At our service, we often meet families who are concerned about their child’s anxiety, fears, or behaviours. As a parent, it can feel overwhelming trying to understand what’s going on – especially when your child seems closed off, nervous, or embarrassed. You just want to say the right thing and make sure they’re getting the support they need. 

Challenges related to anxiety or neurodevelopmental conditions, such as Attention Deficit Hyperactivity Disorder (ADHD) or Autism Spectrum Disorder (ASD), are often more familiar to parents, teachers, and GPs. 

For some children though, they may be experiencing symptoms of Obsessive-Compulsive Disorder (OCD), which is a disorder that is often misunderstood or misdiagnosed. Understanding what makes childhood OCD different is an important first step in helping your child feel safe and supported.  

It can feel tricky, and it’s completely normal to feel unsure. The important thing is that you’re noticing the signs and seeking help – you’re already doing a great job. 

So, What Is OCD in Children and How Can We Recognise It? 

OCD can start at any time from preschool to adulthood, but it most commonly first appears between ages 8–12. 

OCD in children is characterised by two main features: Obsessions and Compulsions. 

• Obsessions are unwanted, intrusive thoughts, images, or fears that cause significant distress. 

• Compulsions are repetitive behaviours or mental rituals that a child feels they must perform to reduce that distress or prevent something bad from happening. 

These behaviours are not just habits or routines- they are driven by anxiety and a powerful urge to feel safe or in control. Children may appear scared, nervous, withdrawn, guilty, or embarrassed, which can make OCD difficult to spot.  

Sometimes, symptoms show up in subtle or “cryptic” ways, such as physical complaints like a sore stomach when faced with a triggering situation. They may also say things like “I can’t tell you,” reflecting shame or fear about sharing intrusive thoughts. Recognising these signs early can make a big difference in getting timely support. 

Common Types of OCD in Children- with Examples 

• Contamination: Fear of germs or illness leads to excessive cleaning or avoidance, such as a washing their hands repeatedly or wipes down items. 
• Checking Behaviours: Repeatedly checking things are safe or “just right”, such as rituals before bed, or checking that the door is locked multiple times. 
• Harm or Sexual-Related Themes: Upsetting or unwanted thoughts that cause guilt or distress, such as thoughts of “what if I hurt someone?” with the child silently repeating phrases to “cancel” the thought. 
• Symmetry / “Just Right” Themes: Strong need for order, balance, or perfection, such as their books, toys, or clothes being positioned in a certain way; high anxiety occurs if things are moved. 
• Perfectionism: Driven by fear of mistakes or doing something imperfectly, such as a child rewriting homework pages repeatedly until every letter looks right. 
• Superstitious or Magical Thinking OCD: Belief that certain actions prevent bad events, such as “If I tap my pencil three times, nothing bad will happen to Mum.” 
• Moral or Religious Themes (Scrupulosity): Excessive fear of being “bad” or breaking rules, such as repeatedly apologising for tiny mistakes or praying until it feels exactly right. 
• Reassurance-Seeking: Needing constant confirmation to ease worry or guilt, such as asking parents over and over, “Are you sure you’re not mad at me?” or “Are you sure I’m going to be okay?” 

How OCD Differs from Anxiety, Mood, and Neurodevelopmental Disorders  

Because OCD can involve worry, checking, or repetitive behaviours, it is often confused with other conditions. Understanding the differences-and looking at real-life examples, it helps families and clinicians identify the right support. 

OCD vs Anxiety 

Anxiety: Thoughts focus on worry or rumination about real-world problems or uncertainties, such as “I’m worried I won’t finish my homework on time,” “What if I don’t make the soccer team?” or “My friend might be upset with me.” 

OCD: Thoughts are intrusive, distressing, and often irrational, leading children to perform rituals to reduce anxiety, such as repeatedly washes their hands or checks locks because they fear something terrible might happen.  

OCD vs ADHD 

ADHD: Attention difficulties are often due to distractibility or challenges sustaining focus, such as leaving homework unfinished because they get distracted by noise or another activity. 

OCD: Attention difficulties arise when focus becomes consumed by intrusive thoughts or repetitive rituals, such as taking an hour to complete homework because they keep rewriting answers or repeatedly checking tasks to ensure “everything is right.” 

OCD vs ASD 

ASD: Repetitive behaviours are often comforting, enjoyable, or connected to a person’s interests, such as arranging their toy cars in a pattern because it feels calming or enjoyable. 

OCD: Repetitive behaviours are performed to reduce anxiety or prevent a feared outcome, such as arranging their toy cars in precise order and becomes distressed if anyone moves them due to fearing something bad may happen.  

These examples help families and clinicians see how the motivation behind the behaviour differs, which is crucial for accurate assessment and treatment. 

Co-Occurring Conditions 

It’s also important to know that many children experience more than one condition at the same time. OCD often overlaps with anxiety, depression, ADHD, or ASD – research suggests that 30–50% of children with OCD also meet criteria for another mental health or neurodevelopmental condition. 

Because of this overlap, a thorough assessment is essential to make sure your child gets the right support. Understanding the full picture helps clinicians develop individualised treatment plans that address all of your child’s needs, not just one set of symptoms. 

Why Early Recognition Matters 

Children with OCD often hide fears and rituals, worried others will think they’re “strange” or “bad.” Parents might notice excessive checking, reassurance-seeking, or long routines around bedtime, hygiene, or homework- but may not realise these are signs of OCD-related distress. 

Reassurance can sometimes unintentionally reinforce compulsions. That’s why working with a psychologist trained in Exposure and Response Prevention (ERP) is so important. 

With early support, OCD can be effectively managed. ERP gradually helps children face fears while resisting compulsions, teaching them that anxiety naturally decreases over time. In some cases, medication may also complement therapy. 

How You Can Support a Child with OCD 

• Listen with empathy: Validate your child’s experiences. “It sounds like that thought really worries you- thank you for telling me.” 
• Be open with examples: Sharing lists of common OCD behaviours can help children recognise their experiences. 
• Avoid enabling rituals: Reassurance or participation can strengthen compulsions. Proceed at the child’s pace and seek professional guidance. 
• Collaborate with professionals: Consistency between parents, teachers, and therapists helps children feel supported. 
• Celebrate progress: Recovery takes courage. Acknowledge every small step to build confidence and hope. 

My Final Thoughts  

OCD in children is not just a passing phase or an unusual habit- it’s a chronic mental health condition that can cause significant distress and impairment if unrecognised or left untreated. Understanding how OCD differs from other conditions helps families and clinicians respond with compassion, early support, and evidence-based care. 

If you’re concerned your child may be experiencing OCD, our experienced team provides comprehensive assessment and treatment, helping children build confidence, manage anxiety, and regain control of their lives.  

Written by Clinical Psychologist, Taylor-Jane Cox