Signs of OCD in Children

Core Clinical Features to Identify

Children with OCD present with repetitive, intrusive, unwanted thoughts and/or repetitive behaviors or mental acts they feel driven to perform, which are time-consuming or cause significant distress and functional impairment, according to the International OCD Foundation and the American Academy of Child and Adolescent Psychiatry 1, 2
Children experience repetitive and persistent thoughts, images, impulses, or urges that are intrusive, unwanted, and commonly associated with anxiety, as noted by the American Psychological Association 1
The American Academy of Child and Adolescent Psychiatry recommends considering the following obsessions: fear of contamination, concerns about dirt, germs, or getting sick 3, harm-related concerns, persistent worries about harm coming to themselves or loved ones 3, 4, forbidden or taboo thoughts, intrusive aggressive, sexual, or religious thoughts 3, and symmetry concerns, need for things to be "just right" or perfectly ordered 3

Children feel driven to perform these behaviors in response to obsessions or according to rigid rules, as stated by the American Psychological Association 1
The International OCD Foundation lists the following compulsions: washing/cleaning rituals, excessive handwashing, showering, or cleaning objects 3, checking behaviors, repeatedly checking locks, homework, or that nothing bad happened 3, mental rituals, silent counting, praying, or repeating phrases to neutralize fears 3, 4, ordering/arranging, lining up objects, straightening items repeatedly 3, and counting or repeating, performing actions a specific number of times 3

The American Academy of Child and Adolescent Psychiatry notes that rituals taking more than 1 hour per day can be a sign of impairment 2
Avoidance behaviors, curtailing activities to prevent triggering obsessions, can also be an indicator of functional impact, as stated by the American Psychological Association 1

Nearly 25% of males with OCD have symptom onset before age 10, according to the International OCD Foundation 1

The American Psychological Association states that OCD rituals are distinguished by distress and resistance, the child recognizes behaviors are excessive and wishes for more control 1
The American Academy of Child and Adolescent Psychiatry notes that ego-dystonic nature, thoughts feel intrusive and unwanted, not like genuine concerns, is a key differentiating feature 4
Rigid, repetitive patterns, compulsions follow strict rules rather than flexible preferences, is another key feature, as stated by the American Academy of Child and Adolescent Psychiatry 4
Anxiety-reducing function, behaviors are performed to prevent dreaded outcomes, not for gratification, is also a key feature, according to the International OCD Foundation 5

The American Psychological Association warns against confusing OCD compulsions with impulsive behaviors, which are ego-syntonic and fundamentally different from the anxiety-reducing, ego-dystonic nature of OCD compulsions 5
OCD is explicitly distinguished from impulse-control disorders in diagnostic criteria, as noted by the American Academy of Child and Adolescent Psychiatry and the International OCD Foundation 2, 5