Parenting is hard. It’s even harder if your child is suffering from the constant fears, anxieties, and compulsive behaviors brought about by a serious mental health condition like OCD.
If you have a young child and suspect that they might have OCD, it probably feels scary and overwhelming, and you may not know exactly what to do or where to start reaching out for help. The good news is that you aren’t alone. There is hope—and help—out there, and it’s more accessible than ever.
In this article, we’ll talk about OCD and the unique ways that it can present in toddlers and other young children, plus what treatments and support are out there for your little one and for yourself—all with the help of Dr. Nicholas Farrell, licensed clinical psychologist and Regional Director at NOCD.
An overview of OCD
Obsessive-compulsive disorder (OCD) is a mental health condition that is defined by the presence of two main groups of symptoms—obsessions and compulsions—that can interfere with one’s life and well-being.
Obsessions are intrusive thoughts, fears, urges, images, sensations and feelings that don’t line up with someone’s values, desires, or ways of thinking. As such, obsessions can be extremely distressing to people with OCD. They might dwell on those thoughts and attribute significant meaning to them. These thoughts can also be disturbing in nature, causing intense fear and anxiety in the people who experience them.
The distress from obsessions then gives way to compulsions, which are repetitive mental or physical actions that are intended to relieve this anxiety and distress or prevent an unwanted outcome from happening.
People with untreated OCD are often locked in a cycle of these obsessions and compulsions. Because they can feel so enormous and all-consuming, it’s no surprise that people who deal with OCD are dealing with tons of anxiety and stress that can interfere with their quality of life. However, there is even more to consider if you are taking care of a child who might be dealing with OCD.
How to recognize OCD in toddlers
OCD can technically develop at any age, but in many cases, its onset tends to be sometime during adolescence. Research on OCD in early childhood, however, is still fairly lacking, and the majority of the research on childhood OCD has been in older children. It can also be hard to understand this condition during this early life stage since toddlers don’t always have the language to explain what’s going on inside of their minds. However, there is some very important knowledge we have today about OCD in young children.
Just as is true in adults, the kinds of obsessions and compulsions experienced by young children with OCD can vary. However, a survey conducted on children ages 4-8 years old found that it was common for young children with OCD to report having multiple obsessions, some of the most common of which involved:
- Contamination
- Safety
- Fear of their own aggression
- A preoccupation with making things symmetrical
Common compulsions among this younger group included:
- Checking
- Counting
- Seeking reassurance
- Rubbing
- Repetitive hygiene rituals like handwashing
We also know that OCD can be very hard to diagnose in younger children, especially when compared to the process of diagnosing older adolescents and adults. In OCD, obsessions often revolve around the things that people care about the most. Because these intrusive thoughts do not line up with one’s normal way of thinking, older kids and adults can usually recognize and express that their obsessions are “wrong” in some way. They’ll usually know that those thoughts are unrealistic or exaggerated, even if they find their distressing obsessions impossible to dismiss.
However, younger kids may not be able to recognize the difference between intrusive thoughts and their own, nor are they always able to explain what’s going on to others.
“Kids at that age lack the mental capacity to really put into words what their internal private experience is compared to an adolescent or an adult,” explains Dr. Farrell.
He goes on to explain that adults and older children with OCD are able to identify which of their thoughts are intrusive. They’re also better able to voice the fears and concerns that those thoughts can bring, and explain the fears and emotions behind their compulsive behaviors. Unfortunately, toddlers and younger children don’t always have these tools.
“Kids may not be able to identify the specific nature of the scary thoughts that they’re experiencing,” he says. “They may not be able to pinpoint the specific feared outcome or consequence they’re worried about. They may be able to identify a compulsive or repetitive behavior they’re engaging in that they feel that they have to. They can find that it relieves distress, but they may not be able to identify the reason for it.”
Because of these hurdles, diagnosing a younger child with OCD can become a unique challenge. “Unfortunately one of the problems in our field is that there is often quite a large time gap that exists between the time when a youngster starts to exhibit symptoms consistent with OCD from the time to when they’re formally assessed, diagnosed, and can access evidence-based treatment,” says Dr. Farrell.
This means that it’s important for parents and caregivers to monitor for possible signs of OCD in their younger children and to bring these to the attention of mental health professionals as soon as they can if they have concerns. When it comes to OCD, early intervention can be critical, since untreated OCD can often go on to be chronic and even debilitating.
When does your child need help?
If your child’s behaviors are distressing them, yourself, or the rest of your family, it’s time to seek help. Dr. Farrell suggests, “If I were face-to-face with a parent right now who was concerned that their child might have OCD, I would say that it’s best to err on the side of caution here and have their young one evaluated.”
But many children tend to have their own unique quirks and personalities to begin with. There are also other potential explanations for these unusual behaviors, like attention-deficit/hyperactivity disorder (ADHD) or developmental differences, such as autism. So how can you as a parent tell when your child is exhibiting signs of OCD versus other behavioral problems or just a different side of their personality?
A big clue that your child might be showing signs of OCD is if they become secretive about their behaviors, indicating that their compulsions have become very important and necessary to them. Younger children with OCD might hide their compulsive behaviors out of embarrassment or fear of being told to stop.
Similarly, another tell-tale indicator of OCD is that your child exhibits fear and anxiety when they’re stopped from doing a specific behavior.
“It’s more likely to be OCD if the compulsive or repetitive behavior is blocked in some way and it causes a lot of fear and anxiety,” says Dr. Farrell. Because OCD compulsions are done to relieve those negative feelings or superstitiously prevent something bad from happening, you might find that your child becomes extremely stressed or fearful if they are told to stop the behavior. On the other hand, If your child is doing that behavior simply because they enjoy it or find it satisfying and stimulating, they might become disappointed, angry, or irritable if you tell them to stop, but it won’t induce anxiety or fear in the same way that OCD would.
Some parents might hope that their child “grows out” of these behaviors. Unfortunately, this way of thinking can sometimes cause more harm than good—with OCD in particular, symptoms tend to get worse when they’re left untreated.
Dr. Farrell explains that in some cases, parents who might not understand OCD might instead accommodate or “make space” for their child’s symptoms in an attempt to help them. For example, if their child with OCD finds eating their meals with the family too anxiety-inducing or scary, the parents might accommodate those fears by instead serving the children their meals in peace and quiet in their bedrooms. Unfortunately, even though this might be well-intentioned, it can sometimes make the child’s symptoms worse by reinforcing their fears. It can even increase their compulsive behavior, another reason that it can be so hard to diagnose younger children with OCD.
This is why it’s so important to get help if your child is showing signs of OCD—not just for your child, but for yourself as well. In toddlers and very young children with OCD, parents sometimes feel as if it’s their job to carry out the behaviors that the child believes are necessary. For example, in one case study, a four-year-old with OCD depended largely on her mother to carry out rituals like repetitive bathing and specific walking rituals, and the mother was also the subject of the toddler’s extreme anger if her wishes and rituals weren’t followed exactly.
“The majority of the burden that a toddler’s OCD creates is on the family,” Dr. Farrell says. He goes on to explain that, since toddlers might not be able to distinguish their intrusive triggers, it can make diagnosis and proper treatment even harder if the parents are accommodating their symptoms rather than addressing the issue. “The youngster might say, ‘Life is going pretty well so long as mom and dad follow all the rules and agree to all of the requests I make of them.’ They might say that they’re not anxious or bothered that much, while their parents are completely exhausted.”
How is OCD in toddlers treated?
Exposure and response prevention (ERP) therapy is considered the gold standard for OCD treatment, regardless of a person’s age. In ERP, a mental health professional works collaboratively to help people with OCD confront their triggers in a safe and controlled environment. They then work together to learn to sit with uncomfortable emotions, rather than engaging in compulsive behaviors that only reinforce their fears.
No matter what age you are, the general framework for ERP is the same. However, the treatment itself can look significantly different for toddlers than it does for older children and adults.
The first major difference is that ERP treatment for toddlers will need to include much more family involvement from parents, other caregivers, and siblings. Successful ERP therapy for a young child can involve near-constant support and active participation from these family members, especially since it’s important to not enable your child’s behaviors at home.
Another major difference is that adults tend to be more intrinsically motivated to do their therapy since they want to feel better and live a better life, while kids often need outside encouragement and motivation. This is especially true when it comes to ERP since it involves directly facing their biggest fears, though in a careful and gradual manner. “Most kids are just not hardwired to confront a scary situation,” says Dr. Farrell. “So if the task is to get this child to confront a scary situation and to not use any of those compulsions like avoidance or escape behaviors, the kid is naturally going to ask, ‘What’s in it for me?’”
Again, this is where family involvement comes into play. Parents and caregivers will have the important role of finding ways to motivate their children to participate in such a challenging kind of therapy. This is true for all kinds of ERP therapy, but especially if they are taking place virtually—which is often hugely beneficial, allowing children to confront real-life situations at home—where their therapists have less of a direct ability to motivate the child on their own.
If you believe that your child has OCD and want to help them with treatment, it’s important to do your research so you can find a specialist who can address your family’s unique needs. Look for a therapist who is specially trained in ERP and who has experience working with young children.
Finally, it’s also worth noting that helping your child with OCD can be very hard and isolating, but it doesn’t have to be. Other parents are also dealing with the same struggles that you and your family are, and it can be extremely helpful to connect with them. Support groups give parents a safe place to express their fears and worries and to give and receive emotional support.
Where to access effective treatment for your child
Parenting is already hard enough without the burden of OCD, but rest assured that there is hope, there is effective treatment out there, and your participation in that treatment will be critical for your child’s success.
NOCD offers convenient virtual treatment with licensed therapists who specialize in ERP, and can treat children as young as five years old via convenient virtual therapy sessions, covered by most major insurance plans.
If you are interested in learning how NOCD can help your child get better, I encourage you to read about NOCD’s evidence-based approach to ERP therapy. NOCD Therapists are able to work closely with the parents of children in therapy, coordinating therapy exercises, progress, and other important information securely and confidentially.