OCD often first develops around ages six to nine years, but can manifest as early as five. Young children experience the disorder differently than adolescents and adults. A young child may not recognize that their thoughts and fears are exaggerated or unrealistic, and may not be fully aware of why they feel the urge to perform a ritual.  The “just right” feeling the rituals provide are satisfying in the moment, although not long lasting. Over time, in the 9-12 years range, it often evolves into magical thinking and becomes more superstitious in nature.

A child with OCD will respond to their anxiety in a way that is very rigid and rule-bound and interferes with normal functioning. Parents might notice signs such as:

• Repeated hand washing, locking and relocking doors or touching things in a certain order
• Extreme or exaggerated fears of contamination, family members being hurt or harmed or doing harm themselves
• Use of magical thinking, such as, “If I touch everything in the room, dad won’t be killed in a car accident”  
• Repeatedly seeking assurances about the future
• Intolerance for certain words or sounds
• Repeatedly confessing “bad thoughts” such as thoughts that are mean (thinking a friend is ugly), thoughts that are sexual (imagining a classmate naked) or violent (thinking about killing someone)

How OCD can go undetected

Signs of OCD might not always be obvious. Compulsions can be very subtle, so parents and other caregivers might not notice when a child is doing them, or they might not understand that a particular behavior is a compulsion. Other signs might be invisible to parents, like when a child compulsively counts to a certain number in her head.

As children get older and realize that some of their fears are nonsensical, or their behaviors unusual, they might make greater efforts to hide their OCD symptoms from parents, teachers and friends.  Children with OCD can sometimes suppress their symptoms in certain situations, like at school, only to explode at home because of the tremendous effort.

OCD can also be mistaken for a different disorder. Many children with OCD are distracted by their obsessions and compulsions, and it can interfere with their ability to pay attention in school.  A teacher might notice a child having difficulty focusing and assume the child has ADHD.  It could also be mistaken for another anxiety disorder or be overlooked when a child with OCD also develops depression, which kids with OCD are at risk for, especially without treatment.

This publication was adapted from the Child Mind Institute (https://childmind.org/guide/parents-guide-to-ocd/) 

Reviewed by:  HB M.D., PL M.D.  | 04/2024