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OCD Awareness Week: What to Look For and How to Support Your Child

6 days ago
7 min read

Picture an 11-year-old I'll call Maya. She earns straight A's, listens in class, and has never once been sent to the office. Her teachers describe her as dreamy. Her parents describe her as an easy kid, if a little tired lately.


What no one sees is the first ten minutes after every bedtime. Maya lies still in the dark, silently counting to a number that feels safe, then replaying her day to make sure she didn't do anything wrong. Weeks ago, a thought crashed into her mind: what if I hurt my little brother? She would never. She loves him. But the thought felt so awful that she decided it must mean something terrible about her, and she has told no one. So she counts, reviews, and mentally takes the thought back, over and over, hoping to feel sure again.


The only clues are small. Homework takes longer than it used to. She asks, "Are you mad at me?" more than seems necessary. She falls apart over small things at home after holding it together all day. Her parents wonder if it's hormones or middle school stress. Her pediatrician wonders about attention. Nobody wonders about OCD, because nobody can see it.


Maya is a composite, not a real child, but families like hers walk into my office more often than you might think. And the quiet, well-behaved kids are the ones I worry about being missed.



This OCD Awareness Week, here is what I want every parent to know.

OCD is not about being neat, and it is not a quirk. It is a treatable anxiety-related condition that can take hours of a child's day, and it is far more common, and far easier to miss, than most parents realize. Below is what to look for, why so many kids go undiagnosed, and how to support a child who is struggling.


What OCD actually is

OCD has two parts that feed each other.

  • Obsessions are unwanted, intrusive thoughts, images, or urges that cause intense distress. They feel real, sticky, and impossible to dismiss.

  • Compulsions are the things a person does, physically or mentally, to make the distress stop or to prevent something bad from happening. The relief is brief, and the doubt comes back stronger.


That cycle is the disorder. The content of the obsessions varies widely: contamination, harm, symmetry, "just right" feelings, religious or moral worries (scrupulosity), relationships, sexuality, and fears of losing control. A child can have several themes at once, and themes often shift over time.


OCD is not a choice, not a parenting failure, and not the same as a preference for order. Many people with OCD know their fear is excessive and still cannot talk themselves out of it. That gap between knowing and feeling is what makes it so exhausting.


What to look for

The signs you can see are only part of the picture, and Maya's story is why. Watch for both.

Things you may notice

  • Excessive handwashing, long showers, or avoiding "contaminated" objects and places

  • Checking, such as locks, backpacks, homework, or the stove, again and again

  • Repeating actions until they feel "right," or needing things arranged or even

  • Frequent requests for reassurance ("Are you sure I'm not sick?" "Promise I didn't do anything bad?")

  • Homework that takes hours because of erasing, rewriting, or restarting

  • Rituals around bedtime, doorways, or certain numbers and words

  • Avoiding people, places, or activities with no clear reason


Things that are easier to miss

  • Sudden irritability, meltdowns, or tears at home after holding it together all day at school

  • Declining grades or slow work despite strong ability

  • Trouble falling asleep, or a bedtime routine that keeps growing

  • Stomachaches or headaches, especially before school

  • Confessing small "wrongs" repeatedly, or asking if they are a bad person

  • Withdrawing from friends or activities they used to enjoy


One or two of these does not mean OCD. What matters is the pattern: the behaviors take up significant time (often an hour or more a day), cause distress, and get in the way of school, friendships, sleep, or family life.


Why OCD goes unnoticed

OCD is often called the "hidden" disorder, and Maya shows why. Several things work together to keep it out of sight.


The obsessions happen inside the mind. A child cannot easily describe a thought like "what if I hurt someone?" because the thought itself feels shameful or frightening. Many kids assume the thoughts mean something terrible about them, so they say nothing. Intrusive thoughts about harm, sexuality, or morality are common features of OCD. They are not wishes, and they are not predictions. But a child who does not know that will hide them.


Many compulsions are mental, not physical. Not every compulsion is something you can watch. Mental compulsions can include:

  • Silently repeating words, phrases, or prayers

  • Counting or "cancelling" a bad thought with a good one

  • Mentally reviewing past events to check that nothing wrong happened

  • Mentally checking whether a feeling or thought is "real"

  • Arguing with a thought to reach certainty

To an outside observer, a child doing this simply looks quiet, distracted, or daydreaming. Teachers may read it as inattention, and it is easily mistaken for ADHD.


Kids hide, and they are good at it. Many children with OCD hold it together at school and fall apart at home. Others do their rituals privately, in the bathroom or at bedtime, or learn to disguise them. Shame and fear of being judged "crazy" keep many from telling anyone.


The stereotype gets in the way. When people picture OCD, they picture handwashing or color-coded closets. A child whose fears center on harm, religion, relationships, or identity, or whose rituals are all in their head, does not fit that picture, so families and clinicians may not consider it.


It overlaps with other conditions. OCD can look like generalized anxiety, ADHD, perfectionism, depression, or even oppositional behavior, and it frequently occurs alongside them. A child whose rituals are time-consuming and mental may be evaluated for the wrong thing, or only for one part of the picture. A thorough evaluation looks at the function of the behaviors, meaning what the child is trying to prevent or relieve, and not only how they appear.


The result is that families often wait years between the first symptoms and an accurate diagnosis. Earlier recognition matters because OCD tends to grow when it is fed, and treatment works best when it starts sooner.


Supporting your child after an OCD diagnosis

A diagnosis can bring relief and worry at the same time. Here is what helps most.


Start with the right treatment. The gold-standard treatment for childhood OCD is cognitive behavioral therapy with exposure and response prevention (ERP). In ERP, a child gradually faces feared situations or thoughts while practicing not doing the compulsion, at a pace they can handle, and learns that the anxiety rises and falls on its own. For some children, medication, usually an SSRI prescribed by a psychiatrist or pediatrician, is added, particularly when symptoms are moderate to severe. Ask any prospective therapist specifically about their training in ERP, since general talk therapy alone is not enough for OCD and can sometimes make reassurance-seeking worse.


Understand accommodation. When a child is in distress, parents naturally step in: answering the same question twenty times, buying new items, washing things again, rearranging routines, or reassuring. This is love, not a mistake. But it keeps the cycle going, because the child never learns they can tolerate the doubt. Reducing accommodation is one of the most powerful things a parent can do, and it works best gradually and with a clinician's guidance, not all at once.


Respond to reassurance requests with warmth, not answers. Instead of answering the question again, try something like:

  • "That sounds like OCD asking. I know it's hard, and I think you can handle not knowing."

  • "I love you, and I'm not going to answer that one. Let's do something together while the feeling passes."


Name it, and separate your child from it. Many families find it helps to talk about "the OCD" as something that bosses their child around, not as part of who they are. Kids often feel enormous relief hearing that intrusive thoughts are common features of the disorder and say nothing about their character.


Stay calm and consistent. Avoid yelling, punishing, or telling a child to "just stop." They would if they could. Praise effort and bravery, such as resisting a ritual or facing a fear, over outcomes.


Keep the rest of life going. Protect sleep, friendships, activities, and play. OCD tries to shrink a child's world, and a full life is part of the treatment.


Bring in school. Share the diagnosis, with your child's input, with the counselor or a trusted teacher. Accommodations such as extra time, reduced rewriting demands, or a private check-in plan can be put in place through a 504 plan or IEP when OCD is affecting learning.


Look after yourself too. Parenting a child with OCD is tiring. Parent support groups and your own therapist or coach can help you stay steady, and a steady parent is one of the best predictors of a child's progress.


When to seek an evaluation

Consider an evaluation if your child's thoughts or rituals take up an hour or more a day, cause real distress, or interfere with school, sleep, friendships, or family life. You do not need to wait for it to get worse. A comprehensive evaluation can clarify whether OCD is the right explanation, rule in or out overlapping concerns such as ADHD, anxiety, or autism, and point to the right treatment.


If you read Maya's story and recognized your own child, you are not overreacting. At Minds in Progress in St. Charles, we provide comprehensive evaluations, individual therapy for children and adolescents, and parent coaching. Reach out and we will help you figure out next steps.


Resources

Organizations and support

Books for families

  • What to Do When Your Brain Gets Stuck by Dawn Huebner (for children)

  • Freeing Your Child from Obsessive-Compulsive Disorder by Tamar Chansky (for parents)


If your child is in crisis

If your child is having thoughts of harming themselves, call or text 988 (Suicide & Crisis Lifeline) or go to the nearest emergency room. OCD is treatable, and kids with OCD can and do get better with the right help.


Maya's parents did nothing wrong, and neither did you. Your child is not broken, and you did not cause this. With early recognition, effective treatment, and a supportive home, children with OCD can build full lives that the disorder no longer runs.

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