OCD in Children & Adolescents

OCD affects 1% to 3% of kids and teens. Half of all cases start in childhood or teenage years, and 1 in 5 start by age 10. This shows how important it is to know about OCD and get help early.

OCD can greatly affect a child's life. They may spend so much time on their intrusive thoughts and rituals that it’s hard to focus on schoolwork or enjoy time with friends and family. This can cause frustration, loneliness, and trouble in school. Kids might avoid activities or subjects that trigger their OCD, feel embarrassed or misunderstood by their peers, and skip social events to avoid being noticed. At home, OCD can cause stress because parents and siblings might not understand the child's behavior, and the time spent on rituals can disrupt family activities.

Children with OCD have obsessions and compulsions:

Obsessions: These are unwanted thoughts or fears that cause anxiety. Common ones include:

• Fear of Contamination: Worrying about germs or getting sick.
• Harm: Fear of hurting themselves or others.
• Symmetry and Order: Needing things to be arranged just right.
• Forbidden Thoughts: Intrusive thoughts about things that feel wrong or inappropriate.

Compulsions: These are repetitive actions to reduce anxiety from obsessions. Common ones include:

• Washing and Cleaning: Excessive hand washing or cleaning.
• Checking: Repeatedly checking things like doors or homework.
• Counting: Counting objects or steps to feel safe.
• Arranging: Organizing items in a specific way.
• Repeating: Doing actions or saying words multiple times.

OCD in children and teens can be treated with therapy, medication, or both. After a careful evaluation, the MindWeal provider will recommend a treatment plan based on several factors: the type and severity of the symptoms, the child's treatment history, the urgency of the treatment, and how the child and family feel about therapy and medication. The goal is to find the best way to support the child's mental health and help them feel better.

Cognitive Behavioral Therapy (CBT) with Exposure and Response Prevention (ERP) is a proven treatment for OCD in kids and teens. This therapy helps children face their obsessions (intrusive thoughts) and learn to stop their compulsions (repetitive actions). It gradually exposes them to their fears in a controlled way, helping them manage without performing compulsive behaviors. By learning these skills, children can gain control over their OCD symptoms and improve their daily functioning. Therapy can be used alone or with medication, depending on what’s best for your child.

Therapy can greatly help with OCD, especially when the therapist is experienced and the individual attends regularly. However, it can be challenging. It requires regular sessions and a skilled therapist. Facing fears can be tough, and therapy might be less effective if OCD symptoms are very severe or if there are additional mental health issues. In such cases, combining therapy with medication might be best.

Yes, medications can be very effective for treating OCD in children and adolescents. Studies have found that kids who took medication for OCD did better than those who took a placebo (a sugar pill). Research also shows that kids who take medication often see their OCD improve faster than those who only go to therapy or do nothing. The best results usually come from combining medication with therapy.

The medications effective for treating OCD in kids and teens are:

1. Selective Serotonin Reuptake Inhibitors (SSRIs): These are usually the first choice. They include Sertraline (Zoloft), Fluoxetine (Prozac), Fluvoxamine (Luvox), and Escitalopram (Lexapro).
2. Clomipramine: This older antidepressant is used if SSRIs don't work.
3. Atypical Antipsychotics: These can be added to SSRIs or Clomipramine to improve their effects.
4. Antihistamines: Medications like Hydroxyzine and Diphenhydramine (Benadryl) help with anxiety and sleep problems related to OCD.

These medications have been shown to help manage OCD symptoms. Your child’s healthcare provider can help decide which medication is best suited for your child.

Choosing the right medication for your child's OCD is a careful process. We only recommend medications that have been shown to work in research studies. Our choices are guided by practice guidelines from national organizations like the American Academy of Child & Adolescent Psychiatrists and the American Academy of Pediatrics.

The treatment guidelines tell us an SSRI should be chosen as the first-line medication for treatment. If it doesn’t work, we try another SSRI. After two unsuccessful attempts, we may switch to Clomipramine. If these medications are partially effective, adding an atypical antipsychotic may give the primary medication the boost it needs.

Our providers look at your child's age, past medications and their effects, family history of medication responses, and the preferred form of medication (capsule, tablet, or liquid). By following these steps, we ensure your child gets the best possible care tailored to their needs.

To find the right dose for your child’s medication, we start with a low dose and gradually increase it. We continue this until we find the dose that effectively reduces symptoms without causing side effects. During treatment, you and your child will have regular check-ins with the clinician. These meetings allow us to see how well the medication is working and if there are any side effects. During these visits, the clinician will adjust the dose as needed to ensure your child gets the best results.

When your child starts taking medication for OCD, you might see some improvement in 2 to 4 weeks, with more progress over 8 to 12 weeks. Some children feel better quickly with a low dose, while others might need a higher dose. We start with the lowest dose to help children get used to the medication and reduce side effects. Each dose is given about a month to work. If it doesn’t help, we increase the dose. Finding the best dose can take 8 to 12 weeks. Full benefits are usually seen after 6 to 9 months of treatment. It's important to be patient and trust the process. With time and the right support, your child can start to feel better.

Yes, your child may experience some side effects from the medication at first. Common side effects from SSRIs include headaches, trouble sleeping, changes in appetite, stomach pain, and diarrhea. Most of these side effects are mild and get better over time. We start medications at a low dose to help minimize these side effects. It's normal to worry about side effects. Side effects are important to consider when deciding if a dose needs to be adjusted. Sometimes, it can be hard to tell if a symptom is a side effect of the medication or anxiety about taking the medication, like a stomachache.

The FDA has added a "boxed warning" to all antidepressant medications to alert doctors and patients about the need for special care when these medications are used in children, adolescents, and young adults. This warning states that antidepressants are linked to an increased risk of suicidal thoughts and behavior in a small number of children and teens, especially at the beginning of treatment.

Research shows a slight but notable increase in the risk of suicidal thoughts and behaviors among children and teens taking SSRIs. However, in research studies, this did not lead to actual suicide deaths. Studies also show that kids who are in therapy do not have this increased risk. While the current evidence does not definitively prove a clear link between antidepressants and these increased risks, the benefits of treating OCD generally outweigh the potential risks.

It is crucial to monitor your child closely if they are on an antidepressant. Pay careful attention to any changes in mood, behavior, thoughts, or feelings, especially when starting a new medication or adjusting the dose. Watch for any sudden changes, as these can indicate increased risks and may need immediate action. By closely observing and reporting these changes, you can help ensure your child's treatment is safe and effective

No, the medications prescribed by our providers are not habit-forming. Your child will not become physically or emotionally dependent on them. These medications help reduce OCD symptoms, but they are just one part of the treatment. When medication & psychotherapy/counseling are used together, they offer the maximum benefit.

Medications can help shape your child's personality over time in a positive way. They reduce OCD symptoms, which can lead to more positive feelings, thoughts, and behaviors. When your child feels less anxious & stressed, they can think more positively and start engaging in activities they might have previously avoided. Participating in positive activities helps boost their self-confidence, which in turn promotes even more positive behavior. This creates an upward cycle of improvement. These positive changes show that medication helps your child feel and function better without changing who they are.

You will know that the medication is working if you notice these improvements in your child: 

• Your child talks less about obsessive thoughts and doesn’t act on compulsions as much.
• They seem more relaxed and happy, enjoying life more.
• They can do things they couldn’t before, like going to school or public places.
• Their schoolwork, relationships, and activities improve.
• Their overall well-being and confidence are better. 

Approach conversations with empathy and patience. Ask open-ended questions to encourage sharing. Listen actively, showing that you understand and care. Avoid being critical or dismissive. Let your child know it’s okay to feel the way they do and that you are there to support them.

Discuss their concerns openly and involve them in treatment decisions, understanding their fears to help address them. Emphasize the benefits of medication in managing anxiety and improving quality of life. Use the DESC technique to communicate effectively and foster cooperation—click here for a guide on implementing this method. If necessary, consult their healthcare provider to explore alternative treatment options. 

Maintain regular communication with your child, their teachers, and school counselors to understand how OCD symptoms their school functioning. If OCD is impacting your child, discuss with their provider and counselor whether school accommodations would be helpful. If recommended, work closely with school staff to develop an individualized education plan (IEP) or 504 plan. Ensure the school provides the necessary accommodations. Being proactive helps create a supportive school environment.

Consult with a healthcare provider to determine if homeschooling is appropriate. In most cases, homeschooling can make OCD symptoms worse because avoiding OCD triggers can increase anxiety, stress and compulsive behaviors over time. However, in some situations, homeschooling can be a temporary solution. If your child's provider recommends this and you choose this route, work towards gradually reintroducing your child to a school environment. Collaborate with your child's therapist and school staff to create a transition plan for when your child is ready to return.