Obsessive-Compulsive Disorder

OCD is a common problem. It often goes undiagnosed. Many children do not talk about their worries. It can take time for parents or caregivers to see that compulsive behaviors are becoming distressing and time consuming.

It is estimated that over 6 million people in the United States have OCD.

• Boys are somewhat more likely to have OCD than girls, especially at younger ages.
• Many children have symptoms that seem to come and go.
• Other kids have symptoms that keep getting worse and get in the way of their daily life activities.
• For children who come to treatment with behavior problems, the underlying cause may be OCD.

Doctors have not yet found the exact causes of OCD. Research suggests that these factors play a part in developing OCD:

• Genetics. Children with OCD are more likely to have some relatives with OCD or other anxiety disorders.
• The chemical messenger serotonin. OCD responds positively to medicines that affect the level of serotonin in the brain.

Some examples of obsessions include excessive worries about:

• Contamination (dirt, germs, getting sick)
• Perfectionism (school work, clothing, appearance, art work)
• Safety (natural disasters, dying, bad things happening to someone)
• Rule breaking (excessive tattling, becoming upset if a rule is broken, rigid thinking or feelings that things have to be moral or “just right”)
• Disturbing thoughts or images (getting stuck on thoughts about things like scary movies, television, hurting others, disturbing sexual images)

Examples of compulsions or rituals include:

• Excessive washing, cleaning, straightening, ordering, arranging
• Repeating actions until they feel “just right” or are done a specific number of times
• Symmetry (doing things an even number of times or balancing things)
• Asking the same question over and over again, especially about time and safety
• Having to be reassured frequently
• Confessing or apologizing excessively
• Superstitions (having lucky words or numbers)
• Checking, touching, tapping, counting
• Collecting or storing a lot of items (hoarding)

Most children have routines at mealtime, bedtime or when saying goodbye. These routines usually decrease as children get older. For children with OCD, these behaviors continue. The routines may become intense, frequent, upsetting, time consuming or get in the way of your child’s daily life activities.

OCD in children and teens that is untreated can lead to:

• Trouble focusing on school work or doing homework
• Trouble doing regular chores or daily tasks (such as getting dressed, getting ready for bed, being on time to school)
• Social problems (excessive shyness or unwillingness to try new activities, avoiding things that seem difficult)
• School refusal (stomachaches or worries before school)
• Risk for depression (including low mood and self-esteem)
• Family problems and stress
• Problems with eating (avoiding food for fear of gagging or gaining weight)
• Feeling upset about their body image

To get a complete picture, we talk with you, other primary caregivers and your child about their symptoms, challenges, strengths and goals. We consider your child’s medical, school and treatment history. Usually, an evaluation takes 3 visits.

After our evaluation is complete, we meet with you to share our understanding of your child. This feedback session brings together your expertise in your child and our expertise in treating children and teens with anxiety disorders.

We recommend evidence-based treatment options. These might include referrals for care at Seattle Children’s or services in the community.

We offer a stepped-care approach to treatment. This approach involves starting with the least intensive intervention and moving up to more intensive options depending on how others have worked for you. This strategy allows us to provide more equitable care to more families. These steps of care involve:

• Parent and youth CBT groups at Seattle Children’s to teach coping skills. This is the first step.
• Short-term individual therapy involving both the child and their parent or caregiver, when we have openings.
• OCD Intensive Outpatient Program for severe OCD that has not responded to group or individual therapy.
• Medicine for your child’s condition or adjusting your child’s current medicine as needed.
• Referrals to community resources.
• Read more about Stepped Care in Outpatient Psychiatry (PDF).

• Children don’t react to illness, injury, pain and medicine in the same way as adults. They need – and deserve – care designed just for them. They need a healthcare team specially trained to understand and meet their needs.
• Our doctors have special training in how to diagnose and treat children. They are focused on how today’s treatment will affect your child as they develop and become an adult.
• Our experts base their treatment plans on their experience and up-to-date research on what works best – and most safely – for children and teens.

• During visits, we take time to explain your child’s condition and treatment options. We support you in making the choices that are right for your family.
• Learning that your child has OCD can be stressful for the whole family. We connect you to community resources.
• Seattle Children’s can help with your family’s needs related to financial counseling, schooling, housing and transportation. We also provide interpreter and spiritual care services. Read about our services for patients and families.

We use evidence-based treatment called cognitive behavior therapy (CBT) for OCD. For kids and teens with OCD, we focus on exposure and response prevention (E/RP). This involves teaching your child to face their fears (for example, germs) in a repeated fashion and avoid doing compulsions (for example, washing hands). Over time, their fears and anxiety decrease.

Exposure therapy has proven to be the most successful treatment for anxiety disorders, including OCD. It is even more effective when combined with time-limited use of medicine.

Many children with OCD need CBT for 2 to 6 months. Usually they take medicine for 12 to 15 months.

We offer E/RP:

• Through anxiety/OCD group therapy
• In individual (child and caregiver) therapy sessions, when our providers have openings
• As part of our Intensive Outpatient Therapy for OCD Program 

Children and parents dealing with OCD can benefit from taking part in our anxiety/OCD group treatment. This is the first step in our phased approach to treating OCD. 

In these CBT groups, we teach about anxiety and practice skills to face and overcome fears. Groups for parents are offered at the same time as the groups for children and teens.

Learn more about the anxiety therapy groups we offer.

After completing anxiety/OCD group therapy, many families want or need further support to use on an individual basis. We can help you continue to coach your child on skills to use, specifically exposure activities, when they are having obsessive thoughts and doing compulsive symptoms.

We offer this treatment after group therapy, when our providers have openings.

Kids or teens with moderate-to-severe OCD who have not improved significantly with 10 weeks of outpatient treatment (weekly group or individual therapy) may be referred to our OCD Intensive Outpatient Program. It offers therapy 3 hours per day, 3 to 4 times a week. Kids 11 to 18 years old get exposure practice in the clinic. We also train parents to do exposure exercises at home with your child.

Learn more about our Obsessive-Compulsive Disorder Intensive Outpatient Program.

Children with moderate-to-severe OCD may be referred for medicine evaluation. Selective serotonin reuptake inhibitors (SSRIs) are often used to treat OCD in children and teens. Serotonin is a chemical messenger in the brain.

Research has found that kids and teens have significantly better outcomes if they take SSRIs along with receiving CBT for OCD. Other medicines can also be helpful, especially in severe cases that have not responded to standard treatments.