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.

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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.

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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.

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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.

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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.