A Comprehensive Parent’s Guide to OCD in Children
OCD is not a disorder only adults struggle with: it does not discriminate. Unfortunately this means that children can have OCD too. The Child Mind Institute explains that, “The disorder can manifest as early as 5”. Children can even start showing symptoms around the age of 3, but will only usually be diagnosed from 5 years old onwards.
OCD in children is a fairly common occurrence. Beyond OCD explain that, “Current estimates suggest that one in 100 children has OCD, which means that millions of children worldwide are suffering from this disorder.”
This can sound like a really scary prospect, especially from a parent’s point of view. This guide is here to help you understand OCD in children, as well as equipping you with the information you need to help your child if they are displaying OCD symptoms.
What are obsessions and how do they present in children?
Just like in adults, children with OCD experience ‘obsessions’. Obsessions are thoughts or fears that play on the child’s mind. Depending on their age, and the child as an individual, they may be aware that these thoughts and fears aren’t really logical, but they are also unlikely to be able to control their obsessions. It’s likely that these obsessive thoughts will make them feel very anxious.
Obsessions can be grouped into a variety of categories. Some of these categories are shown below (this is not an exhaustive list):
- Contamination: This can revolve around obsessions with germs, bodily fluids, chemicals and cleaning.
- Symmetry: These obsessions are focused on symmetry in the child’s day to day life, for example items on their plate being symmetrical at meal times.
- Responsibility for harm: Obsessions of this kind typically involve the child feeling that they are responsible for the safety of the home or loved ones. This often leads to compulsions which must be carried out to ‘keep their family safe’.
- Violent or aggressive obsessions: This may involve the child fearing they are going to harm someone else or themselves.
- Numerical obsessions: These focus around numbers, for example having a specific ‘lucky number’ or ‘unlucky numbers’.
- Hoarding: These obsessions revolve around fears of throwing things away, or urges to collect or keep certain objects.
Often these obsessions, then lead to actions which are called compulsions.
What are compulsions and how do they present in children?
Compulsions are actions children with OCD take to ‘deal’ with their obsessions. They may take the form of rituals or repetitive acts, often done in very specific ways. To the child, it will seem as though they ‘have’ to carry out the compulsion in order to relieve the anxiety or fear caused by the obsession.
It may feel to them that these compulsions have the power to keep them and their loved ones safe, or to stop bad things happening. They may need to carry out compulsions a specific number of times, in a specific order or in response to a certain stimuli.
Some examples of the type of compulsions children might carry out include:
- Cleaning: This can be cleaning themselves (such as washing their hands), cleaning objects or cleaning areas of the home repeatedly
- Re-doing or re-starting things: This could be any act such as school work, a craft or a game. They may throw out, delete or ‘get rid of’ what they were doing and begin again.
- Touching: They may need to touch or tap specific surfaces or objects, often a specific number of times.
- Checking: This could include things like checking over and over again that they’ve put a toy back, checking the door is locked or the light is off for example. They may even check and recheck pieces of school work to make sure it’s ‘perfect’.
- Counting: Children may have a preference for certain numbers in their day to day life, for example needing to have a specific number of vegetables on their plate. They may count (in their head or out loud) to a specific number that feels ‘right’ to them when they experience an obsessive thought. They may also have unlucky numbers they ‘need’ to avoid.
- Hoarding: Hoarding means collecting objects to extremes. Children may collect a specific type of object. They may struggle to throw things away for fear that something bad will happen if they do.
These are just a few examples of how compulsions may present. They can be different for each individual child and be experienced to different degrees.
Signs of OCD in a child
It can sometimes take a while to notice signs of OCD in a child, especially if the child is younger and the symptoms are mild. Many children without OCD have certain ‘rituals’ or routines they like to stick to and this doesn’t mean they are displaying signs of OCD. They may have a ‘bedtime routine’ they need to happen in order to sleep properly for example. This can be a normal part of development and learning about the world around them. This chapter of a book on the topic explains, “While these behaviors may appear ritualistic on the surface, they would not be classified as compulsions if they do not cause significant impairment or are excessively time-consuming; additionally, interruption of these rituals typically would not cause severe distress in the child “
It can be tough to pinpoint when this normal development becomes something which is detrimental to a child’s life. It’s important to know that this is common and it doesn’t mean you ‘haven’t been paying enough attention’. It can be hard to spot OCD at first.
You may begin to notice signs of your child carrying out compulsions, which could present in the ways we’ve previously discussed. Other signs of OCD you may notice include:
- Feeling very emotional: Children with OCD may struggle to control their emotions. They may often appear anxious, distressed, sad, worried or even angry.
- Seeking reassurance: You might notice your child asking for extra reassurance a lot. For example they may repeatedly ask if things are ok or if they’ve done things right.
- Struggling with decisions: Your child may struggle with day to day decisions (even things that might seem small) as a result of their anxiety.
- Unable to cope with ‘the imperfect’: You may notice that your child needs to have things in a specific order or to be done in a certain way, and that they become very distressed or angry if this doesn’t happen.
- Trouble concentrating: Your child may struggle to focus on school work and even day to day tasks like watching TV or playing games. This is often because there’s so much going on in their mind.
- Taking a long time to do day to day tasks: You might notice your child taking a long time to get dressed, to take a shower, to wash their hands or to complete any other daily task. This is often because they need to do things repeatedly or may need to re-do the task if it didn’t ‘feel right’ the first time.
There are also symptoms of OCD you may not see, such as what is going on in the child’s head. Some of their compulsions may involve counting in their head as we mentioned earlier, or ‘thinking’ a phrase repeatedly. These are aspects of OCD which can be much harder to detect in children, especially if they’re unable to express what they’re going through.
What should I do if I notice signs of OCD?
If you are concerned you are seeing signs of OCD in your child, the first step is to take your child to their regular doctor and discuss your concerns. Their doctor may be able to start ruling out other causes and refer you to a specialist. The specialist will usually be a child psychiatrist or psychologist who specializes in treating children with mental illness.
This process of being referred to a mental health specialist can take time. In the meantime, you should try not to panic (although it’s easier said than done). It’s important to try and carry on ‘as normal’. It’s a great idea to keep notes of symptoms you are noticing: this will help to give the specialist a clearer view of what your child is experiencing when you do attend the appointment.
While you’re waiting to see a specialist you could do your own research and gather information. Ensure you use reputable resources and focus on facts, otherwise it can be easy to get overwhelmed and add to your worries. Be kind to yourself during this time and know that you’re doing the best you can to get help for your child.
How is a child diagnosed with OCD?
Once you see a child psychiatrist or psychologist, they will begin the diagnostic process. This will likely take time and be over a few sessions in order to make sure your child is getting the right diagnosis and in turn, the right treatment.
The sessions will involve the specialist chatting with your child to see how much they are aware of and how they feel. They will ask specific questions to try to assess what the child is going through. Depending on the child’s age, the specialist may play games or do crafts with the child to make them feel more comfortable and to see how they react in specific situations.
Your child may need to fill out questionnaires or forms (depending on their age you will be able to do this with them or for them). Often the specialist will want to see the child alone and you will wait outside. At the end of each session, the specialist will typically talk through the session with you to keep you up to date. They will let you know what happens next.
Over time, the specialist will eliminate other causes, such as other mental illnesses and behavioural issues. If the child has obsessions or compulsions, or both, and the symptoms are significantly impacting their life, then a diagnosis of OCD is likely. If the specialist reaches a diagnosis of OCD, you and your child will be guided through what treatments are available and how to cope moving forward.
Why do children develop OCD?
Research suggests that the brain of OCD patients is different than in those who don’t struggle with OCD. Scans have shown that some areas of the brain specifically function differently in those with OCD, particularly in regards to how these areas of the brain communicate with one another. This article explains that the areas affected include, “the orbitofrontal cortex, the anterior cingulate cortex (both in the front of the brain), the striatum, and the thalamus (deeper parts of the brain).”
Neurotransmitters, which are like little messengers made up of chemicals within the brain, also seem to be affected in those with OCD. There may be an imbalance of serotonin and dopamine among other chemicals. These two neurotransmitters are responsible for helping us regulate and control our emotions and maintain a general sense of wellbeing, among other vital roles.
In the genes
If a child has a close relative with OCD, they are more likely to develop OCD. This becomes even more likely if their relative’s OCD developed in childhood. Beyond OCD state that, “About 25% of OCD sufferers have an immediate family member with the disorder.”
Aside from the genetic component, there are some other factors which can make children more likely to develop OCD. Children who have experienced trauma in their lives are more likely to experience OCD. Children who have other behavioural problems may be more predisposed to developing OCD.
Some children have temperaments and personalities which make them more prone to anxiety. While OCD can’t be caused by stress alone, stress in the child’s life can be the catalyst for the development of OCD symptoms.
Some children can also develop OCD after an infection, but this is quite rare. This is called PANS (Pediatric Acute-onset Neuropsychiatric Syndrome). It used to be called PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal), before it was understood that infections other than strep could be the cause. PANS is a set of sudden severe OCD symptoms after an infection. Scientists aren’t sure exactly why this happens in some children and not in others.
It’s not your fault
The causes of OCD are rarely clearcut. It’s important to remember that it is not your fault. OCD isn’t caused by how you parent your children unless there is trauma involved. Making a ‘mistake’ in your parenting or raising your voice when you got frustrated isn’t going to cause OCD. Remember not to be too hard on yourself.
How does OCD feel for children?
OCD can feel very frightening and confusing for a child. They may not understand fully why they feel the way they do. They may struggle to express how they are really feeling. It’s often hard enough for children to learn to express their thoughts and deal with complex feelings, even when mental illness isn’t in the picture. The Child Mind Institute explains that, “a child may lack the self-awareness to recognize that his thoughts and fears are exaggerated or unrealistic, and he may not be fully aware of why he is compelled to perform a ritual”.
Each child is different and their experience with OCD will likely differ greatly. Some children may be aware that ‘something is wrong’ and this may cause extra worry and anxiety. They may feel embarrassed and try to hide their OCD behaviours from their friends, teachers and family members. They might feel isolated and alone in their struggles.
For some children, they may be able to live a fairly happy, full life despite their OCD, even before treatment. For others, their OCD may be severe and become debilitating. Either way, there are treatments and management techniques which can help a child to manage their OCD. There is always hope.
Psychological therapies are usually on an outpatient basis. This means you will take your child to their therapy session in a clinic or therapists office and then take them home after each session. Usually sessions happen once or twice a week over the course of a few weeks.
Cognitive behavioural therapy (CBT)
OCD in children is primarily treated with cognitive behavioural therapy (CBT). CBT is a talking therapy which focuses on helping the child to understand their OCD and to gain greater control over their symptoms.
If you’re in the UK, you will likely be referred to a CBT therapist on the NHS (National Health Service) through your child’s doctor or mental health specialist. If you are elsewhere, or choose to seek help privately, it’s vital you ensure that the therapist you choose is properly qualified and has experience of working with children with OCD.
Through CBT, the child will learn that even though their compulsions feel like they’re helping, that they’re actually feeding into a cycle and making their OCD worse. They’ll be taught tools to break the cycle and cope with their obsessions in more helpful ways. They’ll be guided through facing their fears and learning to overcome them.
A CBT therapist treating a child will make these CBT techniques accessible to the child, so that they can understand their treatment and make the most of it. The sessions will likely be weekly for a number of weeks (usually 6 to 8 weeks). The therapist may involve you in some of the sessions, while for other sessions they may see the child alone.
A specific type of CBT known as exposure and response prevention (ERP) is often used to treat OCD. With ERP, the therapist will guide the child (or parents depending on the child’s age and level of understanding) through producing a hierarchy of things they fear. They’ll face each fear, starting with the least stressful, in a gradual way so that they can overcome them.
The Child Mind Institute explains that, “This technique introduces a child to the objects of his obsession in incremental doses in a controlled environment, in which he can experience his anxiety and distress without resorting to compulsions.”
This article from Harvard Medical School by Jacqueline Sperling, PhD explains that ERP, “helps a child gradually resist engaging in compulsions while learning that the outcome is not as bad as expected – or, at least, can be tolerated.”
An important part of CBT for children with OCD is teaching their parents how to support them at home. It’s likely that the therapist will take you through what your child is learning, helping you to understand their OCD too! They’ll guide you through how to recognise when your child is engaging in compulsions and how to respond in a helpful way in those situations.
It’s important to find a balance between supporting your child and not feeding into the OCD cycle. This book chapter explains this aptly: “Family-based CBT incorporates parent tools such as behavior management skills training; parents are trained in behavioral strategies such as implementing reward systems, modeling, and ignoring behaviors that are reinforced by attention”
Your child (and you) may be given ‘homework’ between CBT sessions. These are usually tasks and techniques to work on at home in the child’s day to day life to help them overcome their OCD. When they attend the next session, the therapist will go over how their homework went and move forward from there.
For some families it can be helpful to attend counselling or talking therapy as a family. This can help everyone to come to terms with the child’s OCD and gain a greater understanding. Therapy can equip family members with the emotional acceptance and tools to deal with the situation, helping every family member to support the child effectively. Talking therapy can also help to deal with any other family issues which may be contributing to a stressful home environment.
Especially in younger children where the child is very reliant on their parents to lead the way, family therapy can help parents to guide their child in their OCD journey. This book explains that, “Extensive research demonstrates the importance of accounting for family factors in the treatment of pediatric OCD”.
Your child may be prescribed medication to help control their symptoms. It’s important to know that medication won’t ‘cure’ your child’s OCD, but rather can help them to manage their symptoms and gain some relief. Starting a psychiatric medication at any age is a big decision, so it’s important to take your time to make the right choice for you and your child.
The medication prescribed for children is typically an antidepressant known as SSRIs (selective serotonin reuptake inhibitors). These come in tablet form and will need to be taken every day. The International OCD Foundation explains that there 3 SSRIs which have been approved for children: “fluoxetine (Prozac), fluvoxamine (Luvox) (approval from 8 years of age), and sertraline (Zoloft ).”
SSRIs work by trying to correct the imbalance of chemicals in the brain, specifically serotonin. They can often help to ease OCD symptoms and help children to feel a bit more in control. SSRIs can also help with general anxiety and depression which often comes along with OCD.
Sometimes when SSRIs don’t work, a Tricyclic Antidepressant (TCA) will be prescribed. These are an older form of antidepressants and do tend to have more side effects, which is why SSRIs are typically prescribed first. TCAs work in a similar way to SSRIs, creating a better balance of chemicals in the brain. The only approved TCA for children is, “clomipramine (Anafranil ) (approval from 10 years of age)”.
Antidepressants can have side side effects which are important to take into account before your child starts any medications. These side effects can vary depending on the specific medication described and for each individual. Some of the more common side effects include:
- Problems going to the toilet (diarrhea or constipation)
- Restlessness (children often find it difficult to sit still)
- Problems sleeping (either insomnia or feeling drowsy)
- Weight gain
- Dry mouth
- Problems concentrating
While the side effects can sound worrying, they’re often short term and ease after the first couple of weeks. If side effects don’t ease after a few weeks, it’s important to bring this up with your child’s doctor. They may be able to adjust the dose or try another medication. It’s often a process of trial and error to figure out which medication works.
Medication can take a number of weeks to start working, so it’s important not to lose hope if you don’t see changes right away. Give it time to see if your child is experiencing any benefits and keep an open line of communication with your child’s doctor.
Many people take medication for the long term to control their OCD and this is a valid choice. As your child grows up and potentially engages in more therapy, their doctor should continually re-evaluate their medication and keep you up to date with their options (such as gradually tapering off medication).
Not every child needs to take medication for their OCD. This is a very personal decision and it’s important it comes from an informed place. Do your research and don’t be afraid to ask the doctor lots of questions. Some children (especially in milder cases) have success with psychological therapy without medication. Others find that a combination of both therapy and psychological treatment has the best results.
OCD can feel very isolating for children, especially if they don’t see any of their peers openly struggling with similar issues. They may feel that they’re ‘not normal’ or that they don’t fit in. Attending support groups with other children with OCD or other mental illnesses can help them to understand that they aren’t alone. This can help them to form friendships with other children who understand what they’re struggling with. This can be particularly useful for older children and teenagers.
In some cases where the child’s OCD is severe or outpatient treatment isn’t suitable, children may attend an inpatient programme. This means that they will go to stay at a mental health hospital or clinic and have intensive, daily sessions with mental health specialists. This sounds worrying, but in some cases can be very successful in treating a child’s OCD.
OCD and school
How does OCD affect a child at school?
OCD can be all-consuming for a child. Depending on the severity of their symptoms, they may be able to focus on schoolwork sometimes or they may struggle to focus at all because their mind is so busy. Often OCD makes it hard for the child to sleep and this tiredness can result in little, if any, energy to put into their schooling.
Due to this tiredness combined with high anxiety, often children can find it hard to control their emotions. They may be frustrated, irritable and short tempered in a school environment. When they are so focused on compulsions and obsessions, it can be difficult for a child to make school their priority. If you’re always frightened that something is bad is going to happen and you have taken on so much responsibility in your mind, school can seem unimportant.
Often the child’s obsessions may lead to them needing to carry out compulsions at school. This can be very disruptive to their schoolwork and unfortunately, sometimes it can be disruptive to others in the classroom including pupils and teachers. Often when a child is acting ‘differently’ than other children, their peers struggle to understand and bullying can become a significant problem. When teachers don’t understand the reason behind a child’s behaviour, they may interpret this as a child being naughty and punish them.
A child with OCD may struggle to keep up with their class and may fall behind. They may struggle to concentrate on homework which can lead to further problems. None of this means that your child is intelligent or capable: it simply means that their OCD is getting in the way! The Anxiety and Depression Association of America explains that, “Although students with OCD typically have average to above-average intelligence levels, they may be unable to learn the same way others do because their focus is frequently on their obsessions or compulsions.”
Some of the primary ways a child with OCD may behave at school which you or their teachers may notice are summarized below:
- Often being late or absent from school
- Struggling to control their emotions leading to disruptive behaviour, frequent crying or anger outbursts
- Finding it hard to complete schoolwork or homework
- Re-doing work (as we mentioned earlier, a child with OCD may throw out work when they make a mistake because it isn’t ‘perfect’)
- Going to the bathroom often (this may be to carry out their compulsions or to try to re-focus in a quieter environment)
- Avoiding certain places, people or activities within the school
- Avoiding touching shared surfaces which lots of other children might have touched (like door handles, tables and school equipment)
- Carrying out obvious compulsions (checking, tapping, repeating actions, etc)
- Seeking frequent reassurance from teachers
Deciding whether to inform your child’s school
The choice about whether or not to inform your child’s school about their OCD is a personal one. There are potential pros and cons to both choices. Unfortunately stigma is still present around mental illness, even within children. Some parents don’t feel that telling their children’s teachers would be helpful. Others worry about bullying that could potentially come from other children because their child is ‘different’ or getting extra attention from teachers.
On the other hand, letting the teachers (and potentially other children) know what is going on may help them to understand your child is not behaving out of ‘naughtiness’. This can enable them to be more understanding and helpful rather than punishing the child. Making the school aware of your child’s medication can help them to be aware of side effects. The school may even be able to work with you to provide extra support for your child, helping them get the most out of their schooling despite their OCD.
Take your time and consider your options before making the best choice for you and your child. Your child’s therapist or doctor may be able to help you make this choice.
Helping a child with OCD cope with school
Once you’ve decided whether to inform your child’s school, you can then figure out how to help your child. If you decide to keep your child’s OCD private, you can help them by talking through what they are struggling with at school. You may be able to come up with solutions together. It’s a great idea to consult your child’s therapist about the situation: they may be able to give valuable coping tips and strategies for your child to utilize to help them focus more effectively.
At home you can help your child to focus on homework by setting aside a quiet, calm space where they can carry out their work with few distractions. Your child’s therapist may be able to guide you through techniques you can use to assist your child in getting the most out of their homework.
If you decide to tell your child’s school, the previous advice can still be useful. As you talk to your child’s teachers, the school should work with you so that you’re a team, helping your child to get the most out of school despite their OCD. You could talk to the teachers to explain how OCD may affect your child and what they could expect. You could even choose to provide reading material to help teachers get informed.
You may be able to provide guidance for the teachers from your child’s doctor or therapist tailored specifically for your own child in regard to how the school can help them. If everyone involved is comfortable doing so, it can be useful for the school to interact directly with a child’s therapist for further guidance.
The school themselves should also be proactive in helping your child. Some of the help which may be offered at school includes:
- Being more patient with your child’s behaviours, understanding that they’re not being naughty
- Being understanding of absences and allowing time off for therapy appointments
- Working with you to encourage the child with therapy techniques and taking medication
- Being aware of medication side effects
- Keeping you up to date of your child’s behaviour and progress
- Seating your child where there are less distractions to help them focus
- Giving the child extra time to complete work
- Providing an aid: this is simply a person who is trained to help children with additional learning challenges. They will be dedicated to assisting your child. They will often attend all of your child’s lessons with them, or sometimes just the lessons the child struggles with the most.
- Allowing your child to take tests in a private room so they are less distracted.
- Providing a laptop: this can make the need to erase and restart work less time consuming and less distressing for children.
- Arranging a signal with the teacher to allow your child to take a break when they need one without causing a disturbance to other children.
- Skipping tasks that may be particularly difficult for a child with OCD, such as reading in front of the class.
- Peer understanding: This often involves your child (with the help of their teacher) talking to their class to explain what OCD is, how it might affect them at school and how their friends can help. This can enhance understanding and reduce bullying from other children.
- Being aware of the child’s triggers so they can help them to cope (for example some subjects might be harder for children with OCD, such as maths for children whose obsessions focus around numbers).
- Helping your child build confidence and praising their progress.
- Teachers keeping an eye out for signs of bullying so it can be dealt with quickly.
While OCD can certainly make doing well at school harder for your child, it doesn’t mean they can’t succeed. With help and the right treatment for their OCD, children can thrive and fulfil their true academic potential.
How you can help your child
A great place to start is understanding as much as you can about what your child is going through. Coming from a place of knowledge really is power. This gives you a basis to help your child understand what they’re going through; to recognise symptoms; to get them professional help and to aid them in overcoming their OCD.
Once you’re aware of OCD symptoms it’s vital to face things head on. If OCD is left ignored, brushed away or avoided, it can get worse for your child. As hard as it can be to accept your child has a mental illness, it’s vital for them (and for you) to be proactive in seeking help and to take action to deal with OCD.
This article explains that, “By being proactive and taking action, you’ll greatly improve your child’s chances of successfully gaining control over this potentially debilitating disorder.”
In fact children whose parents are actively involved in their treatment and help them to tackle their OCD have much better success from treatment. This study from Child Psychiatry & Human Development concluded that, “children whose parents actively participated in treatment showed significantly more remission from 6-month to 3-year follow-up than children with limited parental participation.”
Advocate for your child’s treatment
Unfortunately due to stigma and often lack of appropriate mental illness education for doctors, you may need to be very proactive in advocating for your child’s diagnosis and treatment. Being clear, firm, respectful and persistent tends to bring the best results. If you feel that you and your child are not getting the treatment you deserve, don’t be afraid to seek a second opinion or ask for another doctor.
It’s a good idea to ask plenty of questions and voice your concerns openly when any medical professional is suggesting a new treatment or test for your child (or just anytime you’re concerned). You don’t have to agree to anything right away. You can take your time to go away and do your own research before making an informed choice. Depending on your child’s age, it can be helpful to talk to them at home to see how they really feel and what they want.
Keeping notes of what happens during appointments and asking for copies of your child’s medical records can help you to stay informed. Making note of symptoms and how they’re affecting your child can help you and the professionals to get a clearer picture of how OCD is affecting your child in their daily life. These notes become even more important during new treatments or medications to help you keep track of any side effects or progress.
Talk things through
It’s important to regularly talk things through with your child. How much information you give them about their OCD and how you explain it is a personal choice, but in general being as open and honest as possible is best. When children understand their OCD, it can help them to feel less afraid and can make treatments much more effective.
Regularly giving your child a safe space to open up about how they feel and what they’re going through can be extremely beneficial for them. It can also help you understand how to help them.
Help your child feel understood and accepted
Your child may feel very isolated because they feel different. Stigma means that unfortunately they may be treated as though they are ‘not normal’ by others. This can be devastating and confusing for a child. It’s important that you do your best to talk this through with them and let them know why other people might not understand.
It’s important that your child knows that it’s not their fault and that they haven’t done anything wrong. They are not ‘bad’ or ‘naughty’. It can help to explain that it’s the OCD which is causing these symptoms, rather than themselves as a person. Giving them hope that things can get better is vital. Fundamentally it’s important to let them know that having OCD doesn’t make them ‘crazy’ or ‘not normal’, and that they are not alone.
There are some great resources online and books which can help children with OCD to understand their condition more clearly. There are online and in person support groups and community programmes which you could ask your child’s therapist or doctor about. There may be local resources you can find of your own accord.
Keep up with medications and treatment strategies
It’s vital that any prescribed medications are taken as instructed. This may involve taking them at specific times of day each day. This is important in order for the medications to work effectively and to reduce side effects.
It’s also important that you help your child to keep up with any coping techniques they are learning through therapy. You may need to help them to complete ‘homework’ they’ve been given between sessions.
You may have tools you learn through therapy which you need to continue proactively using to help your child. It’s common for children with OCD to try and involve their family in their compulsions, for example not wanting their parents to touch a certain area for fear of contamination, or asking for their food to be placed in a specific way on their plate. This can lead to what’s known as accommodation, meaning the parent is actually accommodating the child’s OCD behaviours. Accommodation can be defined as, “family members’ modification of their own behavior in order to assist in their child’s OCD-related rituals”.
It can be really tough for a parent to refuse their child ‘reassurance’ and see them getting distressed, but you must remember that giving them this ‘reassurance’ is actually making their OCD worse. It’s important you don’t reinforce their compulsions, so sticking to the guidance you’ve been given from their therapist is pivotal.
Educate and encourage other loved ones to effectively help your child
It can be difficult for others in the family and extended family unit to understand why your child may be behaving in a certain way. Siblings in particular may act out of frustration or anger. It’s important to help others understand the basics of what your child is going through and share the tools you learn through therapy regarding how to react to the child’s behaviour in a helpful way.
Helping loved ones to understand that OCD is not your child’s fault and enabling them to understand the difference between behaviour caused by OCD and the child’s personality, can reduce frustration and contribute to stronger personal connections with your child.
This can be a hard balance to strike because it’s also important that others (especially other adults) in the family take responsibility for educating themselves and proactively supporting your child. If you feel that someone is impeding your child’s progress or being stigmatizing, don’t be afraid to set clear boundaries on your child’s behalf.
Use positive self-talk
OCD can have a marked impact on a child’s self-esteem. They may be very down on themselves, often speaking negatively about themselves or using negative phrasing in reference to their OCD. Helping your child replace negative phrases with more positive alternatives can be really beneficial.
It’s also really helpful for your child to hear you using positive self-talk rather than criticizing yourself. For example, if you drop something in the kitchen instead of being annoyed with yourself, you could say ‘oops, I made a mistake. I’ll try again!”. Children pick up on how their parents deal with situations and will often model their behaviours in accordance.
For both you and your child, introducing relaxation techniques into the home can become a positive habit which helps to control anxiety, regulate emotions and reduce stress. You could introduce mindfulness into the home. There are lots of great resources online for guided meditations for children and guidance to aid you in introducing mindfulness into daily activities.
Set aside a ‘calm space’
It’s a great idea to create a safe, calm space in the home where your child can go to relax and unwind. This could be their bedroom or another area depending on what you have available. You could introduce dim lighting, calming music and plenty of blankets and cushions for example. This could be a great place to practice mindfulness, to read or for your child to just sit quietly for 5 minutes without being disturbed.
Creating a ‘happy box’
Putting together a box full of resources which your child can access anytime they’re struggling can be useful. The box could include distraction tools, such as arts and crafts, a DVD of their favourite film or a game to play. You could include sensory items to help ground your child in the present, such as a stress ball to hold or essential oils to engage their sense of smell. You could include a journal if your child is old enough to write, so they can get their feelings off their chest. You could also include phone numbers to call if they need assistance.
How to help yourself cope
OCD isn’t just hard for the child to cope with, it can be really hard for you too! There are a lot of challenges that come along with trying to help your child. It can be emotionally, financially and energy draining. It’s so important that you take care of yourself too.
Do your research
We’ve talked about doing your research for your child. However, it’s also important to do research for yourself. There are lots of resources online for parents which can help you find coping strategies. There are people sharing their personal stories; videos and books which can give you more insight; blogs which share advice and articles which can guide you in the right direction. Take your time to inform yourself about how you can help yourself cope.
Focus on facts
As much as reading personal stories can be helpful and inspiring sometimes, they can also feel a bit overwhelming and scary. If you find that personal stories of children with OCD are not reassuring you, focus on the facts and reputable resources.
It’s not just your child who needs support, you do too! Seek support from loved ones. Let them know what’s going on: talk to them about your feelings instead of bottling things up and ask for practical help when you need it. We all need help sometimes. There’s no shame in reaching out.
Mental health charities or local organizations may be able to help you with finances, with child care and with coping as a family. Search online or ask your doctor about any available resources. Similarly, there may be local support groups you can attend for parents so you can find other people who really understand what you’re going through.
Self-care can be defined as: “The actions that individuals take for themselves, on behalf of and with others in order to develop, protect, maintain and improve their health, wellbeing or wellness.” This includes eating well, exercising, practicing daily hygiene, taking time for yourself and much more.
As a parent it can be hard enough to remember to practice self-care when you’re busy looking after a child, but when your child has extra challenges, your self-care can be put on the back burner completely. It’s vital you prioritize your self care as much as possible. You can’t look after someone else without looking after yourself.
Be kind to yourself
It’s so easy to feel guilty for being annoyed or frustrated with your child’s behaviour. Many parents feel guilty that they didn’t notice symptoms ‘soon’ enough, or didn’t push hard enough for treatment. It’s vital to regularly remind yourself that this isn’t your fault. You’re doing your best and that is more than good enough.
You are not a bad parent. You are not failing. You are not alone. Remind yourself that you are trying your best. Be kind and compassionate with yourself, just as you would be for a friend in the same situation.
Comorbid mental illnesses
If a child has OCD, it’s common for them to have another mental illness alongside their OCD. They may receive an additional diagnosis during the diagnostic process for OCD. While this can feel overwhelming (OCD on its own is hard enough to cope with), it means other issues can be treated and managed at the same time as OCD.
What does this mean for their future?
While there is currently no cure for OCD, with the right treatment, management strategies and support, children can still live a full life and have a very promising future. Children who learn how to deal with their OCD already have the tools in place to continue managing their OCD in adulthood. Often this provides a great basis for them reaching their goals later on in life. This study on the topic concluded that, “Most children with OCD achieve remission or significant improvement in their symptoms.”
As children grow into adults, they may decide to change or stop their medication or to engage in different kinds of therapy. As long as they do this with the guidance of their doctor, it’s important to support them in making their own choices. Children with OCD can grow up into adults who can follow their dreams, achieve remission from their symptoms and live fulfilled lives despite their OCD! There is always hope!
Walczak, M., Esbjørn, B.H., Breinholst, S. et al. (2017), “Parental Involvement in Cognitive Behavior Therapy for Children with Anxiety Disorders: 3-Year Follow-Up.” Child Psychiatry Hum Dev 48, 444–454
International OCD Foundation, (2020), “About Medications for Pediatric OCD”.
Beyond OCD, (2019), “Parent’s Role In Treatment”.
Self Care Forum, (2020), “What do we mean by self care and why is it good for people?”
Ammar Albanna, MD, Khalid Bazaid, MD, Muhammad Waqar Azeem, MD, (2017), “Obsessive-Compulsive Disorder in Children and Adolescents: An Overview” Psychiatric Annals. 2017;47(10):512-518
Child Mind Institute, (2020), “Obsessive-Compulsive Disorder Basics”.
Beyond OCD, (2019), “Helping A Child Who Has OCD”.
International OCD Foundation, (2020), “Signs & Symptoms of Pediatric OCD”.
Fugen Neziroglu, Yvette Fruchter, (2018), “Manifestation and Treatment of OCD and Spectrum Disorders within a Pediatric Population”. Anxiety Disorders – From Childhood to Adulthood, Neşe Kocabaşoğlu and R. Hülya Bingöl Çağlayan, IntechOpen.
Beyond OCD, (2019), “Causes Of OCD In Children”.
Jacqueline Sperling, PhD, (2018), “Helping a child with obsessive-compulsive disorder”. Harvard Health Publishing, Harvard Medical School.
Anxiety and Depression Association of America, (2018), “OCD at School”.