Though most of us think of childhood as a carefree time of life, children do experience worry and self-doubt from time to time. For some young people, these feelings can be severe enough to be debilitating.

In 1 to 2 percent of American kids and teenagers, thoughts and actions that initially appear to be garden-variety childhood anxiety may actually be obsessive-compulsive disorder. The disorder is common enough that its acronym is often misused to describe someone who is very orderly, perfectionistic or rule-bound: "She's a little OCD," someone might say of a person intently tidying up a pile of books. As a child psychiatrist who has treated many children with this disorder, I can attest to the fact that OCD is not about someone driven to do things perfectly.

Recognizing OCD in Your Child

A child with OCD has persistent, unwanted, stressful thoughts, known as obsessions, then tries to make them go away through repetitive behaviors or rituals, known as compulsions. One child could be irrationally afraid of germs or contamination, and wash her hands 10 or more times in an effort to get rid of the feeling that something will go wrong if she doesn't clean her hands just right. Or maybe a child fears that harm could come to him or his family, and he tries to rid himself of this anxious thought by checking, rechecking and re-rechecking all the window and door locks before going to bed at night.

One common compulsion I see is a child asking her parent the same question over and over: "Will you be coming back to pick me up today?" or "Will I throw up after I eat this food?" The child believes that the reassurance will prevent bad things from occurring. Some kids with OCD just repeat a certain word or prayer, believing that this will stop something scary from happening.

OCD crosses all cultures and economic levels. The cause is not known, but people who have a parent or sibling with the disorder are at a higher risk of having it. A stressful event, such as a car accident or the start of school, often causes OCD symptoms to surface and parents to notice the behaviors for the first time.

To be sure, some OCD behaviors might seem like a natural response to common fears. Many of us have re-checked the locks on the doors, or triple-checked that we've turned off the stove. So how is a parent to know when these behaviors are a problem? The answer is, when these behaviors interfere with daily life and take up a lot of time. Is your child missing the bus because she has to walk in and out of the doorway six times? Does your child get up early in order to try on eight different outfits in the morning, until he finds one that feels like it hangs exactly evenly on his body? Another thing to consider is whether a child is distressed when he cannot complete a ritual. If you try to make your child stop, are there tears, tantrums or fights?

Distinguish Your Child From the Disorder

If this sounds like your child, take heart: OCD responds well to treatment, and there is much that you as a parent can do to help. The important thing is to distinguish your child from the disorder. Your child needs to know that it's the disorder causing him or her to unlock and lock the door 30 times; that's why it helps when you say, "Okay, that's the OCD and I am on your team against OCD." I often remind parents not to see OCD as something they need to punish. It's understandable to be frustrated, but remember that the child does not really want to behave this way. So when your daughter insists on washing her hands for the eighth time, making you late for work, remain calm and remember that this is not a fight against your child, but against OCD. Your role is to help.

Psychotherapy, especially cognitive behavioral therapy (CBT), can be very effective for children with OCD. The form of cognitive behavioral therapy typically used to treat kids with OCD is called exposure and response prevention. The therapist gradually exposes the child to his fears, and then helps him refrain from choosing to perform the repetitive behavior. In my office, one example of this kind of treatment involves Scantron forms, those test answer sheets with little circles that kids must color in with a No. 2 pencil. I have seen more than one child with OCD who obsesses about test-taking because of those sheets. They think they must color it in absolutely perfectly before turning it in. If they don't fill it in perfectly, they erase and start over, again and again, until there are holes from erasing so much. This makes test taking nearly impossible. We teach them to fill in the circles imperfectly, to cope with the discomfort that follows, and learn that nothing bad happens if the completed sheet does not look exactly the way they feel it should. This starts to dispel the OCD belief that the Scantron must be perfect.

Parents are involved in this kind of therapy - as co-counselors who help implement these strategies day to day. A lot of the success of the treatment depends on the motivation of the parent and the child. It takes time and energy to manage the disorder, but the benefits are priceless.

In more severe cases, medications can also help. Typically, selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine, sertraline and fluvoxamine are used. For most young people, these drugs work best in combination with therapy. The good news is that with appropriate treatment, children can make significant improvement in their OCD.

If you are concerned that your child might have OCD, consult your pediatrician to rule out any medical reasons for your child's behavior and get recommendations for treatment programs and mental health professionals. A good source for treatment options in your area is the resource directory of the International Obsessive-Compulsive Foundation (iocdf.org), where you can also read further about the disease. The Anxiety and Depression Association (adaa.org) is also a good resource to identify therapists and contains information for teens and college students.


Dr. Allison Tweedie is a child and adolescent psychiatrist at the Mid-Atlantic Permanente Medical Group and practices at Burke Medical Center in Virginia. She graduated from the University of Pennsylvania School of Medicine and completed her child psychiatry residency at Children's Hospital of Philadelphia.