Kids love rituals. In fact, they often insist on them. The mashed potatoes can’t touch anything else on the plate. Bedtime stories have to be told in a specific order. Soccer games must be played in that one pair of lucky socks. But sometimes these patterns of behavior are more than just being a “picky kid” and wanting things a certain way; sometimes they’re a sign of obsessive-compulsive disorder (OCD).

As a parent who wants to help a child with OCD, you may feel overwhelmed and even a bit helpless. The good news is that there are highly effective treatments for pediatric OCD, and they tend to benefit the entire family, not just the child who has the condition. After all, says Dr. Nicholas Farrell, PhD, a licensed clinical psychologist and a Regional Clinical Director at NOCD, “living a life constricted by your child’s intrusive thoughts and fears and coping strategies isn’t fair to parents or siblings.” 

Countless children with OCD have learned to manage their thoughts and emotions, so that they are able to lead happy, fulfilling lives. Learn about pediatric OCD treatment by booking a free call.

What’s the best treatment for OCD in children?

Childhood OCD is best treated by a licensed mental health professional who specializes in understanding the ins and outs of the disorder. The OCD treatment with decades of clinical research backing its effectiveness is called exposure and response prevention therapy (ERP). In ERP, kids learn to face their fears through exposures without giving in to compulsions. 

Kids can’t “just stop” their symptoms, and believing that they can usually only adds to the distress and anxiety they feel.

Before we dive deeper into exactly what ERP entails for children, let’s explore some key characteristics of the condition. 

What is OCD in children?

OCD has two parts: obsessions and compulsions. The “obsessive” part of OCD involves intrusive thoughts, images, sensations, feelings and urges that aren’t wanted. For example, a child may have a thought that the TV remote is covered in deadly germs. When these thoughts hijack a child’s mind, they trigger intense anxiety or distress. The “compulsive” part of OCD is the child’s response to those obsessions—actions that briefly make the anxiety go away, like washing their hands over and over after touching the remote.

Kids’ OCD obsessions can be about anything, but commonly include the following themes:

• Fears about germs, cleanliness, and getting sick (“Touching the dog could make me contaminated and sick.”)
• Thoughts about harming themselves or others (“If I pick up this pair of scissors for my art project, I might stab someone”)
• A feeling that things absolutely must have a precise order or symmetry (“My pencils aren’t lined up, and I can’t do homework unless they are.”)
• Hyper-responsibility for what happens to others (“If I don’t tap my fingers on the table 12 times, something bad will happen to someone I love.”)

Common compulsions in kids:

• Repeatedly checking locks, toys, or shelves
• Counting or repeating words
• Rereading sentences or rewriting homework over and over to get it “just right”
• Spending lots of time washing hands, showering, cleaning, or doing other rituals to prevent contamination
• Needing excess reassurance from caregivers

Considering that OCD can show up at a very young age or not until later in their teenage years, you might notice that a child’s anxieties and rituals change significantly over time. In fact, it’s quite common for OCD to switch themes in both childhood (as well as adulthood), especially as children grow and are exposed to new areas of life. 

“With kids, anxiety can migrate. It might be all about home for a few months, then the focus can shift to their school or daycare, and then on friends,” says Dr. Farrell. For instance, maybe they spend months obsessing over the “perfect” bedtime routine, and then one day it’s all about a preoccupation with how their homework looks.

Also important to keep in mind: “The thoughts and behaviors you’re noticing in a child are probably the tip of the iceberg,” Dr. Farrell says. “Often, there’s a whole bunch of stuff beneath the surface, that the parents—through no fault of their own—probably have zero awareness of. That’s because the symptoms of OCD feel highly embarrassing. So there’s secrecy, when a child tries to blur the symptoms that come with OCD.”

Three signs it’s time to seek professional help for a child with OCD

OCD isn’t a personality quirk or some sort of growing pain. It’s a mental health disorder that will not get better on its own. In fact, if left untreated in children, OCD tends to become more difficult to live with in adult life, says Dr. Farrell. “Adults who have lived with OCD for years need a longer time in treatment before they see improvement,” says Dr. Farrell.

Simply put: If you have a hunch that your child has OCD, it’s imperative to seek out treatment. Here are some of the signs that your child has OCD and it’s time to make a call to a specialist:

• Your child’s fears are having an impact on everyone: “Anxiety is a normal part of growing up, but when it interferes with school, friendships or family life, we recommend parents seek treatment for their child,” says Shannon M. Bennett, PhD, a pediatric psychologist at NewYork-Presbyterian Hospital/Weill Cornell Medical Center in New York. Adds Dr. Farrell: “If, say, you can’t go out to eat because your child is afraid of germs in restaurant food, or if you’re about to get rid of the family pet because your child has repeated thoughts about harming it—then you should consider getting help.”
• OCD takes up a lot of time. If your kid spends more than an hour a day on their compulsive behaviors, then they may have OCD. “One of the under-appreciated aspects of OCD is just how much time it consumes,” says Dr. Farrell. “A child might have no after-school activities, no friends, because of all the hours they have to devote to their compulsive activities.”  
• You notice your kid is having a hard time, but they can’t put it into words. “A kid and a grown-up might both need to tap the doorframe five times, close their eyes and silently repeat a prayer every time they go through a door,” says Dr. Farrell. “If you ask the adult, he can tell you exactly what he thinks he’s preventing when he does that. If you ask an 8-year-old, she might say ‘I don’t know. It just feels like something I have to do.’” Translation: Just because children can’t articulate the “why” behind their thoughts and behaviors doesn’t mean they’re not struggling and in need of support.

What actually happens in OCD treatment for kids

As mentioned earlier, the best treatment approach for children with OCD is called exposure and response therapy (ERP). ERP is done in partnership with a trained therapist, and it’s adapted for your child’s unique needs. It helps kids manage their symptoms long-term by gaining the skills they need to stop engaging in compulsions. 

But what does that actually look like in practice? Let’s take an example of a 7-year-old boy named James who fears germs and contamination. He experiences extreme anxiety when touching anything “dirty” or “unsafe.” To ease his distress, James spends hours per day washing and sanitizing his hands until they’re red and raw. 

James’s ERP treatment starts by putting him in situations that are mildly triggering. For instance—touching his own books or pencils without washing his hands. As his ERP therapy progresses, James would be encouraged to touch objects that aren’t his own, like a bowling ball at his friend’s birthday party, without constantly using hand sanitizer during the event.

It sounds scary, and it can be at first, but the great benefit of working with a trained ERP therapist—especially one who has experience working with children—is that kids are never alone during this process. They have the support and tools they need to cope with the anxiety. When kids stop engaging in compulsions, they learn that the thing that was so terrifying starts to feel like less of a threat. 

How can parents help their kids cope?

Parents, of course, have an important part to play in helping a child manage OCD. It’s important to be patient, stay informed, and work with your child’s therapist as a team. Not only that, but there are some things you can do at home.

The most important thing you can do to help your child may be the toughest, at least at first. With the therapist’s help, you’ll need to break the habit of making room for your child’s OCD symptoms. That habit, which clinicians call “accommodation” (others may refer to it as “enabling”) actually makes things worse. But it is very hard to resist. “When we see our children’s suffering and in emotional pain, there’s a natural tendency to think, ‘What can I do to relieve your distress?’” says Dr. Farrell. “We’re hardwired to be that way. And that is why so many parents are lured into the trap of accommodating their child’s OCD.” 

For example, Dr. Farrell says, imagine that 8-year-old Jennie experiences intrusive, unwanted thoughts that she will unexpectedly die in her sleep. She develops a ritual at bedtime, where she has to repeatedly hear mother and father say, “Don’t worry, honey, you’ll sleep soundly and nothing will happen to you.’” 

“Mom and dad know that if they refuse to reassure their child, there’ll be hours of kicking, screaming, and banging on the door,” says Dr. Farrell. “So of course it’s an easier choice to say, OK, we’re going to give OCD the answer it’s seeking here.” When they do, the child goes off to sleep soundly. And the parents also get a good night’s rest. The problem is that enabling compulsions actually helps keep the OCD cycle alive in your child rather than interrupting the pattern of obsessions and compulsions.

Sometimes, an ERP therapist will work with parents or other caregivers in sessions where the child is not present; the goal is to help them build a willingness to deal with an upset child today for the sake of long-term improvement. “Part of therapy for children involves teaching parents to have a thicker skin about their child’s distress,” Dr. Farrell says. 

“I often find myself saying to parents, if your child was struggling with a substance use issue, if they were sneaking alcohol from your liquor cabinet or buying illicit drugs, you wouldn’t compromise, right?” says Dr. Farrell. “If the child said, ‘I just need one more hit,’ what would you do? I have never worked with a parent who would cave in that instance. That is the mindset parents need to remove accommodations and prevent compulsions.”