How to Spot Pediatric OCD

It is estimated that about 3 million children in the US are experiencing Obsessive Compulsive Disorder.  While onset can come at any age, most OCD begins to present in late elementary and early middle school.  Children who begin to experience acute compulsions at this age may report specific phobias and obsessions that began as young as 4 years old.  

Like with adults, OCD behaviors and fears tend to be a source of shame for children.  Many children will mask OCD and few seek treatment soon after onset.  The International OCD Foundation estimates that, on average, children do not seek treatment for 2.5 years after OCD onset. Usually parents bring children into therapy due to an escalation in problematic behaviors like emotional reactivity and school/social refusal.  

OCD can be easily misdiagnosed as Generalized Anxiety Disorder (GAD) in children. 

Most pediatric clinicians are well-versed in GAD but have no training in OCD.

Physical compulsions can look like “quirky” kid behavior. 

Ordering, arranging, and checking behavior can be rewarded in a school or home environment, as it can be seen as “responsible,” mature behavior. 

Adults may feel pleased with how compliant a people-pleasing child may be, without understanding that the root of this behavior is extreme anxiety. 

Similarly, an overly clean child can be seen as healthy and careful, and praised by adults around them for meticulous decontamination.  

Psychodynamic and play therapy for children will usually reveal the content of worry, and in the case of GAD can be effective treatment.  However, neither of these two modalities will be impactful if a child is suffering from OCD. 

Psychodynamic and play therapy may actually reinforce the OCD, as it will give the child a space to focus on their fears and worries.  While temporarily calming, this type of therapy actually reinforces the obsessive fears.  Therapy may actually become a compulsion in and of itself.  Many therapists are enlisted by children in reassurance-seeking behavior and other mental compulsions, wherein the fear is soothed by a trusted adult. 

When pediatric OCD is suspected, parents must seek expert intervention.  The only effective treatment modalities are Exposure Response Prevention (ERP) and Cognitive Behavioral Therapy (CBT).  

If you suspect that your child might have OCD and are interested in OCD treatment to help your child find real relief, please contact Kairos Wellness Collective for an evaluation.