Understanding OCD in Children and Teens: How Symptoms Change with Age

Obsessive-compulsive disorder (OCD) can affect individuals of all ages, but its presentation often shifts as children grow into teenagers. While younger children may struggle to articulate their thoughts and feelings, teens often attempt to hide their symptoms due to embarrassment or shame. Recognizing these age-specific signs can help parents and caregivers provide the right support and seek effective treatment.

OCD in Young Children: When Quirky Behaviours Become More

OCD in young children can be tricky to identify. Kids often struggle to express their thoughts clearly, making it difficult to recognize when their behaviors are rooted in anxiety rather than typical childhood routines. Parents may notice certain patterns, but the child may not be able to explain why they feel compelled to act a certain way.

Common Signs of OCD in Young Children

• Repetitive Routines & Rituals: Children may insist on performing actions in a specific order, such as turning off lights a certain way, touching objects repeatedly, or needing to step in and out of a room multiple times.
• Excessive Checking & Reassurance Seeking: Kids may repeatedly ask parents questions like, “Are you sure you locked the door?” or “What if I get sick?” They may seek comfort constantly, even after receiving reassurance.
• “Bad” Thoughts and Fears: A common concern in young children with OCD is intrusive thoughts related to harm coming to loved ones. For example, a child may repeatedly worry, “What if my mom dies?” and perform rituals to prevent it from happening.
• Meltdowns When Routines Are Disrupted: If an expected routine changes—such as not sitting in a preferred chair or missing a step in a bedtime ritual—children with OCD may become distressed, overwhelmed, or inconsolable.
• Relationship-Based OCD: Even young children can struggle with obsessive worries about relationships. They may fear, “What if my mom doesn’t love me?” or “What if my friends don’t like me?” leading to excessive questioning and overanalyzing interactions.

How Parents Can Help

• Observe Patterns: Pay attention to repetitive behaviors and distress linked to specific routines or fears.
• Use the Same Language: In OCD treatment, therapists often teach parents to use the same phrases as their child to reinforce therapy strategies. Consistency helps children feel understood and supported.
• Limit Reassurance: Instead of repeatedly confirming that “everything is okay,” parents can encourage their child to tolerate uncertainty, which is a key aspect of OCD treatment.

OCD in Teens: When Anxiety Becomes Overwhelming

As children grow into teenagers, OCD symptoms often become more complex and difficult to detect. Adolescents may recognize that their thoughts are irrational, but they feel powerless to stop them. Many teens try to hide their OCD symptoms due to feelings of shame, fear of being judged, or a desire to fit in with peers.

Common Signs of OCD in Teens

• Intrusive Thoughts and Sexual Obsessions: While all teenagers experience some degree of worry about sexuality, teens with OCD may develop distressing and unwanted thoughts about inappropriate or taboo subjects. These thoughts can cause extreme guilt and anxiety.
• Harm-Related Obsessions: Some teens develop intense fears that they might accidentally harm someone else or themselves, even though they have no actual desire to do so. This can lead to excessive checking behaviors—ensuring they haven’t run someone over, harmed a sibling, or left a dangerous object out.
• Checking, Counting, and Rituals: Similar to younger children, teens may engage in rituals to “neutralize” their obsessive thoughts. This might involve counting steps, tapping objects, or performing specific movements to prevent bad things from happening.
• Reassurance Seeking: Teens may repeatedly ask parents, teachers, or friends questions like, “Are you sure I didn’t offend anyone?” or “Do you think I’m a bad person?” This behavior can disrupt relationships and create a cycle of dependency.
• Academic Perfectionism & Feeling Stuck: Many teens with OCD struggle with schoolwork because they feel the need to reread, rewrite, or overanalyze assignments to ensure they are “perfect.” This can lead to procrastination, frustration, and feeling overwhelmed.

Why Teens Hide OCD Symptoms

• Shame and Embarrassment: Teens may recognize that their thoughts and behaviors are irrational but fear being judged by peers or adults.
• Fear of Losing Control: Many worry that talking about their intrusive thoughts—especially those related to harm or sexuality—will result in punishment or being labeled as “dangerous.”
• Desire for Independence: Adolescents may resist parental involvement in their mental health, even when they need help. They may downplay their struggles to avoid drawing attention to themselves.

How Parents Can Support Their Teen with OCD

• Create a Safe Space for Conversations: Let your teen know they can talk to you without fear of judgment. Normalize discussing mental health and OCD symptoms.
• Encourage Professional Help: Therapy, especially Exposure and Response Prevention (ERP), can help teens develop strategies to manage their symptoms.
• Recognize Avoidance Behaviors: If your teen avoids certain topics, activities, or people due to anxiety, this could be a sign that OCD is interfering with their life.
• Gently Set Boundaries Around Reassurance: Instead of providing excessive reassurance, help your teen learn to tolerate uncertainty by using phrases like, “I know this is hard, but I believe you can sit with this feeling.”

OCD is Treatable: Help Is Available

Whether your child is just beginning to show symptoms or your teen is struggling in silence, OCD is a treatable condition. With the right support, children and adolescents can learn to manage their symptoms and reclaim their lives.

At Acorn Counselling, we have therapists on our team that specialize in helping children and families navigate OCD treatment. If you’re concerned about your child’s symptoms, we’re here to help. Reach out to learn more about evidence-based approaches like ERP and how we can support your family on this journey.

Early intervention and understanding can make all the difference. Let’s work together to empower your child and help them break free from OCD.