Obsessive-Compulsive Disorder in Children: 10 Common OCD Symptoms That Parents Should Know

Many people have heard of obsessive-compulsive disorder (OCD). But did you know that kids and teenagers can have OCD, too? OCD is relatively common, possibly affecting up to 1% to 2% of children and teens. 

But OCD in young people can be hard to spot. In fact, OCD is sometimes called the “hidden epidemic” in kids and teens because the symptoms are often overlooked. Many kids and teens keep their symptoms to themselves, or they don’t realize that they’re signs of a treatable condition. This means it can take a long time — sometimes even years — for children to get a diagnosis and treatment.  

What is OCD?

OCD is a mental health condition that can happen in people of any age. OCD usually begins in the preteens (ages 8 to 12) or the late-teen or young-adult years. 

OCD causes two main types of symptoms: 

• Obsessions are recurrent thoughts and fears that are unwanted and intrusive. They often lead to feelings of guilt, shame, or worry. In children and teens, obsessions often include worrying about germs, illnesses, or bad things happening. Obsessions can also include violent or sexual thoughts or images. 

• Compulsions are actions or rituals that a person feels compelled to do over and over. These behaviors help to relieve the anxiety caused by obsessions. In children and teens, this often includes doing repetitive movements, checking or counting, rearranging or hoarding things, or saying words or numbers out loud. Compulsions can also include asking the same questions multiple times, confessing, or apologizing.  

For the person experiencing them, obsessions and compulsions are clearly connected. And sometimes this connection is clear to others as well. For example, a child who’s worried about burglars might repeatedly check that the door is locked. 

But sometimes people who see the behavior can’t make sense of the connection in the child’s mind. For example, a child who’s worried about death may retrace their steps repeatedly to “protect” their parents. 

OCD symptoms in children: 10 signs that your child may have OCD

It’s not always easy to spot the signs of OCD in your child. After all, it’s normal for children and teenagers to have routines as well as questions, concerns, and worries from time to time.

And children with OCD are often embarrassed or scared by their obsessions, and they’ll find ways to explain away their compulsions. Or they may not view their thoughts and actions as excessive. 

OCD symptoms are often intense, upsetting, and hard to control — to the point where they start to interfere with your child’s daily life. 

Here are 10 examples of behaviors you may notice if your child has OCD: 

1. They’re very afraid of contamination or germs. For example, they go out of their way to avoid touching other children.

2. They worry about their loved ones dying or going away.

3. They have a strong need for order or symmetry. They may constantly rearrange or “even up” their toys.

4. They feel like they have to make their work perfect or “just right.” They may constantly redo their work.

5. They have a hard time leaving the house on time because they constantly recheck things. For example, they may make sure the door is locked multiple times.

6. They spend hours in grooming rituals, including washing hands, showering, and toothbrushing.

7. They repeatedly ask for reassurance. They may ask the same question over and over, and it may seem that no amount of reassurance comforts them.

8. They have elaborate rituals. For example, their bedtime routine may become more complex and elaborate over time. If their ritual is interrupted, they often need to start everything from the beginning.

9. They worry a lot about morals or what’s “right and wrong.” Some children spend a lot of time on religious activities, like prayer, confession, or attending religious services.

10. They feel a strong need to repeatedly count and recount objects.

Can preschoolers have OCD symptoms?

Preschoolers can have OCD, but it’s not very common. OCD is more likely to first appear when your child is a preteen, an older teen, or a young adult. 

And remember that elaborate routines and rituals are developmentally normal for toddlers and preschoolers — especially when those routines are comforting rather than upsetting.  

Sometimes, small children can have OCD that’s caused by a strep infection. This is a rare condition called Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS). It’s most common in children ages 3 to 12. Symptoms are usually dramatic and start very suddenly.

Are there physical symptoms you should look for in a child with OCD? 

On its own, OCD doesn’t have any physical symptoms. But many children and teens experience anxiety alongside OCD. When this happens, OCD-related anxiety and behaviors can lead to:   

• Headaches

• Stomachaches

• Sleep disturbances

• Muscle pain

• Fatigue

• Rashes from repeated hand-washing 

What causes OCD in children?

It’s not clear. Experts don’t know for sure why some children get OCD and others don’t. 

Like many other mental health conditions, OCD might be caused by a combination of genetics, environment and life experiences, and brain structure and function. 

There’s also some evidence that OCD might be linked to health problems during pregnancy and childbirth — like smoking during pregnancy, premature birth, and low birth weight. 

Risk factors that increase a child’s likelihood of developing OCD

Here are some risk factors that could increase your child’s risk for OCD:

• A close family member with OCD: Having a parent or sibling with OCD increases the risk for childhood OCD — especially if the family member also had symptoms as a child or teen. 

• Traumatic or stressful life events: There’s some evidence that traumatic or stressful life experiences might trigger OCD in a person who is already at risk. Some research studies have also shown a link between childhood trauma and OCD. 

• Brain structure and function: There’s evidence that people with OCD might have certain structural brain differences, especially in areas that deal with behavior and emotions. 

• Temperament: Some research has shown that children who are shy or have a lot of unwanted emotions may be more likely to get OCD. 

And keep in mind: More than half of children and teens with OCD have at least one other mental health condition, like tic disorder, ADHD, depression, or anxiety. It’s not clear whether these other mental health conditions are a risk factor for OCD, or if there’s another type of link between them. 

How common is OCD in children?

It’s not totally clear. We do know that OCD in children is less common than other mental health conditions, like anxiety and depression. 

At least 1 out of every 200 kids and teens in the U.S. has OCD, according to the International OCD Foundation. Other estimates show that it may be closer to 2 to 4 out of every 200 kids.   

Can OCD be passed down from parents to children? 

Researchers don’t know for sure. Though scientists haven’t discovered a specific gene for OCD yet, some children seem to be born with a higher chance of developing OCD. As with many disorders, genetics may play a role. 

Here’s what research shows so far: 

• OCD does seem to run in families. People with a family member who has OCD have a higher risk of getting OCD, compared with people who don’t. 

• OCD symptoms are more likely to be shared between identical twins than by fraternal (non-identical) twins. Since only identical twins have the same genetics, this suggests that OCD may be hereditary. 

• OCD that begins in childhood seems to be more connected to genetics than OCD that starts as an adult.  

• There might be hundreds or even thousands of genetic variations that play a role in OCD. These same genes might also be connected to other mental health conditions that can also run in families, like anxiety disorders.  

Remember that just because a parent has OCD, it doesn’t mean that their child will definitely get it too. And the opposite is true as well: Children can also develop OCD even if no one else in the family has it. 

How is childhood OCD different from adult OCD?

Children and adults with OCD have the same types of symptoms. In fact, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) uses the same criteria to diagnose children and adults, with one key difference: Children are less likely to see their compulsive actions as irrational. 

Childhood OCD is also more common in boys. But in teenagers and adults, it seems to be slightly more common in women. 

When to talk to a pediatrician about OCD

If you think your child might have OCD, consider contacting your family pediatrician. Your pediatrician can help to sort out what’s “normal” behavior versus OCD. 

OCD can look different in different children. But here a few clues that it’s time to get professional help:

• Your child’s symptoms take up a lot of time every day, usually an hour or more.

• Your child’s symptoms are causing problems at school or home, or in relationships.

• Your child’s symptoms are distressing to them.

• Your child’s symptoms cause problems with family members, friends, or caregivers.

• You notice your child doing tasks to relieve anxiety or stress, rather than for enjoyment or play.

How do you diagnose OCD in children and teens?

OCD in children and teens is usually diagnosed by a mental health provider, like a child psychiatrist. To be diagnosed with OCD, your child or teen needs to have obsessions and compulsions that:

• Are ongoing

• Are a problem in day-to-day life

• Affect how your child thinks and behaves

• Are not caused by substance use, or another mental or physical health problem

To better understand your child’s symptoms, healthcare providers may use the Children’s Yale-Brown Obsessive Compulsive Scale. This worksheet can also help you and your provider track your child’s symptoms over time. That way you can see whether they’re getting better. 

Options to treat OCD in children and teens

OCD can feel overwhelming. But there are many good treatments available. The right treatment for your child will depend on their: 

• Age

• Symptoms

• Other mental or physical health conditions, if any

Cognitive behavioral therapy

For mild or moderate symptoms, treatment usually starts with a special type of cognitive behavioral therapy (CBT). This is called CBT with exposure and response prevention (CBT-ERP). CBT-ERP can help children and teens learn to face their obsessions and fears, and to resist performing compulsions. It’s successful for about 3 out of 4 of kids and teens with OCD. 

Medication

Medication can be helpful, too. For best results, it’s usually used together with CBT-ERP. 

Your provider might suggest a medication for OCD if your child:

• Has severe OCD symptoms

• Has another mental health condition, like depression or an anxiety disorder

• Is not willing or able to participate in therapy

• Has tried CBT-ERP, but it hasn’t been successful

Selective serotonin reuptake inhibitors (SSRIs) are usually the first-choice medication for treating OCD. Sometimes clomipramine, another antidepressant,  is used instead. 

If your child has PANDAS, they may also need to be treated with an antibiotic. 

Can you outgrow OCD?

Possibly. There’s some evidence that OCD will go away by adulthood in about 40% to 60% of children and teens. For other young people, OCD is a lifelong disorder — though most are able to get much better over time with ongoing treatment. 

What can you do to support a child with OCD?

Having a child with OCD can affect the entire family. Your child’s pediatrician or mental health specialist can help you learn how to support your child. 

Here are some strategies that may help: 

• Try not to accommodate. Even though it’s natural as a parent to want to reduce anxiety for your child, avoid accommodating your child’s requests. When family members participate in the child’s rituals or avoid situations that trigger anxiety, it tends to feed the need to carry out other compulsive behaviors. Consider creating a family contract that helps create boundaries. 

• Remain empathic. Acknowledge how hard it must be for a child feeling distress. Comments like, “Enough already; I told you the oven is turned off!” are not helpful and tend to increase anxiety. Instead, set empathic boundaries, such as, “I know you’re feeling anxious about the oven, but we already checked, and it was turned off. Now it’s time for us to leave, so we’re not going to check again.”  

• Name the OCD. Calling OCD by another name can be helpful for children. The “bully” or “witch” are good options. This helps children think of their OCD as a separate entity that the entire family will work against. Together, the child and family can find ways that let the child “win” against the OCD. 

• Support your child’s treatment. Staying in close contact with your child’s healthcare providers — and following up on recommended treatments — can both go a long way toward your child’s recovery. 

• Get support for yourself, too. Caring for a child with OCD can be challenging. Reach out to family and friends to get care and support for yourself. Many people also find it’s helpful to join a support group or class where they can connect with other caregivers of children with OCD. 

You can find some more helpful tips and resources here: 

• How to Help Your Child: A Parents’ Guide to OCD

• A Complete Guide to OCD, from the Child Mind Institute

• International OCD Foundation

Why trust our experts?

Written by:

Karen Hovav, MD, FAAP

Karen Hovav, MD, FAAP, has more than 15 years of experience as an attending pediatrician in a variety of clinical settings. She has worked in a large academic center in an urban city, a small community hospital, a private practice, and an urgent care clinic.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

Reviewed by:

Sarah Gupta, MD

Sarah Gupta, MD, is a licensed physician with a special interest in mental health, sex and gender, eating disorders, and the human microbiome. She is currently board certified by the American Board of Psychiatry and Neurology.

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