental conditions, so a checklist shouldn’t be used to diagnose a child. A qualified mental health professional can consider the child’s thoughts, behaviors, emotions, relationships, and daily functioning to better understand what’s happening.
OCD Can Affect the Whole Family
OCD doesn’t only affect the child experiencing the thoughts and compulsions. Families can gradually begin changing their routines around OCD without realizing it. A parent might repeatedly answer the same question, check something for a child, avoid certain places, or participate in a ritual because it seems like the easiest way to reduce the child’s distress in the moment.
This is sometimes called family accommodation. It doesn’t mean parents are causing OCD or responding incorrectly. However, these patterns can unintentionally become part of the OCD cycle. Family education and involvement can help parents and caregivers understand how to support a child without reinforcing compulsions.
How Adults Can Respond
If you’re concerned about a child’s behavior, start with curiosity rather than judgment. Instead of telling a child to “just stop” a ritual, try to understand what may be happening underneath it. Is there a fear they’re trying to prevent? Are they feeling like something bad will happen if they don’t complete a certain routine?
It can also help to avoid describing a child as difficult, dramatic, stubborn, or overly particular when they’re struggling with compulsions. OCD symptoms can cause genuine distress, even when the behavior doesn’t make sense to someone else.
Adults don’t have to determine whether a child has OCD on their own. If symptoms are taking up significant amounts of time, interfering with school or family life, or causing noticeable distress, talking with a qualified mental health professional can help. An evaluation can also help distinguish OCD from other conditions with similar symptoms.
Treatment for Obsessive Compulsive Disorder
There is treatment for obsessive compulsive disorder, and children and teens can benefit from evidence-based approaches. Treatment may include:
- Cognitive behavioral therapy (CBT): Helps children recognize patterns in their thoughts and behaviors and develop healthier ways to respond.
- Exposure and response prevention (ERP): A form of CBT that gradually helps children face feared situations while learning not to rely on compulsions.
- Medication: May be considered for some children and teens based on their individual needs and in consultation with an appropriate healthcare professional.
- Family involvement: Parents and caregivers can learn how to support treatment and avoid unintentionally reinforcing OCD compulsions.
Treatment doesn’t look exactly the same for every child. A professional evaluation can help determine whether symptoms fit OCD, whether another condition may be contributing, and what approach makes sense for the child and family.
How Western Youth Services Can Help
For children and teens in Orange County who may need mental health services, Western Youth Services’ Mental Health Clinics provide individualized, solution-focused outpatient services primarily for Medi-Cal eligible clients under 21. Services include clinical and psycho-diagnostic assessments, risk assessments, individual and family therapy, case management, mental health consultations, medication support, and connections to other services. WYS clinicians also use evidence-based approaches, including cognitive behavioral therapy.
An assessment can give families a clearer picture of what a child is experiencing and what next steps may be appropriate. Families who aren’t sure where to begin can connect with WYS’s Access Coordination team, which serves as a single entry point to WYS and its collaborative network and can help identify services and community connections through One Door Any Door.
Raising OCD Awareness
OCD Awareness Week takes place October 11th through the 17th and provides an opportunity to increase understanding of OCD, challenge misconceptions, and encourage people affected by OCD to seek appropriate treatment. But conversations about OCD don’t have to wait for one week in October. A child doesn’t need to be in crisis before an adult takes notice. Repeated thoughts, rituals, reassurance-seeking, and avoidance are worth paying attention to when they’re interfering with everyday life. For families looking for OCD resources, organizations such as the CDC, American Academy of Child and Adolescent Psychiatry, International OCD Foundation, NAMI, and Child Mind Institute offer information about symptoms, diagnosis, treatment, and family involvement. These resources can be a helpful starting point, but they aren’t a substitute for an individualized evaluation from a mental health professional.
If you’re concerned about a child’s thoughts, behaviors, mood, or ability to manage everyday life, reaching out to a mental health professional can be a meaningful first step. With the right evaluation and treatment, children and teens with OCD can learn ways to manage their symptoms and take back time that may have been lost to compulsions. Learn more about Western Youth Services and available mental health services at westernyouthservices.org, or call 888-312-0406 to speak with an Access Coordinator.
Western Youth Services works hard to protect the privacy of the children we help. As such, the names of our clients are changed.
Sources:
- https://pmc.ncbi.nlm.nih.gov/articles/PMC4413836/
- https://deconstructingstigma.org/guides/ocd-kids-teens
- https://www.cdc.gov/children-mental-health/about/obsessive-compulsive-disorder-in-children.html
- https://kids.iocdf.org/professionals/mh/treating-ocd-in-children-teens/
- https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Obsessive-Compulsive-Disorder-In-Children-And-Adolescents-060.aspx
- https://childmind.org/topics/ocd-related-disorders/?gad_source=1&gad_campaignid=23480498315&gbraid=0AAAABCCOvtLMqJa04H1qg-tSJslOPwYaW&gclid=Cj0KCQjwk5nVBhDiARIsAHNGqacN7z_SE0O90KS6EfhWrM7-f_XKFHw0MKis9BVxphhDumEoDhB90BQaAj4cEALw_wcB
- https://mhanational.org/conditions/obsessive-compulsive-disorder-ocd/
- https://www.nami.org/types-of-conditions/obsessive-compulsive-disorder/
