How OCD Shows Up in Children and Teens
- Reading Time: 10 minutes
Obsessive-compulsive disorder (OCD) manifests differently depending on the age of the patient. Studies published by the International OCD Foundation on obsessive-compulsive disorder show that 1 out of 40 adults develops OCD at some point in their life. Among those affected, children are the most difficult to diagnose. This is due to the confusing nature of OCD.
It’s important to understand the symptoms of early OCD to prevent it from permanently affecting children. This prevents the mental health issue from escalating or being misdiagnosed as OCD.
- Amanda Mulfinger, PhD, LP
- Updated: July 3, 2025
Table of Contents
Key takeaways:
Pediatric OCD is a serious mental health issue, not just odd behavior.
OCD symptoms change with age, from physical rituals in kids to mental ones in teens.
Look for distress, secrecy, and daily disruption as signs anxiety is escalating.
Diagnosis involves clinical interviews; OCD often co-occurs with other conditions.
CBT and ERP are key treatments, heavily supported by family and school involvement.
What Is Pediatric OCD?
Pediatric OCD is a mental health issue characterized by repetitive behaviors and unwanted thoughts. It is a compulsion that repetitively interferes with the daily life of a child, as they have to accommodate their life around the compulsion.
Defining OCD in Younger Populations
OCD manifests differently in the younger population because children may not understand their compulsion. The developmental difference leads to fear and confusion, riddled with internal compulsions.
Children struggle with simpler rituals, such as lining up their toys or repeatedly touching things. On the other hand, teenagers frequently engage in mental rituals such as repeating words in their mind or counting silently. Most parents mistake this for distraction or daydreaming.
According to studies by Carolin S. Klein at the University Hospital of Psychiatry and Psychotherapy in Tübingen, Germany, OCD affects an average of 1% of children and 4% of teenagers. The condition appears around the ages of 8 to 11, which makes it more difficult to diagnose.
Since symptoms vary, parents and teachers alike don’t see the early signs of OCD. Children with this condition also face anxiety, shame, or guilt because they can’t properly explain why they feel the need to perform these rituals.
When Anxiety Becomes Something More
Worries and mild anxiety can turn into something more when they start disrupting the child’s daily life. Common red flags that the anxiety has escalated include the following:
- Emotional Distress: The child feels a lot of guilt, fear, and shame that doesn’t go away even after reassurance-seeking.
- Secrecy: The child tries to hide their compulsion out of fear that people will think they’re strange.
- Disruption: The rituals are starting to take a significant amount of time and interfere with sleep, meals, or school.
- School Avoidance: Children refuse to go to school because they are overwhelmed by their obsessions and rituals.
Seek professional help if the patterns repeat too much and the behavior interferes with daily functioning. Early intervention keeps the symptoms from getting any worse.
Symptoms of OCD in Children vs Teens
Symptoms of OCD are more externalized during childhood years and internalized during adolescence. Intrusive thoughts are their base, but they manifest differently depending on the child’s awareness levels.
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Common Obsessions in Youth
Common obsessions in youth center around harm fear, contamination, religious thoughts, and perfectionism. These intrusive thoughts disturb their ability to relax and enjoy their day.
Children fear that their thoughts will result in negative real-world outcomes. Teens ruminate on them and try to find ways to undo them.
Common obsessions manifest as follows:
- Contamination Fear: The fear of getting sick after they touch something dirty.
- Harm OCD: Not wanting to harm someone they care about, such as the fear of harming pets.
- Scrupulosity: Moral or religious obsessions that include praying repeatedly or continuously seeking forgiveness.
- Perfectionism: The need to do things just right.
As an example, a child might fear they’ll poison their pet cat if they don’t wash their hands three times. Teens could also think silently for hours, mentally replaying something they may have done wrong.
Common Compulsions and Rituals
Common compulsions include ritualized behaviors such as handwashing or tapping to cope with their obsessions. This helps reduce anxiety and can be both internal (mental) and external (physical).
Children frequently express the following compulsions:
- Repeatedly washing or sanitizing their hands
- Tapping objects an exact number of times
- Repeatedly checking schoolwork, doors, and locks out of fear of making mistakes
- Seeking reassurance by asking repetitive questions
Children wash their hands and are more physical in their compulsions. Teens count and experience other symptoms alongside the common ones. This includes:
- Counting in their heads until they get to the perfect number
- Silently repeating special prayers or words
- Creating mental scenarios to undo bad thoughts
- Consistently reviewing past actions to check for mistakes
Avoidance is a key symptom, as kids refuse to touch specific items. They can also avoid certain colors or numbers for no apparent reason. Without intervention, these can solidify.
What Makes It OCD and Not a Phase
OCD is different from your average “quirky behavior” because the pattern persists and affects their daily routine. When it’s just a temporary habit, they want to do it. However, when it’s OCD, they have to do it.
Some signs that suggest the symptoms escalated into OCD include the following:
- The ritual gets in the way of their daily activities, such as doing their homework, going to school, or spending time with friends.
- Stopping the ritual (intentional or not) leads to increased anxiety and even a breakdown.
- The child feels distressed when they can’t perform the activity just right.
- The frequency and duration are much longer than typical routines and can take hours.
- Lack of control over the behavior, even if they know it doesn’t make sense.
Keep developmental stages in mind when you reach this question. For example, a young child who still believes in fairy tales may just have a vivid imagination. That said, if these patterns lead to functional impairment and fear, it may signal OCD.
Diagnosis and Evaluation
Therapists evaluate OCD by taking a look at their symptoms and history. They search for patterns that fit the mental health criteria and determine if their symptoms are for OCD or something else.
How Therapists Identify OCD in Youth
Therapists identify OCD in youth by performing a clinical interview. Here, the therapist will have an in-depth discussion with the child and parents alike. During this interview, therapists evaluate obsessive patterns that fit the DSM-5 criteria. This is the main diagnostic manual for mental health conditions.
Family interviews are common for diagnosing OCD. Studies by Simran K. Kalra for the National Institute of Mental Health (NIMH) show that 45% to 65% of OCD cases in children are inherited from parents.
During the intake, therapists will gather background information about daily routines and aspects of your child’s development. They may also:
- Gather school and family reports to see if it affects their attendance, daily life, or learning
- Observe how the child behaves during the interview
- Create a symptom timeline to see when the symptoms emerged.
Diagnosis is frequently delayed because the child is ashamed or afraid of being labeled as “weird.” This secrecy, along with mislabeling of symptoms, could result in a diagnosis that takes months, perhaps years, to emerge.
Comorbid Conditions and Diagnostic Overlap
OCD symptoms overlap with various conditions such as ADHD, tics, autism, depression, and anxiety. There is a chance that one child may have two of these conditions at the same time. Studies by Prerika Sharma at the Turner Institute for Brain and Mental Health in Australia show that 75% of patients with OCD also have anxiety.
This is referred to as a comorbidity, and it could mean that your child is juggling more than one mental health issue at a time. There’s also the chance that the overlapping symptoms mimic OCD but point way beyond it.
Some common neurodevelopmental disorders that appear alongside OCD include:
- Anxiety: Worrying excessively about different life areas
- Depression: Irritability, sadness, and loss of interest caused by stress
- ADHD: Inability to sit still or pay attention due to obsessive behavior
- Tics: Repetitive sounds or movements
- Autism: Strong need for consistency and rituals
Kalra, S. K., & Swedo, S. E. (2009). Children with obsessive-compulsive disorder: are they just “little adults”?. Journal of Clinical Investigation, 119(4), 737–746. https://doi.org/10.1172/jci37563
The symptoms confuse even experienced providers. As a result, clinicians differentiate these symptoms by looking at the motivators and timeline. If the disorders co-occur, treatment is adapted to address the child’s every need.
How OCD Affects Daily Life
OCD affects daily life by sending intrusive thoughts that disrupt your lifestyle. This includes school, social life, and your emotional health. Family can also unknowingly reinforce one’s OCD, which “locks” in the rituals.
School, Social Life, and Emotional Health
Rituals, intrusive thoughts, and the avoidance associated with OCD prevent you from focusing on the task in front of you. OCD episodes can appear when your child is in class, making it impossible for them to focus on their lessons.
The urge to repeat the situation leads to them refusing to go to school entirely. Fear of bullying could make teens withdraw and hide their thoughts. They hide their perfectionism so they don’t appear as strange, but this avoidance also leads to more isolation and even more bullying.
The OCD disrupts learning, and the “good” routines suffer. This happens because the child lives in a state of secrecy and anxiety.
The Role of Family Accommodation
Many parents unknowingly reinforce OCD because they see it as a quirk. They may end up frequently reassuring the child or modifying their routine so they feel at peace. Some common family accommodation methods include:
- Parents adjust the place or topic to prevent anxiety
- Parental response covers frequent answers to soothe doubts
- Rituals expand as parents are “helping” them
These offer short-term relief for a child with OCD, but they permanently change home dynamics. Caregiver support is important at this stage, as it teaches parents how to set boundaries and help the child recover.
Evidence-Based Treatment Options
The most common ways to treat OCD are CBT and ERP. School and family support are essential to promote good behavior and restore a sense of normalcy.
CBT and ERP for Children and Teens
Cognitive Behavioral Therapy (CBT) and Exposure and Response Prevention (ERP) coach children to gradually accept their fears and let go of their rituals. This could involve touching an object they feel is scary or learning to skip certain rituals.
Studies by Ahsan Nazeer show that combining individual therapy with family sessions has a 70% response rate. This makes it more effective compared to standardized CBT and has fewer chances of recurrence.
Therapy involves individual sessions, parent sessions, and at-home exercising. A good therapy structure includes behavioral games, visual aids, and active parent involvement.
Exposure hierarchy helps the rituals fade. This happens because the child now knows how to face the situation without completing the ritual.
Role of Family and School Support
Clinicians advise the introduction of family therapy, accommodation reduction, and sometimes an Individualized Education Program (IEP) for OCD recovery. For instance, family therapy shows parents how to respond without enabling their rituals.
Some common strategies include the following:
- Psychoeducation: Parents understand how OCD works and why reassurance or enabling should be avoided.
- Response Prevention: Parents are coached on how to avoid excessive reassurance.
- Setting Limits: Parents learn what rituals to stop participating in while maintaining compassion.
- Exposure Plan: The therapist identifies the actions that worsen OCD symptoms and sets up a gradual reduction plan.
Teacher awareness is just as important, as children spend a good part of their day at school. The schools support children with OCD using the following classroom accommodations:
- Extra time for assignments
- A private area where they practice their coping skills
- Support plans to ease their transition.
When both the teachers and the parents monitor the child’s progress, children learn to gradually manage their OCD. This prevents them from falling back into bad habits as everyone is working towards the same goal.
When Medication Is Considered
Doctors prescribe medication in moderate to severe cases. These decisions are made by a child psychiatrist, together with the family. Keep in mind that the pharmacological treatment is not meant to ease the symptoms.
Nazeer, A., Latif, F., Mondal, A., Azeem, M. W., & Greydanus, D. E. (2020). Obsessive-compulsive disorder in children and adolescents: epidemiology, diagnosis and management. Translational Pediatrics, 9(S1), S76–S93. https://doi.org/10.21037/tp.2019.10.02
The cognitive therapy continues even with the medical treatment being underway.
Studies at Stanford University on OCD pharmacological treatments show that an average of 40% to 60% of patients will improve after four weeks of SSRIs. Common treatments include sertraline, fluvoxamine, and, in some cases, clomipramine.
Symptoms ease after prolonged therapy, which lasts months or even years. Data published on the International OCD Foundation on medication treatment for obsessive-compulsive disorder suggests that an adequate medical treatment should last at least 8-12 weeks.
Get Help for OCD in Children and Teens
Getting help for OCD in children and teens is essential, especially in the early stages of the condition. Repetition maintains and escalates OCD symptoms by training them to expect the rituals. Therapy interrupts the vicious cycle of rituals.
Why Early Treatment Matters
Early identification is important because it gives you a wider treatment window. OCD does not go away on its own, but the behavior wasn’t significantly “locked in.” Children can easily develop new skills as part of the relapse prevention strategy.
Therapy reshapes thought patterns at an early age. Studies on the teen brain by the National Institutes of Health suggest that most of the brain development happens by the ages of 6-8, but it finishes maturing in the mid to late 20s.
Early action improves the overall prognosis because the brain is still underdeveloped. The obsession does not affect their daily functioning either, making it easier to “reset.”
Meet Noah Scanlon, M.A., Pediatric OCD Therapist
Noah Scanlon is a licensed therapist at Cabot Psychological Services with experience in pediatric OCD. He frequently takes cognitive behavioral (CBT) or psychodynamic approaches to therapy.
Noah helps his new clients build relationships on open communication and trust. The warm, tailored care and experience create an environment where teens open up about their rituals and obtain effective treatment.
Stanford Medicine. (n.d.). Pharmacotherapy. Obsessive-Compulsive and Related Disorders. https://med.stanford.edu/ocd/treatment/pharma.html