Children with OCD: what are the signs?

Kids worry. Feeling anxious, having doubts, or being worried is pretty normal at any age. For those who are experiencing OCD (obsessive-compulsive disorder), they may feel unable to stop focusing on those feelings – no matter how much they want to – which can compel them to behave in certain ways.

Although OCD most commonly occurs for those over the age of 21, children as young as five have been diagnosed, with between 30-50% of adults with OCD reporting that their symptoms started before or during adolescence. OCD affects around 12 in every 1,000 people in the UK, from young children to adults of all genders, social and cultural backgrounds. Around 50% of diagnosed cases are considered severe, with individuals experiencing OCD for around 12 months on average according to OCD-UK.

While some people experiencing OCD may involve loved ones with their compulsions (this can be in the form of asking for help completing tasks, pushing for a parent to repeat or say a phrase in a specific way, or seeking reassurance), others may hide their rituals and compulsions out of fear of being judged.

If you are worried about a child, teen, or loved one, there are a number of signs you can keep an eye out for that can be indications that they may be experiencing OCD and could benefit from further help and support.

How common is OCD in children and teens?

OCD typically becomes more problematic and has a significant impact on the lives of adolescent men and women in their early 20s, with women more likely to experience the condition (75%). A type of anxiety disorder less commonly diagnosed in children, cases of kids as young as six have been reported. Charity OCD-UK report that around 25% of diagnosed cases start by the age of 14, with a gradual onset of symptoms typically occurring.

OCD can be more difficult to spot in children and teens. Younger children may struggle to express how they are feeling, while older children and teens may feel embarrassed, confused, or ashamed. This can make it trickier for parents and teachers to spot problems as they start to arise. Knowing what symptoms and signs to look out for specifically in children and teens can help us to recognise when additional help and support may be needed.

OCD rituals, compulsions, and signs to look out for

While OCD affects everyone differently, it usually causes a pattern of thoughts and behaviours exhibited through four main steps:

• Obsession – unwanted or intrusive thoughts that are often distressing, repeatedly entering or playing on the person’s mind.
• Anxiety – intense feelings of anxiety or distress, often brought about by obsessive, intrusive thoughts.
• Compulsion – repeating actions or thoughts that they feel compelled to do, due to the anxiety and distress caused by obsessive thoughts.
• Temporary relief – a short reprieve from completion of compulsive actions, followed by the return of anxiety and obsession, leading to the cycle beginning once again.

We all experience unwanted thoughts from time to time such as worrying we’ve forgotten to lock the door or didn’t remember to pack something in our bag, but it’s when that worry becomes persistent, dominates our way of thinking, or interrupts other thoughts that it can be a cause for concern.

In children and teens, the symptoms of OCD can present a little differently than in adults. More likely to experience just obsessions and compulsions rather than all four parts of the cycle, they may exhibit one symptom more prominently than the others according to leading behavioural care providers. As signs may not appear in equal measures, they may be overlooked or dismissed as ‘quirks’ or normal parts of childhood behaviour, when they could be an indication of OCD.

Many young people experience OCD for a period of time before parents or teachers realise, often only noticing if they are completing overt rituals, seem overly worried, or if they are told about the concerning thoughts by the child themselves.

Individual symptoms may not be a cause for concern, however, multiple symptoms over a prolonged period of time can be an indicator that a child may be experiencing OCD. Behaviours and indications to look out for can include:

At school, in clubs or extracurricular activities

• Repetitive actions e.g. getting up from their chair multiple times in a set way, taking and replacing a book from a shelf or bag multiple times, arranging pens/crayons in a specific or ‘right’ order, touching or tapping things a set number of times or in a specific way.
• Handwriting anxiety e.g. appearing worried about their writing being neat, erasing words or letters until they get them ‘right’, scribbling out pages that are ‘wrong’, tearing out pages with mistakes.
• Avoiding interaction with other children or equipment whilst playing outside.
• Frequent requests to use the toilet.
• Counting or repeating steps e.g. repeating the same path to class three times before entering, counting the number of steps between the classroom and playground.
• Expressing frustration, anger or upset when shifting between subjects.
• Asking questions repeatedly or seeking reassurance that an answer is correct numerous times.
• Seeming distracted, disengaged, or having trouble listening in class.

At home

• Fear of coming into contact with germs from common everyday objects or things in the outside world e.g. pets, wildlife, rubbish.
• Expressing little or no interest in playing with new children or toys.
• Hoarding or collecting high quantities of objects.
• Spending an unusually long or excessive amount of time washing their hands or possessions, or frequently returning to the restroom to re-wash their hands.
• Increased time completing everyday tasks such as getting dressed, finishing homework, showering, or packing for school.
• Insisting a parent or loved one do or say things in an exact way.
• Completing rituals or sharing worries or fears that making a mistake may cause bad things to happen. E.g. not counting to a certain number whilst completing a task may result in a loved one being injured or not checking the door a set number of times could lead to the house being broken in to.
• Showing an unusual preoccupation with death or abstract concepts like good and evil.
• An intense interest or obsession with a specific number e.g. they may prefer the number three, repeating actions in groups of three, retracing their steps three times, or cutting food into three equal pieces.
• Difficulty making decisions or seeming indecisive.

For many, symptoms of OCD can change regularly or seem inconsistent. Some symptoms may increase or decrease in frequency and strength, depending on how stressed or tired they are feeling. While normal, this isn’t necessarily a sign that symptoms are lessening or they are getting better – it’s still important to seek help and advice from your GP or a qualified expert if you are concerned.

Help and support

If you are concerned about a young person, it’s important to seek help and support if OCD may be having a significant impact on their life. If you are worried about a child or teen, try talking to them about your concerns; it is unlikely that things will get better on their own without a formal diagnosis, treatment and support. Let them know that there are people who love and care about them, and are there to support and listen to them.

Speaking to their GP about symptoms can be one of the first steps towards getting a referral to CAMHS (Child and Adolescent Mental Health Service). To find a qualified counsellor specialising in children’s mental health and OCD near you, use our advanced search.