How to find treatment for a child with OCD

Kids love rituals. In fact, they often insist on them. They have to make sure their closet door is shut before they go to bed. They’ll only play soccer in that one lucky shirt. The mashed potatoes can’t touch anything else on the plate, or that plate might be shoved off the table. Toys have to be on that shelf lined up in this order.How to find treatment for a child with OCD

Sometimes as a parent you have to push back. If the lucky shirt is in the wash, well, too bad. Often, though, it’s easier to let your kid have their way. After all, it could just be a phase, right? That tantrum over the smelly lucky shirt, or the mashed potatoes that got a little too cozy next to their broccoli, might make a funny story one day. 

But sometimes the “phase” doesn’t go away. And your kid’s rigid, repeated rituals and scared anxious feelings might make you wonder: Could my child be living with obsessive-compulsive disorder (OCD)? 

OCD isn’t a personality quirk or some sort of growing pain. It’s an anxiety 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 Nicholas Farrell, PhD, a licensed clinical psychologist and a Regional Clinical Director at NOCD. 

And it’s a fairly common mental health disorder. Research shows that OCD affects between 1 and 4% of the population worldwide, including 1 to 2% of children. With kids, it can show up at a very young age, or not until later in their teenage years (the average age of OCD symptoms’ appearance is 10). In younger children, OCD appears more in boys than girls, but during and after puberty, it is more common in girls. 

The good news is if these behaviors turn out to be OCD, there are effective treatments that can free your child, and your family, from this condition. Children with OCD learn to manage their thoughts and emotions, so that they are able to lead happy, fulfilling lives. 

But that requires understanding what OCD is, so you can find the right help.

What is OCD?   

The “obsessive” part of OCD involves  intrusive thoughts, images, sensations, feelings and urges (for example, thinking that the TV remote is covered in deadly germs). When these thoughts hijack a child’s mind, they trigger intense anxiety. The “compulsive” part is the child’s response—actions that briefly make the anxiety go away, like washing their hands over and over after touching that remote.  

In children, some of the most common distressing thoughts are:

• Fears about illness, infections, or danger. (If I touch the dog I’ll get really sick.)
• Aggressive or horrific thoughts about harming themselves or others. (If I cut the celery I’ll slice my finger off.)
• 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.)

Some of the most common compulsions kids display are:

• Repeatedly checking locks, toys, or shelves.
• Counting or repeating words.
• Rereading sentences or rewriting homework over and over.
• Spending lots of time washing hands, showering, cleaning, or doing other decontamination rituals.
• Enacting reassurance rituals, like asking mom and dad to remind them that they’re right there to protect them.

“With kids, anxiety can migrate. It might be all about school for a few months, then the focus can shift to their home life, and then on friends,” says Dr. Farrell. So if your child’s anxieties and rituals change a lot, you might not think what they’re dealing with is OCD. 

After all, in adults, OCD might center on one aspect of life, like food safety, relationships, or religion. But children with OCD are often different, Dr. Farrell says. 

Another important trait of OCD in children is that kids often can’t make the connection between their compulsive behaviors and their obsessive thoughts. “For example, 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,” Dr. Farrell explains. “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.’” 

That can make it harder to disentangle a behavior from its cause. But an experienced therapist can help figure out if the taps your kid does may be OCD, or if there could be another mental health issue at play.

One key indicator is how much you feel your life and the life of your child has been distorted by the demands of your child’s fears and rituals. “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.

“If there is clear evidence that the behavior is getting in the way of life—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,” agrees Dr. Farrell. 

This family distress is the surest sign. A second indicator is the amount of time it takes to keep your child on an even keel. If your kid spends more than an hour a day on their compulsive behaviors, then they might well 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.”  

A third sign of potential OCD in a child is helplessness. Does your kid feel powerless to avoid or slow down his obsessive thoughts and feelings? Do you feel they just “can’t help it”?  That could be OCD.

If you’re on the fence about whether your child fits this profile, you should know another important fact about OCD in kids: “The thoughts and behaviors you’re noticing 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 are often highly embarrassing to the sufferer. So there’s secrecy, when a child tries to blur the symptoms that come with OCD.”

How can parents help? 

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. It’s also a good idea to take a good look at how you handle anxiety and stress. Do you have ways to calm yourself down and take a longer view of a stressful moment? Your child will look to you to see strategies that work better than compulsions when dealing with troubling experiences. 

But 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. So 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.'” 

Now, of course, mom and dad are sick of this. “But they also know that if they refuse, 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. But the OCD symptoms are reinforced. 

“Part of therapy for children involves teaching parents to have a thicker skin about their child’s distress,” Dr. Farrell says. Therapy for kids and teens with OCD involves the entire family and other caregivers, as the child’s loved ones learn to stop accommodating. Instead, they’ll learn new approaches that positively reinforce behaviors that help the child get out of OCD’s clutches. Sometimes, the therapist will work with parents or other caregivers in sessions where the child is not present. 

All this does take determination and a willingness to deal with an upset child today for the sake of long-term improvement. “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.”

So what are the treatment options for a child with OCD? 

If your child does need to learn to live with OCD, treatment will benefit your entire family. After all, says Dr. Farrell, “living a life constricted by your child’s intrusive thoughts and fears and coping strategies isn’t fair to parents or siblings.”

If this sounds like your child, and your family, there is good news. There are proven, fast-working, effective treatments for OCD. While there is no magic pill to make difficult thoughts vanish, therapy can teach a child how to manage their OCD. And learning to live with OCD as a child is much better than waiting until adulthood. “Generally speaking, OCD, when untreated, runs a very chronic and often worsening course,” says Dr. Farrell. “Adults who have lived with OCD for years need a longer time in treatment before they see improvement.”

The gold-standard approach to therapy for children with OCD is called exposure and response therapy, or ERP. It helps patients manage their symptoms long-term by gaining the skills they need to stop engaging in compulsions. ERP directly addresses the connection between obsessive thoughts and compulsive behaviors. The therapy gradually and patiently teaches a child how to keep thoughts and feelings from hijacking their mind and guiding their actions. 

For example, imagine 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 would slowly expose him to his anxieties under a therapist’s guidance. This might start with touching “clean” surfaces like books or pencils. Over multiple sessions, James would progress to touching seemingly “dirtier” items—like his mother’s hand, perhaps—that normally trigger urges to wash his hands. All the while, the therapist would coach James through his anxiety, guiding him as he resists the urge to wash his hands after. By resisting the compulsion, James would learn from experience that he can get through the anxiety without performing his compulsive actions.

This process gradually breaks the connection between obsessions and compulsions. It takes consistency across multiple ERP therapy sessions, but facing fears head-on spurs kids to build resilience. They learn that they’re bigger than their fears, and that they can control how they respond to uncomfortable emotions.

Since it was first developed and tested almost 50 years ago, ERP has proven to be effective in helping people who live with OCD regain control over their thoughts and behaviors, rather than being guided by fear and anxiety. In fact, many children feel less distress after only a few sessions of ERP therapy. Parents and siblings get relief too, as the focus of family life shifts away from dealing with anxiety and rituals in favor of shared connections.

What to know about virtual OCD therapy

Between kids, work, and everything else, it can be tricky to make in-person therapy appointments happen. But of course you want what’s best for you kid. And that’s where virtual therapy can really step in. In fact, peer reviewed research shows that live teletherapy sessions of ERP can be more effective, delivering results in less time than traditional outpatient ERP therapy. Children can start to break free of OCD’s grip in as little as two to three months of twice-weekly therapy, says Dr. Farrell. And your family can begin to break free of OCD’s grip, too.