What Parents Should Know About OCD In Children, From Diagnosis To Treatment

An artistic and curious young child, Jordan Brown* has struggled with anxiety since the age of five. But it was not until COVID broke out in 2020, when Jordan was 10, that their worries raged out of control.

They began washing their hands repeatedly until they bled, and they engaged in elaborate clothing-related rituals, like taking off all their clothes when they got home, putting them on a garbage bag, spraying their hands and feet with cleanser, and then walking up one side of the stairwell to the bathroom for a half-hour shower.

Jordan’s mother, Alex Brown,* a Guelph, Ont-based single mom, found herself completely overwhelmed trying to manage these symptoms, which turned out to be signs of obsessive-compulsive disorder (OCD).

OCD is a difficult and sometimes heartbreaking mental health disorder that affects about two to three percent of children and adolescents. Parenting a child with OCD can be challenging, but experts say there is hope.

Treatment for OCD works by helping kids confront or “feel” their difficult feelings so they won’t feel compelled to perform rituals as a way to block them. The right strategies can help children to recover.

What you need to know

• OCD in children can show up as both visible rituals and internal mental compulsions, such as rumination, silent checking or needing constant reassurance.
• The most effective first-line treatment is typically exposure and response prevention (ERP), a type of cognitive behavioural therapy.
• Parents can help by seeking professional support and by avoiding accommodations that accidentally strengthen the OCD cycle.

What is OCD?

Obsessive-compulsive disorder, or OCD, is a form of anxiety that involves obsessions and/or compulsions. Obsessions are recurring, upsetting and unwanted thoughts, images or urges that cause distress. Compulsions are the actions a person feels driven to do to reduce that distress—and they are not always visible. Some compulsions happen internally, such as mentally reviewing events, silently repeating phrases, trying to “cancel out” a bad thought or seeking repeated reassurance.

What are the signs of OCD in children?

Children with OCD may have unhealthy obsessions. For example, they may be obsessed with avoiding germs or contamination, keeping their family and themselves safe, or with symmetry or having things “just right.”

They might also have a variety of different compulsive behaviours. They might repeatedly lock and unlock doors or check the stove if they are concerned about safety; they may keep washing their hands if worried about germs; or they may seek reassurance from their parents that they aren’t bad or that nothing bad will happen to them. Not all compulsions are easy to spot. Some children may spend long periods ruminating, mentally checking, replaying conversations or asking repeated questions in an effort to feel certain, safe or “just right.”

Some children will also count things, line their toys up in a certain way or order them symmetrically as a way to not think about something scary.

How is OCD in children diagnosed?

OCD is diagnosed by a healthcare professional based on whether a child has obsessions, compulsions or both—and whether those symptoms are causing significant distress or interfering with daily life. A child doesn’t need to spend a specific number of hours on rituals to need help; what matters most is how much the symptoms affect things like school, sleep, friendships, family routines and everyday transitions.

Clinicians will also consider whether another condition could better explain the behaviour, and whether the symptoms point to OCD, another anxiety disorder, a tic disorder or, more rarely, a sudden-onset condition such as PANS or PANDAS.

You might want to ask your child why they are performing the ritual to see if it is something they feel compelled to do and if it upsets them.

Healthcare professionals will also consider if the child might be suffering from PANDAS or PANS, a rare condition where an infection, often strep throat, can cause an abrupt and dramatic onset of OCD.

At what age can a child develop OCD?

OCD can appear at any age, but when it develops in childhood, it typically happens between ages eight and 12. It’s rare for OCD to be diagnosed before age five.

Can OCD go away on its own?

If left untreated, OCD tends to get worse, not better, Klinkhoff says. This might be a scary thought for parents whose kids are struggling, but there is hope: “With treatment, OCD can improve or disappear,” she says.

What’s more, treatment may be easier to access now than it has been before, she adds. “COVID has opened up a few more doors because now people even in remote areas can meet with a therapist online.”

How is OCD treated in kids?

The gold standard for OCD treatment is a type of cognitive behavioural therapy (CBT) called exposure and prevention therapy (ERP). This involves systematically and gradually exposing the person to things that they are fearful of so they can learn how to tolerate rather than avoid their feelings.

The therapist may help them rate the things they are scared of from one to 10, with one being the least scary and 10 being the most. The child will then be exposed to something on the lower end of the hierarchy (a three or a four), and work their way toward tolerating more stressful triggers.

The goal is to help the child not perform the ritual that they normally do to calm themselves, and to recognize that nothing bad will happen as a result.

ERP is typically considered the first-line treatment for children with OCD. For kids with moderate to severe symptoms—or for those who aren’t improving enough with therapy alone—a doctor may also recommend an SSRI, a type of antidepressant that can help reduce OCD symptoms. Medication decisions should be made with a clinician experienced in treating children, and they are generally most effective when used as part of a broader treatment plan.

How to help a child with OCD at home

Don't accommodate the rituals

Although this can be difficult if your child is very distressed, it is best not to help them carry out the OCD rituals. Instead, encourage them to cut down on the length of time they perform it and reward their efforts to do so successfully.

To help distract them from the rituals, Klinkhoff recommends offering them ways to self-soothe, like giving them a soft toy or animal or a smooth fidget toy to play with. Or you could help regulate their temperature, for example, by putting a cold ice pack on their neck if they are extremely anxious or giving them a warm bath if they are only mildly anxious.

Reduce reassurance

When a child is anxious, they will often ask for reassurance—for example, “Are you sure the door is locked?” Klinkhoff recommends resisting the temptation to provide any reassurance. It often doesn’t help, and more importantly, it robs your child of the opportunity to practice calming themselves down on their own.

There are, of course, exceptions to this rule. “If there is a huge emotional burst and you need to get them out the door for something important, it is understandable for parents to make the choice to prioritize their child’s short-term needs and provide reassurance,” she says.

Externalize the condition

Labelling the problem and externalizing it—that is, separating it as a problem that does not reside within the child—can help to destigmatize it. For example, Klinkhoff suggests talking about the “OCD monster” (or any other name that sounds mean) and saying things like, “We don’t like the OCD monster, and this is what we can do to tackle it.”

You might also want to work with your child’s teacher so they can support efforts being made at home. The teacher can help validate your child when they are struggling with comments like, “It seems like you are having a hard time with this,” while also avoiding accommodating their rituals.

While evidence-based treatment for pediatric OCD centres on ERP and, in some cases, medication, some families also find that supportive activities such as art, sports or animal-based programs help children manage stress and reconnect with parts of themselves that feel overshadowed by anxiety. These approaches can be helpful complements, but they are not considered replacements for OCD treatment.

For Alex and Jordan Brown, hope is finally coming through a combination of regular ERP therapy and bi-weekly equine therapy. The two-hour equine sessions began with Jordan feeding grass to a horse; today, they can confidently ride a sizeable Clydesdale.

“It’s one of the only times that Jordan is totally focused on something other than anxiety,” says Brown. “It’s the child I remember.”

*Names have been changed

What else should parents know about OCD in kids?

How is OCD different from normal habits or routines?

Many children like routines or go through phases where they want things done a certain way. OCD is different because it involves intrusive thoughts and repetitive behaviours that feel hard to control and that cause distress or interfere with daily life.

When should parents seek help?

If your child’s fears or rituals are taking up a lot of time, making it hard to get through school or family routines, or causing significant distress, it’s worth speaking to your family doctor, pediatrician or a mental health professional.

What should parents avoid doing?

Experts say it’s important to avoid getting pulled into rituals or offering constant reassurance, even though that can feel like the fastest way to calm your child in the moment. Over time, those responses can unintentionally strengthen OCD.

Can schools help support a child with OCD?

Yes. Teachers and school staff can support treatment by responding calmly, avoiding participation in rituals and helping children transition through stressful parts of the day.