What is the Best OCD Treatment for Children?

Obsessive compulsive disorder (OCD) is a type of anxiety disorder that can affect people of all ages, including children, adolescents, and young adults. According to the International OCD Foundation and American Psychiatric Association, this condition affects 1-3% of children. OCD symptoms typically appear around the ages of 6-9 years, but the condition can also develop in younger children as well. Severe OCD can negatively impact a child’s quality of life, including their ability to go to school, play with friends, participate in sports, and follow a daily routine.

Please keep reading to learn more about obsessive compulsive disorder in children and specific ways that anxiety disorders like OCD are treated.

What is obsessive compulsive disorder (OCD)?

Obsessive compulsive disorder is a mental health condition in which a person has unwanted and intrusive thoughts, fears, or sensations called obsessions and unwanted and repetitive behaviors called compulsions. The obsessions cause distress, and the compulsions are performed to cancel the distress. In other words, a child’s anxiety causes them to do things in a rigid or rule-bound manner which interferes with normal functioning.

Some examples of pediatric OCD include:

Repeated hand washing.
Locking and unlocking doors.
Doing things or placing things in a certain order.
Erasing or rewriting things multiple times.
Checking homework assignments a certain number of times.
Being intolerant of certain sounds or words.
Having exaggerated fears of contamination or harm to family members.
Using magical thinking (“if I do this, that won’t happen”).
Repeatedly seeking assurances about the future.
Repeatedly confessing bad or mean thoughts.

What are the risk factors for OCD?

Mental disorders such as obsessive compulsive disorder tend to run in families. Meaning if a child has a family history of OCD, for example, in a parent or sibling, they are at a higher risk of developing it themselves. However, no specific gene for OCD has been identified.

Experts in child and adolescent psychiatry say that environment also plays a role in the development of obsessive compulsive symptoms. Family members can have a significant influence, and a child may pick up obsessions and compulsions from the people around them. Children who experience trauma or stress and develop post-traumatic stress disorder (PTSD) can display OCD symptoms.

Approximately 70% of children with obsessive compulsive disorder have co-existing mental health conditions. OCD is often mistaken for other disorders, such as tic disorders, eating disorders, or attention deficit hyperactivity disorder (ADHD). This can make the diagnosis and treatment of childhood OCD challenging.

How do you recognize childhood OCD?

OCD symptoms develop gradually over time. Family members may not recognize OCD until a child has more severe symptoms. Moreover, many children have poor insight into their symptoms, making the condition harder to recognize.

Remember, occasional unwanted thoughts or normal developmental rituals such as a bedtime ritual do not qualify as obsessive compulsive disorder.

The sooner OCD is diagnosed and treated, the better the outcome. If a child has obsessive thoughts or compulsive rituals that are starting to affect their ability to function normally, this could be a sign of OCD, and they should see a mental health professional.

How is childhood OCD diagnosed?

Mental health professionals use a guide called the Diagnostic and Statistical Manual (DSM) for diagnosing OCD. They take a detailed history from the child’s family members and teachers to assess symptoms. Providers also evaluate if there is an interplay between two or more related disorders (for example, OCD and a tic disorder such as skin picking). They can recommend conservative or intensive treatment programs, depending on the severity of the child’s symptoms.

How do you treat OCD in a child?

Treating OCD in a child involves both psychotherapy and medication treatment. Primary treatment usually consists of cognitive therapy for mild to moderate OCD. Antidepressants such as selective serotonin reuptake inhibitors may be prescribed along with cognitive behavior therapy for moderate to severe OCD symptoms.

In some children with a condition called Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS), a streptococcal infection can cause a very abrupt onset of OCD and tics. In such cases, the symptoms usually respond to antibiotic treatment for strep throat.

What is the first-line treatment for OCD in children?

The first line of treatment for OCD in children is cognitive behavior therapy (CBT). Specifically, a type of cognitive behavior therapy called exposure and response prevention (ERP) is the gold standard treatment for childhood OCD.

ERP involves making a child face their anxieties and fears in a safe and structured environment in incremental steps. The therapist helps the child learn coping skills to experience the distress caused by the obsessions without resorting to compulsive behaviors. Over time, this leads to a decrease in the anxiety disorder triggered by the child’s OCD.

Sometimes, healthcare providers offer ERP therapy in real-world situations, for example, on the playground or in restaurants. It’s important for the family to work with the child’s care team to reinforce the skills learned during exposure and response prevention therapy.

What is the most effective treatment for OCD in children?

The most effective treatment plan for OCD in children depends on the severity of the child’s symptoms. A combination of antidepressants and cognitive behavior therapy works well for many children.

Child and adolescent psychiatrists usually offer the following treatments to children with obsessive compulsive disorder:

Children with mild to moderate severity OCD symptoms usually respond well to ERP therapy 1-2 times a week to treat OCD in an outpatient setting.
Those with more severe OCD symptoms may require an intensive outpatient program, which involves therapy several times a week.
Very severe cases with treatment-resistant OCD may require inpatient treatment.
Practice guidelines also include medications called selective serotonin reuptake inhibitors (SSRIs), a class of antidepressants that can help to reduce anxiety and make the child more responsive to therapy. Examples of SSRIs include citalopram (Celexa), sertraline (Zoloft), fluoxetine (Prozac), and paroxetine (Paxil).

Treatment response and improvement in OCD symptoms vary from child to child. However, children and adolescents with obsessive compulsive disorder, including aggressive obsessions and compulsions, can lead full and productive lives with the proper treatment.

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