Understanding OCD in Children and Teens

OCD involves obsessions, which are intrusive thoughts, images, or urges that cause distress, and compulsions, which are repetitive behaviors or mental acts a child feels driven to perform to make that distress go away. The relief is only temporary, so the cycle repeats, sometimes for hours a day.

Children don’t always experience their thoughts as unreasonable. A younger child may simply feel that something bad will happen if a ritual isn’t done, or that things have to feel “just right.” Many kids also become skilled at hiding their symptoms because they feel embarrassed or confused by them.

Common experiences include:

• Fears about germs, illness, or contamination

• Worries that something bad will happen to themselves or a loved one

• Repeated checking, washing, counting, tapping, or arranging

• Needing things to feel “even,” “symmetrical,” or “just right”

• Asking the same questions over and over and needing reassurance

• Redoing homework, rereading, or erasing until it feels perfect

• Long bedtime, getting-ready, or leaving-the-house routines

• Distress or meltdowns when a routine is interrupted

• Upsetting intrusive thoughts they’re afraid to say out loud

OCD also tends to pull families in. Parents often find themselves answering repeated questions, following special rules, or rearranging routines to keep the peace. This is a completely understandable response, and it’s an important part of what we work on together.v

Why OCD in Children Requires a Thoughtful Evaluation

OCD can be difficult to diagnose in children because it looks so different from one child to the next. One child’s OCD may center on contamination and handwashing, while another’s lives almost entirely in their head as silent counting, reviewing, or praying. Some children can describe their fears clearly, while others can’t explain why they “have to” do something.

OCD can also resemble or overlap with other conditions, including generalized anxiety, ADHD, tic disorders, autism, eating difficulties, and oppositional behavior. A child who refuses to leave the house or melts down over a changed routine might be seen as defiant when OCD is actually driving the behavior. In some cases, symptoms that appear very suddenly may warrant a closer look at possible medical contributors.

Because of this, I take time to understand each child’s specific experience: what the thoughts are, what the rituals are doing for them, how the symptoms developed, and how they’re showing up at home and at school. A careful, unhurried evaluation is the foundation of effective treatment.

My Approach to OCD Treatment

OCD in children and teens is very treatable, and early, well-matched treatment makes a meaningful difference. I take a family-centered, comprehensive approach that may include:

Thorough Evaluation: We’ll map out your child’s specific obsessions and compulsions, how much time they take, and how they affect daily life, along with any co-occurring concerns.

ERP-Informed Care: Exposure and Response Prevention (ERP), a specialized form of cognitive behavioral therapy, is the gold-standard treatment for OCD in young people. I understand ERP principles and often work alongside therapists who specialize in treating children and teens with this approach.

Medication Management: For moderate to severe OCD, or when therapy alone isn’t enough, medication can significantly reduce symptoms and make it easier for a child to engage in therapy. I’ll walk you through the options and the evidence for their use in young people, start carefully, and monitor closely.

Parent Guidance: I’ll help you recognize how OCD shows up at home and learn ways to gradually step back from reassurance and accommodation, in a way that’s supportive rather than punishing for your child.

Helping Your Child Understand OCD: Many kids feel enormous relief when they learn that OCD is something that’s happening to them, not something that’s wrong with them. We’ll help your child understand their OCD and build confidence in their ability to push back against it.

School Coordination: When OCD affects schoolwork, attendance, or the school day, I can help you think through accommodations and communicate with your child’s school when appropriate.

What to Expect

The intake for children and adolescents is completed in three parts:

Part 1: Parent Session (60 minutes)
We’ll meet without your child to talk through your concerns, your child’s developmental, medical, and school history, and your family’s goals.

Part 2: Child Session (60 minutes)
I’ll meet with your child or teen to get to know them directly: how they see things, what feels hard, and what’s going well.

Part 3: Feedback Session (30 minutes)
About one week later, we’ll meet again to go over my impressions and talk through treatment options together.

Between sessions, I’ll review any records you share, such as report cards, prior testing, or treatment records, and, with your permission, speak with outside providers involved in your child’s care.

OCD can feel embarrassing for kids to talk about, and I’ll make space for your child to share at their own pace. The goal of treatment isn’t to make every intrusive thought disappear, but to help your child change their relationship with those thoughts so they no longer control the day.

Who I Work With

I work with children, adolescents, and their families in New York City. Whether your child’s OCD centers on germs, fears of harm, a need for things to feel “just right,” or thoughts they’re too worried to say out loud, effective treatment can help your child and your family take your lives back.

Getting Started

If OCD is taking up your child’s time and energy, or your family’s, you don’t have to manage it alone. With thoughtful evaluation and the right combination of therapy and support, most children and teens improve substantially.