OCD in Children Differs From Adults

Important Differences Between OCD in Adults and Children

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Although many people think of OCD as a disorder that affects only adults, children are also affected. While there are many similarities between adult-onset and childhood-onset OCD, there are also many important differences, too. Let's take a look.

OCD in Children: An Overview

OCD is said to be childhood-onset if symptoms such as obsessions and compulsions occur before puberty. Between 1 and 3% of children will develop OCD and the average age of onset is approximately 10 years of age, although children as young as 5 or 6 may develop the illness.

Interestingly, while boys are more commonly affected by childhood-onset OCD, this trend reverses following puberty. As well, boys with childhood-onset OCD appear to have a greater risk for related conditions including tic disorders.

As children are often just learning to think abstractly, they often have less insight into their obsessions than adults. This, combined with a limited and/or developing verbal ability can make it difficult to make a proper diagnosis.

As well, the content of children’s obsessions can be different from that of adults. For example, it is not uncommon for children with OCD to have specific obsessions related to the death of their parents. The rituals or compulsions of children may also be more likely to involve or be centered around family members than adults. As well, children’s obsessions rarely emphasize sexual themes, although it is important to note that adolescents may actually experience a greater incidence of sexually-focused obsessions.

Finally, children with OCD may hoard more frequently than adults with the disorder.

Childhood-onset OCD also seems to signal a higher risk of genetic transmission of OCD, tic disorders and attention deficit hyperactivity disorder (ADHD).

Treating OCD in Children

As with adult-onset OCD, the current recommended treatment for childhood-onset OCD is a combination of individual or group cognitive-behavior therapy (CBT) and medications that augment levels of the neurochemical serotonin such as selective serotonin reuptake inhibitors (SSRIs).

When undertaking CBT with children, it is essential the parents be educated and involved. Indeed, research suggests that parental involvement is a strong predictor of treatment success.

It may also be helpful to emphasize to children that it is their OCD who is the “bad guy” who is responsible for their symptoms and they and their parents are the “good guys.” Such a technique can help reduce the chances a child will feel blame or shame for having OCD.

Of course, given the sometimes limited cognitive abilities of children, the explanation of abstract concepts needs to be done in a way that is appropriate for the age of the child.

PANDAS: A Special Case of OCD in Children

Sometimes OCD in children can be caused by an autoimmune reaction within the brain. A disease known as Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections (or “PANDAS”) is thought to be triggered by an infection of the same bacteria that causes strep throat and scarlet fever. As the child’s immune system fights the strep infection, it becomes confused and starts to attack an area of the brain called the basal ganglia.

Although changes in a number of brain areas underlie symptoms of OCD, abnormalities of the basal ganglia have been associated with symptoms of OCD. Whereas the symptoms of regular OCD develop slowly, the onset of the PANDAS form of OCD is rapid.


Kalra, S.K., & Swedo, S.E. “Children with obsessive-compulsive disorder: are they just little adults?” The Journal of Clinical Investigation April 2009 119: 737-746.

Geller, D.A “Obsessive-compulsive and spectrum disorders in children and adolescents” Psychiatric Clinics of North America 2006 29: 353-370.

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