Breaking the Childhood OCD Cycle

It can be emotionally draining to watch your child plan their day around OCD’s demands. You try to alleviate your child’s stress, and you inadvertently collude with your child’s anxiety. You may be wondering how you got here, and how to get out. Dr. Courtney DeAngelis, a child psychologist at Columbia University offers expert advice about the childhood OCD cycle, a family’s role in maintaining it, and treatments that work. 

What Is the Childhood OCD Cycle?

Obsessive Compulsive Disorder (OCD) is characterized by unwanted, intrusive thoughts (obsessions) and physical or mental behaviors carried out to ease the discomfort of those thoughts (compulsions). Those who suffer from childhood OCD often get trapped in a cycle. 

The childhood OCT cycle starts when a child experiences an obsession, which creates anxiety. The child gives into an urge to act out a compulsion, generating a feeling of immediate relief. Children learn that listening to OCD “works”—it alleviates their feeling of discomfort. The problem is the relief is fleeting—a new intrusive thought will likely appear again that day. The child learns very quickly, and has that repeatedly reinforced, that compulsions are the only way to get rid of these uncomfortable feelings. 

How Does Childhood OCD Manifest?

Television and movies often depict characters living with childhood OCD as being panicked by germs. But obsessions can manifest in many ways, including intense worry about religion or morality, health, harm happening to self or others, superstitions, and more. Compulsions can also vary between children with OCD, ranging from checking behaviors to cleaning rituals, counting compulsions, and rituals that involve parents or family. 

Simply put, OCD is like a “brain hiccup.” People with and without OCD can experience intrusive thoughts that pop up out of the blue. Those without OCD may react by thinking, “Huh, that was weird,” and continue to go about their day. Children and teens with OCD might respond with questions or judgments about the intrusive thought: “Why did I just think about that? That’s a bad thing to think. Does that mean a part of me wants to do that? Am I a bad kid?” Those judgments and doubts create the anxiety that often drives the urge to complete compulsions. 

How Can Parents Detect Childhood OCD? 

Most adults can think of a “quirk” of theirs that doesn’t make a ton of sense. For instance, you might hit the lock button on your remote key four times, even though you’ve already watched your car headlights signal that the door has been locked. Or you might occasionally change your television volume setting to avoid leaving it at your unlucky number. 

With children, we often encourage the use of routines to create a sense of predictability and security. Remember when you had approximately 17 steps in your toddler’s nighttime routine that you needed to follow exactly to get them to sleep? It might have been quirky, but it worked. 

A parent may wonder if it’s a problem that their child likes to leave the house at an exact time, or if they still have a particular routine in bed. Take notice of how much time your child seems to be preoccupied with their worries and spends on their rituals. If you are at or over the one-hour mark—or the thoughts or behaviors are beginning to cause problems—you might want to reach out to a licensed therapist for more help. 

Both children with OCD and their parents often share that these experiences impact their daily lives in some way. A teen might spend hours in the bathroom throughout the day because of intense anxiety about handwashing. A young child may avoid birthday parties, sleepovers, and playdates in fear that something outside of the house will make them sick. 

Some children and teens are better able to conceal their compulsions, engaging in mental rituals that are not obvious to parents. You might be superhuman in some aspects of your parenting abilities, but you’re not expected to catch these invisible symptoms. If your parenting gut says that something is off, it’s probably worth it to seek the expert opinion of a licensed therapist. 

Family Accommodations for OCD in Childhood

Parents may unintentionally support their child’s OCD rituals, a behavior known as “family accommodations.”  They may do this with the best intentions. More often than not, I ask parents to stop providing this support they have been offering.

Family accommodations only seek to maintain a child’s OCD. Examples are participating in a child’s multi-step nighttime ritual, repeatedly answering “OCD questions” to reassure a child that nothing bad will happen, or buying certain household items reserved for the child or that meet the child’s standards of cleanliness. 

Sometimes OCD can be a “disorder of abundance.” Your teen might not make as much effort to disrupt cleaning compulsions if they believe your home has a never-ending supply of paper towels. Many children and teens are unlikely to feel motivated to change their patterns on their own. This is especially true if you help them, via your accommodations, to rationalize that their OCD doesn't cause problems in the home. 

While you might notice more “problems” when you decide not to participate in some of these compulsions, that doesn’t mean you’re doing the wrong thing. It means you’re breaking away from the cycle of OCD. Sometimes things feel worse before they feel better. 

How Do You Treat Childhood OCD?

It’s a hard sell to convince a child who’s been actively avoiding something stressful to suddenly agree to engage in that stressful thing. Facing their fears, however, is one of the major principles of exposure and response prevention (ERP)—an effective treatment for OCD in childhood. 

When you first learn about ERP, which involves gradually exposing someone to situations that provoke their obsessions, it might sound like torture. To parents or caregivers, it may sound almost unethical. I assure all kids, teens, and parents that I am not in the business of torturing anyone. I am, however, in the business of educating families on strategies that help give your children time back to activities that are meaningful and important to them.  

The good news is that research shows that ERP can significantly improve OCD symptoms. In ERP therapy, your child will learn strategies to cope with anxiety and disrupt the OCD cycle. Your child will likely be asked to create an exposure hierarchy or a “brave challenges ladder.” They will collaborate with their therapist to come up with ideas for activities that require them to face their fears, all while resisting the urge to give into a compulsion. The therapist will guide your child to gradually tackle ideas on this list, helping to essentially rewire the brain. Your child will learn that intrusive thoughts are just words floating around in their head and that compulsions do not have any true ability to protect them.

I once supported a teen who worried they could be responsible if something bad happened just by thinking about it. I wrote on a Post-it note, “I hope that my husband gets a flat tire.” I did this to test out the teen’s belief that saying or thinking something can make it come true. I told this teen I would not throw it away, nor say or do anything to try and “take it back”—my brave challenge. I left the note on my desk for a week. When I saw the teen in our next session, I reported all the tires were round and fully functional.

I kept that Post-it beyond the week to test it out with other patients. Months later, my husband did get a flat tire. I did not have any doubt that my Post-it was responsible. I did not have evidence, though, if I had magical abilities to manifest positive or negative outcomes. So I created another Post-it with, “I will win the lottery.” That one has yet to come true. 

If your child struggles with childhood OCD, help them onto the path of recovery with expert help. Handspring Health offers evidence-based, personalized treatment plans that are designed to help them overcome OCD. Schedule a free consultation today. 

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