OCD in Children and Teens

What are the signs and symptoms of OCD in children and teens?

Some of the signs and symptoms of OCD in children and teens are:

Being overly concerned with dirt and germs, to a degree that interferes with daily life in school, social situations and home life.
Frequent hand washing or grooming, often in a ritualistic manner – red, chapped hands from excessive washing.
Long and frequent trips to the bathroom.
Avoiding playgrounds and messy art projects, especially stickiness.
Untied shoes, since they may be “contaminated.”
Avoiding touching certain “unclean” things.
Excessive concern with bodily wastes or secretions.
Insistence on having things in a certain order.
Having to count or repeat things a certain number of times, having “safe” or “bad” numbers.
Repeating rituals, such as going in and out of doors a certain way, getting in and out of chairs in a certain way, or touching certain things a fixed number of times. This may be disguised as forgetfulness or boredom.
Excessive checking of such things as doors, lights, locks, windows, and homework.
Taking excessive time to perform tasks. You may find a lot of eraser marks on school work.
Going over and over letters and numbers with pencil or pen.
Preoccupation with thoughts of possibly causing harm to self or others, especially parents.
Preoccupation with thoughts of having done something sexually inappropriate despite reassurance
Preoccupation and persistent worries and thoughts of “what if I’m gay?”
Excessive anxiety over having to do daily routines “just right.”
Excessive, unreasonable religious concerns with having sinned or committed a blasphemous act
Excessive hoarding or collecting.
Checking school work over and over, to excess.
Withdrawal from usual activities and friends due to obsessions or compulsions
Excessive anxiety and irritability if usual routines are interrupted.
Excessive daydreaming – the child may be obsessing or doing mental compulsions (must have the “right thought” before moving on to the next activity)
Inattentiveness, inability to concentrate or focus (often mistaken as ADD).
Getting easily, even violently upset over minor, trivial issues.
Persistent lateness to school and for appointments.
Excessive, repetitive need for reassurance for having done, thought, or said something objectionable.
Asking for reassurance, when the answer has already been given.
Repeatedly confessing or apologizing for small infractions or violations of rules or conduct
Rereading and re-writing, repetitively erasing.

If your child or teen displays a symptom from this list, it does not necessarily mean that he/she has OCD. The key is the number of signs and symptoms (multiple signs and symptoms are more indicative of a problem) and the effect they are having upon your child’s functioning in school, in social situations, and in the family. If you suspect a problem, an evaluation by a qualified professional is in order.

Are OCD symptoms different in Kids vs. Adults

Many of the symptoms of OCD listed are similar to the symptoms found in adults. Unlike adults however, children more often do not recognize the senselessness and excessiveness of their obsessions and compulsions, and therefore may not readily recognize the need for treatment. Also, they may involve family members in their rituals to a greater extent than adults do. For example, the child may require that all family members avoid touching a specific “contaminated” area of the house, or wash their hands in a specific, ritualized way. Also, children with OCD are more likely than adults to have additional, co-occurring disorders such as learning disabilities, ADD (attention-deficit disorder), tic disorders, social anxiety disorder, or autistic disorders.

How Many Children and teens have OCD?

About 500,000 children in the United States suffer from OCD, about one in 200 children. This means that around four to five children in an average-sized elementary school, and about 20 teens in a large high school have OCD.

But aren’t some rituals and childhood routines normal?

Absolutely. It is normal for many young children to have routines at mealtime, bedtime or when saying goodbye. These common routines tend to lessen as children get older. However, for children with OCD, the routines continue past the appropriate age, or become too frequent, time-consuming, distressing and begin to interfere with the child’s daily life. That’s when OCD should be considered.

Our whole family seems to be in shambles from the OCD. Is this normal?

Home life often can become very stressful when a child has OCD. This can be extremely baffling and frightening as you observe odd or strange behaviors in your child. Some of the behaviors may become annoying to others, provoking anger and ridicule by family members. Children with OCD often involve family members in their OCD in different ways: asking their parents the same questions over and over, insisting upon help from parents and siblings in completing rituals, and requiring that parents and siblings follow their OCD rituals as well. Outbursts of anger and/or sheer panic may result if the rituals are not followed in the prescribed manner. The stress on the family members can be very strong as they feel that they cannot relax and home life has become highly unpleasant. Parents may feel that they must change the family’s daily routine or give in to the child’s demands to prevent the child from having a “meltdown”. Parents may go through many different distressing emotions including fear, frustration, anger, guilt and sadness. They worry whether their child will ever have a normal life.

Can these children ever get better?

Yes! With the right treatment, children and teens with OCD can successfully learn to manage their OCD and live productive, successful lives. The key is exposure and response prevention, conducted by an expert trained in its use with children and teens.

How does the Treatment of OCD Differ in Children vs. Adults?

The approach to treatment of OCD is largely the same in children as in adults. Both involve exposure and response prevention as the primary tool. In children and teens the treatment concepts are translated into ideas and concepts that kids can readily understand and make use of to fight their OCD.

How early in a child’s life should you seek treatment?

It is best to treat OCD early. The longer it goes untreated, the more generalized the symptoms become. They invade more and more of the child’s life and make OCD more difficult to treat. With treatment, OCD may or may not follow the child into adulthood. Some children may have minimal symptoms as adults or no symptoms at all. Others go into remission, their symptoms disappear, but return during adulthood. OCD symptoms often change over time. The symptoms experienced as an adult are often different from those that person experienced as a child.

I’ve heard that CBT is the best treatment for OCD in children and teens? What is the treatment like?

The most effective cognitive-behavioral therapy for OCD in children and teens is a procedure called exposure and response prevention (ERP). The process of ERP guides children and teens to gradually face and confront the scary thoughts and anxious feelings (exposure), while at the same time encouraging them to resist the urge to do their rituals (response prevention). Through a natural process called habituation, the fears and anxiety reduce as the child sees that their worst fears do not come true even if they do not do their compulsive rituals!

Is Treatment Effective?

Most children/teens with OCD benefit greatly from exposure and response prevention treatment. Of course, no treatment for OCD is a cure-all. Chances are OCD may be something your child will have to manage well into adulthood. However, research shows that early intervention with CBT and exposure and response prevention can provide your child with the foundational tools and skills to manage the OCD effectively in life.

How long does treatment last?

For the majority of children and teens, treatment usually takes between 8-16 weekly sessions to make significant progress. As children and teens with OCD are each unique in their strengths and challenges, treatment may at times require more sessions over a longer period of time to make significant progress. With more severely challenged children and teens, multiple sessions per week may be required initially to make progress.

Should I consider medication for my child/teen with OCD?

In most mild to moderate cases, cognitive behavior therapy (CBT) should be the first line of treatment. If the child doesn’t progress sufficiently from CBT, or has other problems that interfere with progress, such as major depression, medicines should be considered and added to the treatment regimen. The medications for OCD, a class of drugs referred to as “serotonin re-uptake inhibitors,” are often very helpful for children and teens with severe symptoms. While they do not “cure” OCD symptoms, they can reduce the anxiety and intensity of the symptoms so the child or teen can better participate in and benefit from CBT for OCD.

Do you prescribe medications in your Center?

No, we do not have a psychiatrist directly associated with the Center. However, we are familiar with a number of highly qualified psychiatrists in the south Florida community who we regularly work with, who can provide competent medication support and management to our child clients.