Obsessive-Compulsive Disorder
(OCD) in Children

Obsessive-compulsive disorder (OCD) is a condition that causes kids to have unwanted thoughts, feelings, and fears. These are called obsessions, and they can make kids feel anxious. OCD also causes kids to do behaviors called compulsions (also called rituals).

The reason a child has OCD is because the brain cannot self regulate the intrusive thoughts and compulsive behaviors due to lack of a neurotransmitter chemical called serotonin. This chemical is critical as it is needed for the brain to have “brakes” in controlling thoughts and behaviors associated with OCD. 

What Does Obsessive-Compulsive Disorder (OCD) Typically Look Like In A Child?

What Are Obsessions?

Obsessions are fears that kids with OCD can't stop thinking about. They may realize their thoughts don't make sense, but they still feel anxious about certain things. 

These fears might include whether:

• They, or someone else, will get sick, hurt or die
• They said a bad word, had a bad thought or made a mistake
• They have broken a rule, done a bad thing or sinned
• Something is clean, dirty or germy
• Something is straight, even or placed in an exact way
• Something is lucky or unlucky, bad or good, safe or harmful

What Are Compulsions?

Compulsions (rituals) are behaviors that kids with OCD do repeatedly. OCD causes kids to feel they “have” to do rituals to "make sure" things are clean, safe, in order, even or just right. To kids with OCD, some rituals seem to have the power to prevent bad things from happening.

Rituals include things like:

• Washing and cleaning
• Often erasing things, re-writing, re-doing or re-reading
• Repeating a word, phrase or question much more than necessary
• Going in and out of doorways several times in a row
• Checking to make sure a light is off, a door is locked or checking and re-checking homework
• Touching or tapping a certain number of times, or a set way
• Having things in a specific order
• Counting to a certain 'good' number, avoiding "unlucky" numbers

What's It Like for Kids With OCD?

Some kids don't always talk about the fears and behaviors OCD causes. They may feel embarrassed or confused about their fear and keep it to themselves. They may try to hide rituals they do. They may worry that others will tease them about their fears and rituals. Sometimes, it seems so normal for them to think these things, it doesn’t occur to tell anyone.

On the other hand, most kids are going to talk a lot about their fears with their parents. And parents will notice their rituals done at bedtime, when eating or when they are playing. 

Kids with OCD feel unable to stop focusing on their obsessions. They feel like they have to do the rituals to guard against bad things they worry could happen. For some kids, doing a ritual is the only way they feel "everything's OK." Most often, these thoughts or behaviors do not go away on their own.

If they do stop thinking a certain thought or stop a compulsive behavior, it gets replaced with a different thought or behavior. 

What Might Parents Notice With Their Child With OCD?

Many kids have OCD for a while before parents, teachers or doctors realize it. Parents might only learn about these behaviors or obsessions if their child tells them, or if they notice the child seems overly worried or is doing behaviors that seem like rituals.

Sometimes, parents may notice other difficulties that can be a result of OCD.

For example, OCD can cause kids to:

• Have trouble concentrating on schoolwork, or enjoying activities
• Feel and act irritable, upset, sad or anxious 
• Seem unsure of whether things are o.k.
• Have trouble deciding or choosing
• Take much too long to do everyday tasks, like getting dressed, organizing a backpack, completing homework or taking a shower
• Get upset and lose their temper if they can't make something perfect or if something is out of place
• Insist that a parent say or do something an exact way

How Is OCD Diagnosed In Children?

Typically, when a parent brings their child to our office, they usually are not asking if their child has OCD. They are usually coming in because their child is anxious, struggling at school, having meltdowns, overly rigid, demanding or coming across as oppositional or defiant.

Many parents wonder if their child has ADD/ADHD because their child is struggling at school or with homework at home because they cannot concentrate. At NPS, we have an intake that screens for all categories of struggles with children. This is so that we do not miss any important information so we can accurately diagnose your child. It helps us tease out the correct diagnosis that can have some of the same behaviors that can look like OCD, ADHD or ODD.

There are no lab tests to diagnose OCD.

When OCD is diagnosed, it can be a relief to kids and parents. The child is not broken or misbehaving on purpose. The brain just needs help with getting more of the neurotransmitter serotonin available to help self regulate thoughts and behaviors. OCD can get better with the right treatment and support.

How Is OCD Treated In Children?

Since the neurotransmitter serotonin is lacking in a person with OCD, the focus is on helping the body produce more serotonin or release and utilize more of serotonin that it already has. 95% of serotonin is manufactured in the gut. At NPS, we look at the multiple reasons for what could be disrupting the gut from manufacturing serotonin.  Our focus is on the Brain Gut Axis or Brain Gut Connection.

OCD can also be treated with natural supplements that enhance neurotransmitter production responsible for self regulating intrusive thoughts and compulsive behaviors. Counseling is employed to help your child understand why their brain is hijacking their thoughts and making them loop on negative scary things or have rituals that do not make sense.

Most children, once they understand this, feel less anxious when it happens. This is important while treating the child to help their body utilize or manufacture more serotonin to stop the thoughts and compulsions.

Parenting A Child With OCD

What is most helpful for the parent is understanding what is triggering the child’s disruptive thoughts and behaviors. Once a parent understands that a child is not “willfully” being defiant, avoiding homework or demanding to do certain things, they can respond with compassion and support. It is helpful to explain to the child the difference between “them” doing or thinking something vs their “brain” doing it to them. 

Disciplining a Child with OCD

Disciplining a child with OCD typically only makes the situation worse. This is because it is a brain neurotransmitter issue, not a behavioral issue. Education of what is causing the OCD and implementing treatment for it to help the brain be able to self regulate is the answer.

Compassion and coming alongside the child to empathize how hard it is for them when their brain is making them think thoughts over and over or feel the compulsion to do something over and over is most helpful. After your child understands that you “get it” then help your child transition to doing something they enjoy doing to help break up the thoughts or compulsion. 

OCD Medication For Children

For kids who use medicines, doctors give SSRIs (selective serotonin reuptake inhibitors), like Zoloft, Prozac, and Luvox. This is because the SSRI’s help the brain utilize the neurotransmitter serotonin which is the core reason why children experience OCD. If a child cannot swallow a pill, the doctor will prescribe an SSRI medication in liquid form. 

5 Tips On How To Parent A Child With OCD

1. Educate you and your child on OCD
2. Give the OCD a name like Mr. Bossy
3. Do not get overzealous and point out all your child’s rituals
4. Do not be part of your child’s rituals
5. Keep an eye out for new rituals so you and your child are a team