Obsessive compulsive disorder (OCD) in children and teenagers

Obsessions: what are they?

Obsessions are thoughts, images or urges that a child doesn’t want but can’t stop thinking about. When a child has these thoughts, they might also feel very anxious or fearful.

Some examples of obsessions might be:

imagining loved ones getting hurt
being scared of getting sick from touching dirty handles
feeling that something terrible will happen if things aren’t done a certain way – for example, if books aren’t in the right order.

Compulsions: what are they?

Compulsions are things a child feels they must do over and over. Sometimes children might do this to try to stop an obsessive thought. But sometimes children don’t know why they feel and behave this way.

Some examples of compulsions might include:

washing hands repeatedly
praying
hoarding – that is, not being able to throw anything away
counting or tapping
behaving in mildly superstitious ways, like always wearing the same t-shirt to dance class
pulling at hair or picking at skin.

Obsessions and compulsions: should you be worried?

Many children have obsessions and compulsions. They can be a part of child and adolescent development. For example, your child might go through a stage of wanting their bedtime ritual to be exactly the same every night.

Obsessions and compulsions that don’t get in the way of your child’s or family’s life aren’t usually anything to worry about.

When obsessions and compulsions become obsessive compulsive disorder (OCD)

Children and teenagers might have obsessive compulsive disorder (OCD) if they have unwanted thoughts or compulsive behaviour or both, or if the thoughts and behaviour don’t go away and interfere with daily life.

Speak to a health professional if you notice your child has:

more severe obsessions and compulsions than their peers
obsessive thoughts and/or compulsive behaviour that upsets them and stop them from enjoying life or that interferes with your family’s everyday activities
obsessive thoughts and/or compulsive behaviour that lasts for more than 6 months.

How OCD affects children and families

Obsessive thoughts and compulsive behaviour affect children’s ability to relax and enjoy life. So if your child has obsessive compulsive disorder (OCD), they might also have challenges like:

problems at school – for example, difficulty paying attention or doing homework
disrupted routines – for example, difficulty going to school or getting to sleep unless their rituals are done
physical problems from feeling stressed or lack of sleep
social problems – for example, spending more time on their obsessions and compulsions than with their friends, or avoiding social situations because of other people’s reactions to their behaviour
negative feelings – for example, worrying that they’re different from friends and family or that they aren’t in control of their behaviour
other mental health problems – for example, child anxiety, child depression, teenage anxiety or teenage depression.

Obsessive compulsive disorder is a mental health disorder that won’t go away on its own. And sometimes children who have OCD go on to have other emotional health problems later in life. Getting professional treatment for your child with OCD is important.

Getting professional help for children with OCD

If you think your child has obsessive compulsive disorder (OCD), see your GP for a referral to a psychologist, paediatrician or a child psychiatrist who can diagnose OCD.

This mental health professional will also develop a management plan for your child by talking with you, your child and possibly staff at your child’s school. This plan will probably include cognitive behaviour therapy (CBT) to help your child change their thinking and behaviour when they’re anxious.

The plan might also include exposure and response prevention. This involves your child practising facing the things that make them anxious, until these things no longer cause them anxiety or trigger their compulsive behaviour.

It might also include relaxation techniques, breathing exercises and mindfulness to help your child manage their symptoms and reduce the chance that the OCD will come back in the future.

In severe cases and if your child is older than 5 years, your child’s health professional might recommend anti-anxiety medicine or antidepressants. Your child might need antibiotics if their OCD is linked to a streptococcal infection (a throat infection caused by bacteria).

Treatment is most successful when therapy and medicines are used together.

Your GP will probably talk with you about a Mental Health Treatment Plan for your child. If you have a plan, you can get Medicare rebates for up to 10 sessions with a psychologist. If your child sees a psychiatrist, you can get Medicare rebates for these appointments.

Helping children with OCD at home

Children with obsessive compulsive disorder (OCD) need help from a psychologist or psychiatrist to manage their anxieties. It’s a good idea to ask your child’s mental health professional for specific exercises or activities that you can do at home to support your child’s therapy.

In addition to any exercises that the mental health professional suggests you do with your child, there are a few simple strategies you can try at home with your child.

These might include the following:

Reassurance: children with OCD can feel different, isolated and lonely. You can help your child feel less alone by being there to listen. You can also reassure them that anxiety is natural and that you’ll work with them to overcome their OCD.
Relaxation: your child could try breathing exercises or muscle relaxation exercises, meditation or mindfulness exercises.
Positive self-talk: you could encourage your child to practise saying things like ‘I can stop doing this’ or ‘I will be OK if I don’t do this’.
Distraction: you could suggest your child does something else that they enjoy, like reading a book or playing basketball. Even short distractions from worries can be good.
A worry box: you could encourage your child to write down or draw their worries and then put them in the box. This helps your child to put their worries aside instead of dwelling on them.
A calm place: this could be a space inside or outside where your child can do activities that distract them from worries.

When your child with OCD is learning to manage their anxiety, they’ll start small. For example, instead of turning the light on 4 times, they might turn it on only 3 times. Try to be patient with your child’s progress and praise them for being brave and trying. Avoid criticising or getting frustrated with your child if they’re still doing their rituals.

Causes of OCD

We don’t know what causes obsessive compulsive disorder (OCD), although researchers believe that it can happen when parts of the brain don’t communicate well.

We do know that it’s common for children to develop OCD if family members have a history of anxiety or if children have been through a stressful or traumatic event. But children without a family history of OCD can still develop OCD.

And in some rare instances, children develop OCD symptoms after a streptococcal infection or the infection makes OCD symptoms more severe.

If your child develops OCD, it isn’t your child’s fault, and it isn’t your fault.

Looking after yourself helps you give your child what they need to grow and thrive. Staying active, eating healthy food and getting enough rest will help with your energy levels. Sharing support, advice and experiences with other parents can also be a big help. You could try joining an online or face-to-face support group to connect with other parents raising children diagnosed with OCD.