OCD in children and young people

Many children have small habits and rituals. The Royal College of Psychiatrists says lots of children arrange their toys very precisely or avoid stepping on cracks in the pavement. This usually goes away as they grow older.

The full version of current NICE guidance (CG31) says some repetitive behaviours are a normal stage of development between the ages of 3 and 6. They tend to pass on their own and are rarely time-consuming or distressing.

OCD is different. An unwanted thought, image or urge keeps coming into your child’s mind and makes them anxious or uneasy. This is an obsession. They then feel they must do something to ease the feeling. This is a compulsion. The relief does not last, so the cycle starts again.

OCD can take up a lot of a young person’s time and energy. YoungMinds says it can affect sleep, school, relationships and hobbies.

Cancelling out frightening thoughts

Some children feel they have to repeat an action many times to ‘neutralise’ a frightening thought, such as a fear of causing harm to their family. NHS inform says this kind of compulsion is particularly common in children with OCD.

OCD-UK describes a related fear, sometimes called magical thinking. This is the worry that just thinking about something bad will make it more likely to happen.

OCD and autism

OCD and autism can sometimes look alike. YoungMinds says some autistic young people have routines or repetitive behaviours that look like OCD, and some have both conditions.

The NHS says almost everyone has unwanted thoughts at some point. These can include sudden violent or offensive images.

In OCD, these thoughts keep coming back and cause a lot of distress. They may be about harming someone, or be violent or sexual. This can be hard to hear as a parent.

YoungMinds says people with OCD are very unlikely to act on their thoughts. Current NICE guidance (CG31) says intrusive sexual, aggressive or death-related thoughts are common in OCD at any age. It says they are often wrongly seen as a sign of risk, and that professionals who are unsure should ask an OCD specialist.

People with OCD often feel ashamed of their thoughts and may find them very hard to talk about, even with family. Our guide to intrusive thoughts and OCD explains more.

If your child has self-harmed, or you think they are at immediate risk, call 999 or go to A&E. For other urgent help, see our urgent help page.

NICE’s full guideline says it is very common for children and teenagers with OCD to involve family members in their rituals.

When parents and carers change what they do to help a child avoid or reduce anxiety, this is called family accommodation. For example, you might:

• answer the same question over and over
• check things for them
• keep reassuring them that everything is fine
• help them avoid things that upset them
• buy large amounts of cleaning products

Accommodation often works like a compulsion. It eases distress in the short term, but it can keep OCD going in the long term. Mind says the more loved ones help with compulsions, the more the person may feel they need that help.

If you recognise this, you are not alone. Accommodating OCD is a normal response, and you are not to blame.

Becoming aware of how you accommodate your child’s OCD, and planning how to change it, is one way you can play a part in helping them overcome it.

The Royal College of Psychiatrists says family members may be able to help exposure treatment by reacting differently to compulsions. For example, they might:

• encourage your child to face the situations they fear
• say no to taking part in rituals or checking
• try not to reassure them that everything is all right

You do not have to do this alone. Current NICE guidance (CG31) says treatment plans should help families reduce their part in compulsions, avoidance and reassurance in a sensitive and supportive way. So it is best to plan these changes as part of your child’s treatment.

Reassurance can feel kind in the moment. But NHS inform says that in the long term it can make compulsions harder to overcome.

NHS inform says that when someone with OCD starts cutting down rituals and reassurance, their distress is likely to get worse at first, but this is temporary.

Current NICE guidance (CG31) covers children and young people aged 8 and over.

For milder OCD, NICE says guided self-help may be considered, along with support and information for the family.

For moderate to severe OCD, NICE recommends cognitive behavioural therapy (CBT) that includes exposure and response prevention (ERP). It recommends this for milder OCD too, if guided self-help has not worked or is not wanted. NICE says the therapy should involve the family or carers and be adapted to suit the child’s stage of development.

In ERP, a therapist helps your child face the things they fear and have been avoiding, starting with what feels easiest. The therapist then helps them stop responding with compulsions.

NICE says families should be actively involved in planning and carrying out treatment. Where it is appropriate and acceptable, parents may be asked to help their child with ERP. It may also help to involve teachers or an educational psychologist.

The NHS says children and young people’s mental health services may offer talking therapies such as CBT face to face, online, through an app or by phone. The Royal College of Psychiatrists says ERP with a professional can take place face to face, by phone or by video link.

OCD Action says some other therapies, such as play therapy or family therapy, are not recommended as treatments for OCD. But some family therapy alongside CBT with ERP may help if cutting down family involvement causes tension at home.

NICE is updating its OCD guidance, and the new version is due in 2027. Find out how OCD treatment works.

The NHS says medicine for OCD is usually a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI).

YoungMinds says young people under 18 are usually only offered medication if they feel unable to do CBT, or if CBT has not helped. It should only be offered if a doctor can monitor its effects.

Current NICE guidance says an SSRI should only be prescribed to a child or young person after a child and adolescent psychiatrist has assessed and diagnosed them. NICE also says that when an SSRI is prescribed, it should be given alongside CBT with ERP.

The NHS says there is a very small chance that SSRIs could cause suicidal thoughts or urges to self-harm. If this happens to your child, contact a GP or go to A&E.

Dr Craig Govan is a clinical psychologist, not a medical doctor, so he does not prescribe medicine. If you have questions about medication, talk to your child’s GP.

You do not need to be sure it is OCD before you ask for help. YoungMinds says getting help early can make it much easier to change things.

Through the NHS

• Your GP or school. A GP, teacher, school nurse or social worker can put your child in touch with local NHS children and young people’s mental health services. These are sometimes called CAMHS.
• Self-referral. Some services let young people refer themselves, and a parent or carer can also make the referral. Young people under 16 may need a parent or carer’s consent. If you are a young person and do not want your parents to know, you can tell your GP.
• Ask about OCD experience. You can ask if the service has someone with experience of treating OCD. YoungMinds says this may not be possible everywhere, but it is worth asking.

At school

Talk to your child’s school. OCD Action says that if teachers know about a young person’s OCD, they can make small changes. These can help them feel more comfortable at school and help them study.

Private therapy

YoungMinds says some families choose private therapy so their child does not have to wait for NHS treatment, or can get help while on a waiting list. It says it is important to choose a therapist with experience of supporting people with OCD.

Dr Govan works with children and adults, and you can book an Initial Consultation without a referral.

If you are worried about your child’s safety

If your child has self-harmed, tried to end their life, or you think they are at immediate risk, call 999 or go to A&E. For urgent help that is not life-threatening, see our urgent help page.

Support for you

YoungMinds runs a Parents Helpline on 0808 802 5544 for advice about your child’s mental health. It is open on weekdays from 9.30am to 4pm, and until 6pm on Tuesdays and Wednesdays.