Decoding OCD and Anxiety in Kids: How to Spot the Signs

Have you ever wondered if your child’s behaviors were typical fears and stresses for their age? Or noticed that they seemed more anxious than other children in their peer group? If you have, you’re not alone. Research indicates that rates of anxiety have increased among children ages 3-17 over the last five years and as of 2020, 5.6 million kids had been diagnosed with anxiety disorders.

But while anxiety disorders have quickly risen to become one of the most commonly diagnosed mental health conditions in children, obsessive-compulsive disorder (OCD), which can present with symptoms resembling those of an anxiety disorder, remains frequently overlooked or misdiagnosed. Given that both conditions can have a significant impact on the trajectory of a child’s life, it’s important for caregivers to look out for their symptoms—and, if symptoms are identified, take steps to find treatment and support.

OCD in kids: What signs should caregivers look for?

OCD can also show up in children of all ages. In younger children, caregivers might be more likely to notice outward behaviors, or compulsions, than the behaviors that happen inside a child’s mind, or obsessions. Children with OCD may be unsure why they feel the urge to perform certain behaviors, or may be unable to explain their reasoning to their caregiver. You may notice that the child believes their behaviors can help prevent something “bad” from happening, regardless of how unlikely or unrelated that feared outcome may be.

Behaviors that suggest a child could have OCD include:

• Intense fears or worries: A child’s fears may include harm coming to themselves, family members, or friends; getting sick or becoming contaminated; or doing something that they consider to be “bad,” to name a few examples. These concerns, also known as intrusive thoughts, are often highly stressful for a child. They likely don’t want to think about them, but feel they can’t stop.
• Repetitive behaviors: This could look like saying a certain word or phrase a specific number of times, checking to make sure a door is locked, praying multiple times, or frequently washing their hands.
• Rigid routines: A child with OCD may be very particular about how they complete certain tasks or the routines they follow during certain parts of their day, like the morning or bedtime, and may become upset if these rituals are deviated from in any way.
• A preoccupation with symmetry or organization: Parents or caregivers may observe a child touching body parts in a certain way to achieve symmetry. This behavior may also be seen in a child spending a great deal of time focusing on the appearance of their homework or the arrangement of their food, toys, or other objects.
• Avoidance: Children with OCD may also avoid situations in which they think something “bad” might occur.
• Magical thinking: You may also notice a child having superstitious beliefs that bad things will happen if they don’t perform seemingly unrelated behaviors, like avoiding cracks in the sidewalk.
• Reassurance-seeking: Another thing that I tell parents to look for is if their child begins asking for reassurance excessively. This could be from their parents, teacher, or others.
• Confessing things they’ve thought or done: This may also be a red flag, especially if a child’s confessions involve things that other children may not feel the need to tell.

Examples of childhood OCD

Like anxiety, symptoms of OCD in children will also vary widely. However, with OCD, there’s the added issue of the disorder’s widespread misrepresentation as only focusing on cleanliness or organization to contend with. As you evaluate your child’s behavior, how much it might be impairing them, and how much of their time it consumes, the diverse presentations of OCD are crucial to keep in mind.

To illustrate some of OCD’s diversity, here are two examples of how it might present in a child:

• 10-year-old Harper has been struggling with checking things. Each night, after her parents are asleep, she spends countless hours walking through every room in the house to ensure nothing was left on. Harper is consumed with worries that someone may have left something running and that this could cause a house fire. Her parents are unaware of these concerns, as Harper hides her behaviors out of the concern that her parents will think she is “crazy.” Lately, in an attempt to calm her worries, she has also been repeating the phrase “we are all safe, no one will die” in her head throughout the day. She often loses track of important things that she needs to remember because she is constantly saying these words over and over to herself, but she worries that a fire will happen if she stops.
• Nova recently began telling her parents every thought she has that she thinks may be “bad.” Her parents keep telling her that it is okay and she doesn’t need to confess her thoughts, but Nova insists that she wants to tell them. Initially, they thought it was just a stage, but in recent weeks, the behavior has gotten more intense. Now, Nova also says certain things out loud after everything she says. If her parents ask her what she wants to do, she will follow up her answer with “I don’t know” or “Maybe.” If they ask what her favorite color is, she will say, “Green, I guess.” Her parents are becoming increasingly frustrated and confused by this behavior.

Anxiety in kids: What signs should caregivers look for?

Anxiety may look very different in younger children than it does in older children or adults. In their younger years, children may lack the vocabulary to recognize how they’re feeling or why they’re feeling that way, making it important for their parents and caregivers to look out for signs that they might be struggling.

Some common symptoms of anxiety that you may notice in a child are:

• Physical symptoms: Children may show early signs of anxiety through complaints of having a stomach ache or headache, as well as feeling ill, shaky, or dizzy. Some anxious children may also experience bedwetting.
• Attention issues: Is your child finding it hard to concentrate? Do they seem easily distracted? When a child is worried, it can become difficult for them to focus.
• Difficulty making decisions: Anxiety and stress can also make a child become paralyzed by having to make a choice, even when it comes to seemingly trivial things. You may notice this in your child as concerns about making the “wrong” decision, or a lack of confidence in their ability to make their own choices.
• Sleep problems: Another sign that anxiety may be lurking is related to sleep. Is your child sleeping too much? Do they complain that they feel tired a lot? Or, on the flip side, are they not sleeping enough? If your child seems restless or hyperactive, this can also be an indication of anxiety.
• Anger, irritability, or temper tantrums: Distress and worry may take on the form of irritability and frustration, particularly in a younger child. If your child seems to take things very personally or is highly sensitive to any correction, it may actually be attributable to high levels of anxiety. 
• Social withdrawal: Anxiety may also be the culprit if children are refusing to go to school, avoiding things that they once enjoyed, not wanting to talk in front of others, or avoiding places where there may be a lot of people. You may notice a child not having many friends or choosing not to participate when children invite them to events.
• Clinginess: You may also notice a child, often a younger one, not wanting to be away from home or a particular caregiver.
• Intense, specific fears: Children may experience narrowly focused fears of one particular item or situation, such as spiders or going to the dentist.

For older adolescents, the signs and symptoms of anxiety will often be similar, though more age-appropriate fears may be experienced. At this older age, a child’s fears will often be magnified. They may not share their feelings as readily as a younger child, or may attempt to hide them from family members, which can cause them to appear withdrawn and argumentative.

Examples of childhood anxiety

It’s important to note that symptoms of anxiety will vary between children, and some of the symptoms previously listed can occasionally be chalked up to a child’s age or developmental stage. However, if you notice these symptoms are persistent, seem to be worsening or not improving, or are affecting your child’s quality of life, it may be time to seek the help of a professional.

To clarify how a parent or caregiver might be able to make this distinction, here are two examples of how you might see symptoms of anxiety in a child:

• Olivia just turned 6 years old and is in 1st grade. Shortly after starting school, she started being “extra” clingy to her mom during morning drop-off. Olivia would tell her mom that she was sick and didn’t want to go. It became so difficult for her mom to leave that she would have to ask a teacher to help take Olivia off her leg so she could exit. Her mom felt terrible about this, and came to dread taking Olivia to school for fear that she would have a meltdown. As she went back to her car each morning, she would end up in tears, feeling an overwhelming sense of guilt.
• Liam is 9 and experiences constant stomach aches. They’ve been going on for years. His parents have gotten doctors to conduct almost every test available, but the results always indicate Liam is physically healthy. Still, they’re concerned. Liam also seems more tired than most children his age and they’ve recently noticed that when they ask him direct questions, he is often unable to make up his mind. Just last weekend, they asked him if he wanted to go to his friend’s birthday party and he went back and forth for over an hour about whether or not he should go before finally deciding not to. Later that night, Liam said he wished he had gone to the party, but worried that something bad might happen if he wasn’t home.

The link between OCD and anxiety disorders

Because it’s common for OCD to co-occur with anxiety disorders, it’s possible for a child to experience symptoms of both conditions—however, one does not require the other. Regardless of whether your child is experiencing OCD, an anxiety disorder, or both, these conditions can cause excessive, persistent distress, which can make it difficult for a child to function in school, their relationships, and their daily life.

Getting the right treatment for OCD and anxiety

Early recognition can make a huge impact for both anxiety disorders and OCD. Getting a child the appropriate treatment sooner rather than later can improve not only their mood, but also their ability to handle stress in the future.

If you think your child might have OCD, it’s crucial to have their symptoms assessed by someone who specializes in OCD. An OCD specialist will have the expertise to determine which behaviors are stemming from OCD and training in the most effective treatment for OCD, Exposure and Response Prevention (ERP) therapy. Traditional talk therapy uses skills that may be helpful for many areas of mental health, but it is not the right treatment for OCD.

If you think your child might be struggling with a co-occurring anxiety disorder alongside OCD, ERP may also be beneficial for their anxiety symptoms. With the help of a qualified specialist, anxiety can be treated either at the same time as OCD, or before/after treatment for OCD, depending on each child’s unique needs.

NOCD Therapists are cross-trained in evidence-based treatments for these conditions, allowing us to provide effective, convenient, and affordable care for both OCD and anxiety disorders. Our therapists also receive specific training in treating OCD in children and adolescents. We work side-by-side with the OCD experts and researchers who designed some of the world’s top OCD treatment programs, ensuring the best care for our members.

Remember that your child is not their OCD or anxiety, and getting better is possible. You can book a free 15-minute call with our team to learn more about your child getting matched with one of our therapists and starting treatment for OCD and a co-occurring anxiety disorder. If you’d like to learn more about OCD and how to best help your child, you can also ask about our family support sessions designed for parents, caregivers, and loved ones, which can help you learn ways to support your child as they work to manage their symptoms.