Insights from Dr. Michael Chu, a board-certified child and adolescent and adult psychiatrist at Rady Children’s Hospital Orange County (Rady Children’s)
Key takeaways
- Obsessive-compulsive disorder (OCD) can begin early and is often misunderstood: Pediatric OCD commonly starts around ages 8–12 but is frequently misdiagnosed. Symptoms include intrusive thoughts (obsessions) and repetitive behaviors (compulsions) that significantly interfere with daily life.
- Early intervention makes a major difference: Seeking professional support quickly, especially OCD‑focused therapies like exposure and response prevention (ERP), can greatly improve outcomes. Parents can also support kids through validation without reinforcing compulsive behaviors.
- Support goes beyond therapy: School accommodations (IEPs or 504 Plans), family understanding, and destigmatizing discussions help children manage symptoms and reduce distress while they work toward recovery.
Early signs of OCD in children
When people think of OCD, they often picture adults struggling with intrusive thoughts and ritualistic behaviors. But OCD doesn’t wait for adulthood. It can begin in childhood, often as early as age eight.
Unfortunately, many healthcare providers frequently misunderstand or misdiagnose pediatric OCD, leaving many children to suffer in silence. In this article, Dr. Michael Chu, child and adolescent psychiatrist with Rady Children’s, discusses how OCD manifests in children, the unique challenges it presents, and expert-backed strategies parents and caregivers can use to support their child’s mental health and well-being.
What is obsessive-compulsive disorder, exactly?
A medical professional must formally diagnose OCD through a thorough assessment, since it often overlaps with other anxiety disorders and can be hard to distinguish. In children and adolescents, OCD affects approximately 1% to 3%, a rate similar to adults, with a slightly higher prevalence in females.
Symptoms typically emerge in two waves: the first between ages eight and 12, and the second in late adolescence to early adulthood. OCD typically involves obsessions, compulsions, or both. These symptoms can vary in severity and may fluctuate over time, with periods of improvement and worsening.
“You could think of OCD as more of a worry or cognitive phenomenon, typically of security concerns or feeling something is not right. Or, they have to do something ‘just right’ or something bad will happen,” explains Dr. Chu. “When you think of obsession, it’s a sensation of having recurrent or persistent thoughts, urges, or visual images that are experienced as intrusive and unwanted. Kids don’t want these thoughts, but they’re very intrusive.”
Unlike general anxiety, which causes broad and persistent worries, OCD involves specific, recurring obsessions that people often try to suppress. This suppression can lead to compulsions, repetitive behaviors or mental actions aimed at easing the distress. For an OCD diagnosis, these symptoms must cause significant distress or interfere with daily functioning.
Why does OCD develop?
Although researchers have not identified the exact cause of OCD, they recognize it as a brain-based disorder with a likely genetic component. Studies have identified specific brain circuits involved, and family history plays a role.
OCD is also frequently comorbid with other psychiatric conditions, especially anxiety. However, the precise origins of the disorder are still not fully understood.
Getting help: The earlier, the better
The most important step that parents can take is to seek help from a mental health professional for diagnosis and treatment, as early intervention significantly improves outcomes. Additionally, offering consistent support and being present for their child plays a crucial role in managing mental health challenges.
“This may include a lot of parental validation for the child without reinforcing compulsive behaviors for OCD. Additionally, children with OCD can also feel ashamed and feel stigmatized, too, so it’s important to provide age-appropriate psychoeducation along with really empowering these children,” advises Dr. Chu.
As a supplement to professional help, parents can advocate for school-based support such as an individualized education plan (IEP) or a 504 Plan. These accommodations—like extended time on tests or homework—can help children with OCD manage academic challenges more effectively.
How is OCD treated?
OCD treatment can be highly effective, especially with early intervention. The first-line approach for most children is therapy, particularly exposure and response prevention (ERP), a specialized form of cognitive behavioral therapy (CBT). Some children may also benefit from medication, and in many cases, a combination of both. While about 30% to 60% of children respond to treatment, recovery can take time and may require several months. Both therapy and medication can positively impact the brain’s neurochemical circuits involved in OCD.
“For children with OCD, typically we do start with therapy as a first-line treatment. Studies have shown therapy is very effective, particularly exposure response prevention. That should be the first-line treatment,” notes Dr. Chu. “However, in patients who have more severe forms of OCD or with a family history of OCD, studies have shown it may be helpful to consider starting these patients on both therapy and medication.”
There is a way through OCD
Ultimately, Dr. Chu emphasizes that parents and caregivers can use proven strategies to manage and reduce OCD in children (and adults). He urges anyone who suspects the child in their care is going through this troublesome condition to reach out to a professional like himself for help.
“If you notice they are struggling with a lot of distress, maybe having poor performance in school, struggling with peer interactions or interactions with other adults, or experiencing particularly obsessive intrusive thoughts that are causing them stress, then that’s definitely a time to get your child connected with mental health services.”
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