Obsessive-Compulsive Disorder in Children and Youth

What it is and how it is treated

Have you ever walked into a room and immediately noticed that a painting is crooked? Does it bother you? What about when the toilet paper roll is turned the “wrong” way around? Or when someone loads the dishwasher the “wrong” way? Do you carry a bottle of hand sanitizer when you take public transit? Or do you need your desk arranged in a very particular way? Most of us have at least one or two such idiosyncrasies that we might casually or flippantly refer to as “being OCD”. In fact, some of these traits might actually be quite helpful to us in keeping us organized and healthy! But while we may be bothered or irritated by the crooked painting, or the disorganized desk, most of us will also be able to move on with the things we need to do and ultimately forget about the things that are “out of place”. Or perhaps we will wash our hands once after taking the bus or subway, and then be done with it. This is what distinguishes our personal idiosyncrasies from actual Obsessive Compulsive Disorder. Those with clinical OCD are not able to “just move on”, and their compulsion to address that which is out of place can significantly impact their daily life and functioning. In the case of children and youth, it can lead to serious impairment in their social functioning or success at school.

While estimates vary, it is generally reported that between 1-3% of children and youth will display symptoms of OCD. While there is no clear age of onset, most people with OCD will develop the symptoms prior to the age of 25, generally in childhood or adolescence. As with most mental health disorders, OCD is understood to arise from a combination of biology and environment. Those with OCD typically have decreased levels of serotonin (a chemical in the brain). There is also believed to be a genetic link to OCD, with it being more common in children or youth who have another family member with the disorder. At the same time, OCD can also be triggered by something in a child’s environment, like a stressful/traumatic event or even hearing negative or frightening messages on the news.

What is OCD?

OCD is considered an anxiety disorder. It is comprised of obsessive thought patterns, which lead to compulsive behaviours. Obsessive thought patterns are distressing or upsetting to the child, and will not go away (i.e., they cannot just distract themselves or “think of something else”). Compulsive behaviours are things that the child feels they MUST do in order to give them some relief from the obsessive and distressing thoughts. This is known as the OCD Cycle:

Negreiros, J. “Identifying and Supporting Students with OCD in Schools”
Cited from: https://www.anxietybc.com/sites/default/files/ocdschools_0.pdf

Some types of obsessive thoughts experienced by children and youth with OCD may include:

  • fears or contamination, or that any germs will lead to sickness or death
  • persistent belief that a loved one will come to harm
  • preoccupation with how their homework or handwriting looks
  • obsessive need for symmetry or order
  • perfectionism, a fixation on having something be exactly right
  • a belief that things need to be done a certain number of times, or else something bad will happen.  Sometimes children will have a “safe/good” or “unsafe/bad” number

As noted, these obsessive thoughts will lead to a high degree of distress in youth, and it will seem to a youth as though there is no way to make the thoughts or negative feelings stop.  Compulsive behaviours are seen as the only way of stopping the thoughts, or of relieving their distress. Compulsive behaviours may include, but are certainly not limited to: 

  • constant hand-washing, sometimes even to the point of developing cracked and bleeding hands
  • needing to shower multiple times per day
  • avoiding public places (bathrooms, buses, malls, even school) out fear of being “contaminated”
  • ritualized behaviour that they believe will keep their loved ones “safe” (e.g., repeating a sentence, persistent checking in with a parent)
  • constantly erasing their work, or redoing their work to the point of never finishing
  • constantly rearranging their desk, locker, bedroom, or other space until it is “just right”
  • repeatedly checking that doors are locked, lights are turned off, windows are closed, etc.
  • needing things to be done a certain number of times (e.g., a light needs to be turned on and off 3 times; needing to repeat an answer 3 times, etc.)

Often, the behaviour is initially successful (if only for a few minutes), which reinforces the false belief that they have to be done. However, this relief is fleeting, and often the youth feels they must do the behaviours more often, or with increasing intensity, in order for the relief to continue.

How is OCD Treated?

The most effective treatment method for OCD involves the use of Cognitive Behavior Therapy (CBT). CBT is a form of “talk” therapy where unhelpful thoughts (obsessions) are challenged, and youth are taught new ways of thinking. They are also taught new behaviours or ways of managing their distress. CBT is used with a variety of mental health concerns, and in the case of OCD it is typically accompanied by something called “Exposure/Response Prevention” (E/RP). In E/RP, a child would be exposed to the distressing situation (e.g., something unclean; a disorganized desk; a light switch turned off only once), and taught ways to decrease the distress that is triggered by this situation, sometimes through relaxation strategies, or by challenging the thoughts that arise. In some cases, medication (specifically an SSRI, or Selective Serotonin Reuptake Inhibitor) is also prescribed to help in treatment of OCD. 

By: Laura Hamilton, M.Ed

Resources for Counsellors

Although typically OCD in youth will be treated by a mental health professional, there are many good resources for school professionals on how to support students with OCD, including: