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Help for Children and Adolescents with Obsessive-Compulsive Disorder (OCD)


About Pediatric Obsessive-Compulsive Disorder (OCD)

The prevalence of Obsessive-Compulsive Disorder (OCD) in youth is estimated as 1/200, which in the US translates to about 500,00 children and teens. The average age of onset is 9 or 10, with spikes around ages 8-12 and in the later teenage or young adult years. However, even very young children can show signs or symptoms of OCD. OCD tends to run in families but doesn’t have to. Some aspects of normal development in younger kids might look like OCD- like having to close a door in a certain way but are not.

OCD is a chronic, neurobiological condition. Typically, it is characterized by waxing and waning symptoms and exacerbations during periods of heightened stress. While a cure is as of yet unknown, there are effective, evidence-based treatments that will be discussed in the following section.

Children and teens often have obsessions and compulsions that are similar to those of adults with OCD.  But there are important considerations. Youth with OCD, especially the youngest, have more difficulty understanding and communicating about their symptoms. Sometimes, they just express “worries.” In other cases, OCD symptoms are masked by, for example, depression or what looks like oppositional-defiant behaviors.

Common symptoms of OCD in youth include morning or nighttime rituals, e.g., saying “I love you” a certain number of times, hand washing, ordering and arranging possessions and asking repetitive questions to which they really know the answers. Other conditions often accompany OCD, or comorbidities - ADHD, anxiety, Autism Spectrum Disorder (ASD), to name a few. Excoriation (skin-picking), hoarding, Body Dysmorphic Disorder (obsessions about minor or non-existent flaws in appearance) and trichotillomania (hair-pulling) are OCD-related disorders. Food or eating-related disorders often have OCD-related elements.

Moreover, early-onset OCD is associated with increased risks for co-occurring Tic Disorders and Attention Deficit Hyperactivity Disorder (ADHD), even more so for boys. Also, because of gender expectancies, girls may fall through the cracks when it comes to early diagnosis of OCD, indeed they seem like “the perfect little girl.” Children with OCD often feel embarrassed or sad. They frequently feel ashamed and hide their symptoms. They can appear tired as if they have the weight of the world on their shoulders or seem too adult or “philosophical” for their age. OCD in childhood often interferes with socialization and academics. When OCD symptoms appear suddenly and severely, along with personality and behavior changes as well as atypical movements, medical evaluation to rule out PANDAS, pediatric autoimmune neuropsychiatric disorders associated with streptococcus, or similar medical conditions should be considered.

Treating OCD in Children

In pediatric OCD, parents, ideally, are strongly integrated into the treatment plan.  They can participate in their child’s care by learning about OCD and their role in the treatment approach in separate sessions — especially about the problem of over-accommodating symptoms. Parents and other family members often have emotional reactions to a child’s OCD, such as guilt or frustration, that need to be aired out and re-conceptualized. Family therapy is often a component of treatment as well. 

Treatment of pediatric OCD must be tailored to the severity of symptoms and the developmental level of the child. The most established Cognitive-Behavioral Therapy (CBT) approach for OCD is Exposure and Response Prevention (ERP). When OCD symptoms are more severe, ERP is often combined with SSRI’s, a class of psychiatric medications which have been shown to have efficacy for youth with OCD.

The idea of purposely exposing their child- even very gradually- to their worst worries seems unnatural and distressing. However, that is exactly the idea behind ERP.

For example, imagine a girl who is afraid that her mother will die if she does not tap her foot according to certain “magic” numbers. This compulsion (ritual) provides relief from her anxiety, but only temporarily. ERP encourages her to face this fear and resist her compulsion. This can be uncomfortable at first, but study after study has shown that it works in the majority of cases.

For younger children, ERP can be translated into age-appropriate games and activities. The “OC Flea” concept developed by Dr. E. Katia Moritz of NBI is an example of this approach.

Adolescents resistant to treatment just as they might be resistant to just about anything else. Since they are at the stage of identity formation, they may be prone to the extremes of either adopting a “sick-role” or, conversely, having difficulty accepting the idea of having OCD altogether. They may easily get into power struggles with parents and/or siblings, which exacerbate their OCD symptoms. Adolescents with OCD often act as if they are in charge of their parents to get them to accommodate their symptoms.

Early Diagnosis Can Improve Outcomes

Research has consistently shown that early identification and intervention can positively affect the course of pediatric OCD. By stopping the progression of OCD early and systematically, symptoms and problems that could have developed and further impact their lives might never have a chance to emerge or seriously worsen. This, of course, provides young people with OCD the best chance for future happiness, the ability to function up to their potential and overall better quality of life.

OCD in youth is a significant issue for all concerned; the goal is to make it a manageable one. Many people with earlier OCD onset have gone on to meet their challenges and build great lives full of purpose and success. We know, we’ve seen it happen hundreds of times!

We’re here to help you through this journey. Call 954-280-3226 to learn more about Pediatric OCD Treatment in Weston, FL.

Neurobehavioral Institute (NBI) is a dedicated mental health center focused on the treatment of Anxiety, Obsessive-Compulsive Disorder, and Related Conditions. We specialize in providing personalized care and evidence-supported Cognitive Behavioral therapies (CBT) tailored to meet your specific needs.


Get control of your life. For more information, please call us at 954-280-3226.

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