• OCD in children is relatively uncommon, but boys are often more affected than girls.
• Some of the obsessions that children with OCD may display are an extreme fear of dirt and germs, obsession with details, and excessive disgust over bodily waste.
• Children may also have compulsions like repetitive handwashing, asking incessant questions, and hoarding objects with little or no value. 
• This article was medically reviewed by Zlatin Ivanov, MD, who is certified in psychiatry and addiction psychiatry by the American Board of Psychiatry and Neurology at Psychiatrist NYC.
• Visit Insider’s Health Reference library for more advice.

Most people are diagnosed with OCD around age 19, but roughly 1-3% of children are diagnosed with it.

Obsessive-compulsive disorder (OCD) — for both adults and children — is a mental condition characterized by intrusive, repetitive thoughts or fears that trigger irrational, compulsive behaviors.

OCD in children is usually diagnosed between the ages of 7 and 12. Here’s what you need to know about the symptoms and treatment options for children with OCD. 

How OCD manifests in children

“In kids, OCD is slightly more common in boys, than in girls, but women tend to catch up later on in life,” says Michael Wheaton, PsyD, an assistant professor of psychology at Barnard College of Columbia University. 

Symptoms of OCD in children 

A child with OCD will experience symptoms of obsession and compulsion. Symptoms vary from child to child, however, the most common obsessions children experience include: 

• Aggressive thoughts about self-harm and harm to others
• Thoughts about doing offensive sexual acts or taboo behaviors 
• Thoughts that may be against religious beliefs they hold 
• An extreme fear of dirt and germs 
• Fear of losing things 
• An obsessive need to know or remember things that may be minor 
• Excessive fears about getting ill or being infected with a disease 
• Fear of saying certain things, or not saying the right things 
• Excessive disgust over bodily waste or secretions
• Obsession with details

Children also engage in compulsive behaviors and repetitive rituals in response to obsessive thoughts. However, the relief from engaging in these compulsions is temporary because performing compulsions ultimately reinforces the obsessions. Therefore, these behaviors can be disruptive and time-consuming. Some of them include:

• Repetitive hand washing or shower routine
• Excessive cleaning of items like tabletops and clothes 
• Needing to repeat routine activities like walking out of a door 
• Having an obsessive need for things to be symmetrical 
• Having checking compulsions such as checking and rechecking several times to make sure they lock a door 
• Hoarding things that don't have any value 
• Spending an unhealthy amount of time counting and recounting things 
• Asking questions repeatedly 

OCD symptoms in children peak and dwindle and sometimes change from one form of the disorder to another. For example, compulsion symptoms might change from repetitive washing to checking. There is usually no evident reason for the change, but in some cases, a trigger may be identified.

How is OCD in children diagnosed?

A child psychologist or a mental expert will need to examine your child. To be diagnosed with OCD, the child must exhibit obsessions and compulsions that are continuous and severe enough to be considered disruptive to their daily life. 

Most medical professionals use the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) to diagnose OCD for children. The scale involves a checklist of common obsessions including ones about contamination, aggression, sexual obsession, superstition, and more.

Children with OCD also frequently struggle with other mental health problems, such as clinical depression, Tourette's Syndrome, ADHD, or other anxiety disorders. This can make an OCD diagnosis in children more difficult than in adults. 

"Children, especially younger children, may present primarily on the compulsion side. They might engage more with repetitive behaviors like washing of hands or repetitive checking of things. They might also have a harder time articulating their obsessions," says Wheaton

What causes OCD in children? 

OCD is a neurobiological disorder, meaning it's caused by an imbalance of certain chemicals in the brain. It is important to know that OCD in children is never the fault of the children or their parents. 

While stress doesn't cause OCD, a stressful event like the death of a loved one, or parents getting divorced might trigger the condition. A stressful event might also worsen symptoms in a child who has already been diagnosed with OCD. 

Some research shows that a strep infection may also trigger the sudden onset of OCD symptoms in children who are genetically predisposed to the condition. This type of OCD is called Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus (PANDAS) if it is triggered by a strep infection. 

Treatment of OCD in children

The treatments that are effective for treating adults with OCD also work for children. Medical experts often begin treatment with behavioral therapy and only include medication in more severe cases.

Exposure and response prevention therapy (ERP)

ERP is a form of cognitive behavior therapy that involves exposing children to their obsessions and simultaneously preventing them from engaging in the compulsions that would usually follow. It is typically the first line of treatment for children with OCD. 

"In ERP, we help people with OCD understand that no real danger can occur as a result of their thoughts," says Wheaton. "We encourage them to face their perceived fears ... to overcome it and discourage them from engaging in compulsions in response to these fears. Over time, they'll become less reliant on using compulsions to feel better," Wheaton says.

Medication

If a child's symptoms are severe, medication may be prescribed. Selective serotonin reuptake inhibitors (SSRIs) are traditionally the first line of medical treatments. 

They help to ease OCD symptoms by raising serotonin levels in the brain, which can help limit obsessive thoughts and mental compulsions. 

If your child's OCD is linked to a strep infection, antibiotics will be prescribed to treat the infection. If the infection is treated properly, there'll also be an improvement in OCD symptoms.

The bottom line   

OCD in children is rarer than in adolescents or adults, and it can sometimes be difficult to diagnose. But if you think your child has OCD, it's important to see a medical professional for a diagnosis and proper treatment.

"Parents need to see this as a real illness. But one that there are effective treatments for. They also need to get connected with a proper treatment provider, because it can be overwhelming for parents to take on OCD by themselves," Wheaton says. 

If you're a parent with a child who has OCD, or you think they have OCD, the International OCD Foundation (IOCDF) offers services that can help you and your loved ones get the proper treatment, Wheaton says.

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