OCD in children & teens

The IOCDF tells young people clearly: you didn’t cause your OCD, and neither did your family.

OCD tends to run in families, but a child can have OCD with no family history, and having a parent with OCD doesn’t mean a child will get it.

Bedtime routines, favourite things, prayers and lucky charms are a normal part of childhood. They usually don’t cause distress or get in the way.

It becomes a concern when rituals take up a lot of time, cause big upset if interrupted, or stop a child doing everyday things.

Exposure and response prevention (ERP), a kind of cognitive behavioural therapy, is a first-line treatment for young people with OCD.

The IOCDF says OCD does not have to limit what a young person can achieve.

Parents may notice

• Family routines slowly changing to avoid upsetting the child
• Needing things done the same way every time
• Redoing homework until it feels “just right”
• Repeated checking or asking for reassurance
• Tantrums or meltdowns when a ritual is blocked

Younger children may fear harm coming to themselves or their family, such as an intruder. Older children and teens may worry more about germs, illness or contaminated food.

Some children count, repeat words or pray silently. Others check doors and windows after parents have gone to sleep.

Because these are hidden, a child may seem “distracted” or “slow” when they are actually working very hard inside.

The IOCDF lists conditions that often occur with childhood OCD, including ADHD, autism, eating disorders, other anxiety disorders, and tic disorders such as Tourette syndrome.

A good assessment looks at the whole child, not just the OCD.

Some young people have unwanted thoughts that feel shameful, like hurting someone or doing something “wrong”. They may fear they will get in trouble or be seen as bad.

These thoughts are not wishes. In OCD, they are upsetting precisely because they go against what the young person values.

Children may not be able to describe what is happening until an adult offers possible words. Books, videos and stories about other kids can make it easier to talk.

See the section “Talking with your child about OCD” for gentle phrases to try.

• Answering the same reassurance question many times
• Changing family plans to avoid triggers
• Doing extra washing or checking for the child
• Joining in or waiting during rituals
• Speaking or acting in a set way the OCD demands

A parent-based approach called SPACE teaches parents to replace accommodation with supportive responses. These acknowledge the child’s distress while showing confidence that the child can cope.

Change accommodation slowly and with a plan, ideally with a therapist. Stopping everything at once can be overwhelming.

PANDAS is linked to a strep infection, like strep throat or scarlet fever. Researchers think the immune system may mistakenly affect the brain while fighting the infection. PANS is a wider group with sudden onset, with or without strep.

Symptoms usually first appear between age 3 and puberty. The condition is considered rare.

Alongside sudden OCD or tics, children may have

• Changes in handwriting or other motor skills
• Hyperactivity or trouble paying attention
• Irritability, sadness or sudden crying
• Sudden changes in eating
• Sudden separation anxiety
• Trouble sleeping, or new bedwetting

If your child’s symptoms appeared suddenly, talk with their health care provider. There is no single lab test, so a careful evaluation is needed.

If your child’s doctor is not familiar with PANS or PANDAS, NIMH suggests the International OCD Foundation as one place to look for knowledgeable providers.

This could be a parent, carer, school counsellor, teacher or doctor. You could show them this guide, or say: “I keep getting thoughts I can’t stop, and I feel like I have to do things to feel OK.”

The IOCDF suggests kids share what they’re going through with their parents so they can find a therapist who knows OCD.

The IOCDF runs events, stories and cartoons for kids and teens with OCD, including an online camp for young people, so you can meet others who understand.

Teens may feel extra embarrassed. Pick a calm, private moment, like a car ride. Let them lead and decide some of the next steps, such as which therapist to try.

Watch for signs like pulling away from friends or activities, or avoiding school to finish work perfectly.

Talking about a character in a book or video can help children talk about their own fears without feeling put on the spot.

The IOCDF’s kids’ site has stories and cartoons from other young people with OCD.

Because OCD often pulls family members in, parents and carers are an important part of treatment. Family support and education are central to success.

UK guidelines from NICE recommend CBT with ERP that involves the family and is adapted to the child’s age for moderate to severe OCD. For milder OCD, guided self-help with family support may be considered.

SPACE (Supportive Parenting for Anxious Childhood Emotions) is a parent-based treatment. Parents learn to reduce accommodation and respond supportively, without the child needing to attend.

In one study plan, SPACE was delivered in 12 weekly one-hour sessions. It can help when a child is too young or not ready for therapy.

Most children start with outpatient therapy, usually one or two sessions a week of 45 to 50 minutes. If that isn’t enough, there are more intensive options.

More intensive options include

• Day programs, usually during working hours, up to five days a week
• Intensive outpatient programs
• Partial hospital programs
• Residential programs

• Are you trained to work with children or teens with OCD?
• Do you include families in treatment?
• Do you use exposure and response prevention (ERP)?
• How much of your practice involves anxiety disorders?
• Would you leave the office for exposure practice if needed?

The IOCDF says more than a quarter of a therapist’s practice involving anxiety disorders is a good sign.