Therapy Dynamics, PLLC

Obsessive-Compulsive Disorder in Children

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by

Kristen
in

What Is Pediatric OCD?

Obsessive-Compulsive Disorder (OCD) is a mental health condition that affects children as well as adults, often showing up between the ages of 7 and 12. OCD involves:

  • Obsessions: Unwanted, intrusive thoughts, images, or urges that cause distress.

  • Compulsions: Repetitive behaviors or mental acts children perform to try to reduce the distress or prevent a feared outcome.

Common themes include:

  • Germs and contamination

  • Harm coming to themselves or others

  • “Just right” feelings or symmetry

  • Moral or religious concerns

  • Superstitious fears or magical thinking

Children often feel confused, ashamed, or frightened by their thoughts, especially if they don’t understand why they keep coming back.

Signs of OCD in Children

You might notice:

  • Excessive handwashing or showering

  • Repeated checking (locks, lights, homework)

  • Repeating phrases or actions until it feels “right”

  • Asking for reassurance constantly

  • Avoidance of certain places, people, or tasks

These behaviors aren’t just habits, they’re driven by anxiety and can interfere with school, friendships, and daily routines.

How OCD Develops in Children

While the exact cause of OCD isn’t fully understood, it likely involves a combination of:

  • Genetic vulnerability

  • Brain chemistry differences, particularly in serotonin regulation

  • Environmental stressors, like trauma or infections (e.g., PANDAS)

OCD is not a character flaw or parenting failure. It’s a neurobiological condition and it’s treatable.

Evidence-Based Treatment: CBT with ERP

Cognitive Behavioral Therapy (CBT)

CBT helps children:

  • Recognize how their thoughts, feelings, and behaviors are connected

  • Challenge distorted or intrusive thoughts

  • Develop coping tools and a new relationship with anxiety

Exposure and Response Prevention (ERP)

ERP is the gold standard for treating OCD in children.

  • Exposure: The child gradually faces anxiety-provoking situations (e.g., touching a “contaminated” doorknob).

  • Response Prevention: The child resists the urge to perform the compulsion (e.g., not washing hands afterward).

This builds tolerance for discomfort and helps their brain learn that nothing bad happens when they don’t do the ritual.

What ERP Looks Like in Practice:

  • Creating a hierarchy of fears (called a “fear ladder”)

  • Practicing exposures at a manageable pace

  • Using rewards, play, and creativity to keep children engaged

  • Teaching caregivers how to avoid accommodation (e.g., not participating in rituals)

With skilled support, most children with OCD improve significantly within weeks or months of treatment.

Involving Parents and Caregivers

Family involvement is critical. Parents may unintentionally reinforce OCD by:

  • Offering reassurance

  • Participating in rituals

  • Avoiding triggers

Therapy helps parents:

  • Understand the mechanics of OCD

  • Set gentle but firm boundaries

  • Support exposures at home

Book Recommendations for Children and Families

Here are some excellent, age-appropriate books that can help explain OCD and support treatment:

For Children:

  • What to Do When Your Brain Gets Stuck by Dawn Huebner
    A child-friendly CBT workbook that explains OCD with metaphors and activities.

  • Up and Down the Worry Hill by Aureen Pinto Wagner
    A storybook that introduces ERP in a non-scary way for young children.

  • Mr. Worry: A Story About OCD by Holly L. Niner
    A beautifully illustrated book that validates kids’ experiences with OCD.

  • Can I Catch It Like a Cold? by Centre for Addiction and Mental Health
    Explains mental illness, including OCD, in a way young children can understand.

For Parents:

  • Freeing Your Child from Obsessive-Compulsive Disorder by Tamar Chansky
    An essential parent guide to understanding OCD and supporting CBT and ERP.

  • Talking Back to OCD by John March
    Teaches kids and parents how to stand up to OCD together.

When to Seek Help

If your child’s routines, distress, or worries interfere with school, sleep, or social life, it may be time to seek a mental health evaluation. Early treatment prevents worsening and gives your child tools they can use for life.

Final Thoughts

Living with OCD can feel confusing and exhausting—for kids and families. But with accurate diagnosis, evidence-based therapy, and family support, children can learn to take charge of their anxiety instead of being ruled by it.

If you’re concerned about your child or would like to explore OCD assessment and treatment options, feel free to reach out. You’re not alone and there is hope!