How do you support a child with OCD? – CHOC

Insights from Dr. Michael ChuA board-certified child and adolescent and adult psychiatrist at Rady Children’s Hospital Orange County (Rady Children’s)

key takeaways

• Obsessive-compulsive disorder (OCD) can begin early and is often misdiagnosed: Pediatric OCD usually begins around age 8–12 but is often misdiagnosed. Symptoms include intrusive thoughts (obsessions) and repetitive behaviors (compulsions) that significantly interfere with daily life.
• Early intervention makes a big difference: Getting professional help early, especially an OCD-focused therapy like exposure and response prevention (ERP), can greatly improve outcomes. Parents can also support children through validation without promoting compulsive behavior.
• Help goes beyond therapy: School accommodations (IEPs or 504 plans), family understanding, and non-discriminatory discussions help children manage symptoms and reduce distress while working toward recovery.

Early symptoms of OCD in children

When people think of OCD, they often picture adults struggling with intrusive thoughts and ritualistic behaviors. But OCD doesn’t wait for adulthood. It may begin in childhood, often as early as age eight.

Unfortunately, many healthcare providers often misunderstand or misdiagnose pediatric OCD, causing many children to suffer in silence. In this article, Dr. Michael Chu, child and adolescent psychiatrist at Rady Children’s, discusses how OCD manifests in children, the unique challenges it presents, and expert-supported strategies parents and caregivers can use to support their child’s mental health and well-being.

What exactly is obsessive-compulsive disorder?

A medical professional should formally diagnose OCD through a thorough evaluation, as it often overlaps with other anxiety disorders and can be difficult to differentiate. In children and adolescents, OCD affects about 1% to 3%, a rate similar to that of adults, with a slightly higher prevalence in women.

Symptoms typically emerge in two waves: the first between the ages of eight and 12, and the second from late adolescence to early adulthood. OCD typically involves obsessions, compulsions, or both. The severity of these symptoms can vary and may fluctuate over time with periods of improvement and deterioration.

Dr. Chu explains, “You can think of OCD as an anxiety or cognitive phenomenon, specifically safety concerns or a feeling that something is not right. Or, they have to do something ‘just right’ or something bad will happen.” “When you think about obsessions, it’s the sensation of having recurring or persistent thoughts, urges, or visual images that are experienced as intrusive and unwanted. Children don’t want these thoughts, but they are very intrusive.”

Unlike generalized anxiety, which causes widespread and persistent worry, OCD involves specific, recurring obsessions that people often try to suppress. This repression can lead to compulsions, repetitive behavior, or mental actions aimed at reducing distress. For an OCD diagnosis, these symptoms must cause significant distress or interfere with daily functioning.

Why does OCD develop?

Although researchers have not identified the exact cause of OCD, they recognize it as a brain-based disorder with a possible genetic component. Studies have identified specific brain circuits involved, and family history plays a role.

OCD is also often comorbid with other psychiatric conditions, particularly anxiety. However, the exact origin of the disorder is still not completely understood.

Getting help: the sooner the better

The most important step parents can take is to seek help from a mental health professional for diagnosis and treatment, as early intervention greatly improves outcomes. Additionally, providing consistent support and being present for your child plays an important role in managing mental health challenges.

“This can include too much parental validation for the child without reinforcing the compulsive behaviors for OCD. Additionally, children with OCD may also feel embarrassed and stigmatized, so it is important to provide these children with age-appropriate psychoeducation while being truly empowering,” Dr. Chu advises.

To complement professional help, parents can advocate for school-based supports such as an Individualized Education Plan (IEP) or a 504 plan. These adjustments—such as extended time on tests or homework—can help children with OCD manage academic challenges more effectively.

How is OCD treated?

Treatment of OCD can be highly effective, especially with early intervention. The first-line approach for most children is therapy, particularly exposure and response prevention (ERP), a special form of cognitive behavioral therapy (CBT). Some children may also benefit from medication, and in many cases, a combination of the two. While about 30% to 60% of children respond to treatment, recovery can take time and may require several months. Both therapy and medication can have positive effects on the neurochemical circuits of the brain involved in OCD.

“For children with OCD, we usually start with therapy as the first-line treatment. Studies have shown that therapy is very effective, especially exposure response prevention. This should be the first-line treatment,” says Dr. Chu. “However, in patients who have more severe forms of OCD or who have a family history of OCD, studies have shown that it may be helpful to consider starting these patients with both therapy and medication.”

There is a way through OCD

Ultimately, Dr. Chu emphasizes that parents and caregivers can use proven strategies to manage and reduce OCD in children (and adults). He urges anyone who suspects a child in their care is going through a distressing situation to reach out to a professional like him for help.

“If you notice that they are struggling with a lot of distress, perhaps performing poorly in school, struggling with interactions with peers or other adults, or experiencing particularly obsessive thoughts that are causing them stress, then it is definitely time to connect your child with mental health services.”

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