What Does OCD Look Like in Kids?

OCD (obsessive-compulsive disorder) is an anxiety disorder that kids can develop as early as 6 to 9 years old. 

Children who have OCD have upsetting fears or thoughts that they are overwhelmed by, and they feel driven to repeat certain actions or rituals to make them stop. Unwanted thoughts are called obsessions, and the rituals they perform are called compulsions.

For instance, a child might be plagued by worries that things around them are dirty and will make them sick, so they feel driven to wash their hands repeatedly, sometimes until their skin is raw and bleeding.

Or a child may be tortured by worries that a parent will be hurt in a car accident and feel driven to touch something a certain number of times to prevent that from happening.

Rituals make the anxiety go away temporarily, but it comes back. OCD usually gets worse until a child is performing so many rituals it makes it very difficult for them to function. Children sometimes hide their symptoms while they are in school and then explode when they get home, from the stress of suppressing them all day.

Some of the most common things kids with OCD worry about are:

• Contamination: Kids with this obsession are sometimes called “germophobes.” These are the kids who worry about other people sneezing and coughing, touching things that might be dirty, checking expiration dates or getting sick.

• Magical thinking: This is a kind of superstition, like “step on a crack, break your mother’s back.” For example, kids might worry that their thoughts can cause someone to get hurt or get sick. A child might think, “Unless my things are lined up in a certain way, mom will get in a car accident.”

• Scrupulosity: This is when kids have obsessive worries about offending God or breaking religious rules.

• Aggression: Kids may be plagued by a lot of different kinds of thoughts about bad things they could do. “What if I hurt someone? What if I stab someone? What if I kill someone?”

• Catastrophizing: Some kids easily jump to the conclusion that something terrible has happened. For example, if her parents are five minutes late to picking her up, a girl who is catastrophizing might tell herself that they’ve decided to abandon her.

• The “just right” feeling: Some kids feel they need to keep doing something until they get the “right feeling,” though they may not know why it feels right. So, they might think: “I’ll line these things up until it just kind of feels right, and then I’ll stop.” And then over time—in the 9-12 range—it evolves into magical thinking and becomes more superstitious in nature.

Compulsions can be things that kids actively do — like line up objects or wash hands — or things done mentally, like counting in their head. A compulsion could also be an avoidance of something, like a child who avoids touching knives, even flimsy plastic ones, because she’s afraid of hurting someone.

Kinds of OCD compulsions include:

• Cleaning: Excessive or ritualized washing and cleaning
• Checking: This includes checking locks, checking to make sure a mistake wasn’t made and checking to make sure things are safe
• Repeating: Rereading, rewriting and repeating actions like going in and out of a doorway
• Counting:  Counting can include objects, numbers and words
• Arranging: Ordering things so that they are symmetrical, even or lined up in a specific pattern
• Saving: This includes hoarding and difficulty throwing things away
• Superstitious behaviors: This includes touching things to prevent something bad from happening or avoiding certain things

• Reassurance-seeking. This takes the form of repetitive questions. “Are you sure this won’t make me sick? Are you sure this is safe? Are you sure no one can break in?” Over and over and over again.

Here are the kinds of behaviors teachers might see in kids with OCD: 

• Frequent requests to go to the bathroom: This could be to wash hands, if someone near the child was coughing or sneezing, or if they touched something that they perceive as contaminated. They could also be washing items—pens, pencils, backpacks, books.
• Constant reassurance-seeking: This takes the form of repetitive questions. “Are you sure that’s the answer? Could you tell me again?”

• Getting stuck on tasks: Sometimes kids with OCD need to finish something before they’re able to move on. So if a child is working out what they did wrong on a math test, and the teacher says, “Now let’s open the textbook and start a new chapter,” they’re not going to be able to shift gears.

• Retracing: If a child leaves the classroom and worries that they left a pencil behind, they’ll go back into the classroom and go to their desk and check. If they had a bad thought as they went through the doorway, they might have to “fix it” by going back through the doorway again saying a good word.

• Obsessive erasing: A child could be erasing a lot because the letters have to look perfect. Or they could have used a word that disturbs them. For example, if they have a fear of vomiting and they’ve written the word vomit, they might not be able to stand seeing that word, so they erase it. Kids start having erasers worn down to the metal. Teachers start to see holes in the paper.

• Distraction: If a child is busy thinking that if they don’t turn the pen cap and count to four the right way then their mom is going to get sick, they’re not going to be paying attention in class.

• Slowness on exams and papers and tasks: Sometimes when kids take a long time they’re struggling with the perfectionism of needing to do things the right way. This could look like learning problems, or inattention, but it isn’t.

• Avoidance: Teachers might see a child who doesn’t want to sit on the floor, or pick things up that touched the floor, or get their hands dirty in art class. Kids with germ fears may avoid a lot of playground activities—it’s gross.

• Tapping and touching symmetrically: If a child sits down at their desk and they accidentally kicks the chair of the kid next to them with her right foot, they’re going to have to then kick it with their left foot. That might look like somebody who’s being oppositional, or somebody who’s got too much energy, but actually it’s OCD.