When you have a dysregulated child, it can feel like an endless puzzle of behaviors and emotions. In understanding the overlap and distinctions between OCD and ADHD, it’s essential to recognize that both conditions are deeply rooted in the brain’s regulation—or, more accurately, a dysregulation of the nervous system.
From my 30 years as a mental health provider, I’ve seen countless children dealing with a lot of challenges with these two disorders. Whether it’s the compulsiveness and persistent thoughts of OCD or the impulsivity and inattention often associated with ADHD, these behaviors reflect a nervous system that’s either overstimulated, understimulated, or simply out of balance.
Obsessive-Compulsive Disorder (OCD) and Attention-Deficit Hyperactive Disorder (ADHD) are two entirely different conditions. However, children and teens are misdiagnosed to have one condition over the other. Most of it is because these mental health issues have overlapping symptoms, which can complicate diagnosis and impact brain development. Ensuring a correct diagnosis is essential for receiving proper treatment and care.
Many symptoms associated with concentration and attention have very similar effects on children and teens with either of these conditions. However, the clinical presentation and brain activity of a child or teen with ADHD are very different from one that has OCD. This complexity often leads to ADHD dual diagnosis misdiagnosis, where ADHD is mistakenly identified in individuals who are actually experiencing OCD, potentially exacerbating the underlying condition.
When a child has OCD or ADHD, it’s not just about behaviors; it's about what’s happening in the nervous system. Both conditions often stem from dysregulation in the brain, meaning the nervous system is either understimulated or overstimulated, which impacts everything from focus to emotional balance.
For kids with ADHD, dysregulation might look like impulsive actions, restless energy, and a constant search for stimulation to “wake up” their brains. In OCD, it shows up as an overactive threat response, where obsessive thoughts and compulsive actions take over to manage overwhelming fears and anxieties. For example, for people with OCD, excessively cleaning or organizing can become a daily ritual, driven by intrusive thoughts that something might go wrong if they don’t perform these actions perfectly.
Dysregulation affects the brain’s frontal lobe, which is responsible for focus, decision-making, and managing emotions. That’s why calming the brain first is so essential—it’s the foundation of real, lasting change. When we address this imbalance, kids are better able to manage their thoughts and behaviors, opening up a pathway for growth, focus, and resilience.
Let's take a closer look at each of these clinical conditions.
What is OCD?
A child or teen with OCD exhibits irrational thoughts and fears, also called obsessions, that lead to compulsive behaviors. Obsessive compulsive symptoms can be particularly challenging for those with ADHD due to the need for strict routines and precision. Compulsions are the behaviors that OCD-affected individuals engage in to get rid of their obsessions or decrease their distress.
Almost everyone has obsessive thoughts and compulsive behaviors at some point in their lives, but that does not mean they have OCD. To be diagnosed with an obsessive-compulsive disorder, one must be unable to function normally daily, and these behaviors must occur one more hour a day.
General OCD Symptoms
All OCD fears and intrusive thoughts are unique, but there are some common themes that impact children and teens. OCD intrusive thoughts are rarely logical and can be dark and scary. Children and teens can be pretty adept at hiding these internal worries, so parents can be surprised when they are revealed.
Individuals with OCD tend to demonstrate an inhibited temperament and are overly concerned about the consequences of their actions, which can impact their cognitive performance and daily functioning. Some of the common OCD symptoms are irrational fears, anxiety, unwanted thoughts, compulsive behavior, impaired inhibition, and sleep disturbances.
What is ADHD?
ADHD is more than a lack of focus. Children with Attention Deficit Hyperactivity Disorder may have difficulties with hyperactivity and impulsive behavior, sustaining attention, or both. Additionally, they suffer from poor executive functions, which adversely impact their academic, social, and personal lives.
There is a misconception that ADHD children cannot focus. But, in reality, they may be hyperfocused when they are interested. Their ability to hyperfocus is due to the stimulation their brain receives when they are excited or interested. Stimulant medication can lead to changes in brain activity and structure, potentially normalizing brain volume in ADHD patients but also exacerbating obsessive-compulsive symptoms in those misdiagnosed, highlighting the importance of accurate diagnosis.
General ADHD Symptoms
There are different types of ADHD, but the hyperactive and impulsive symptoms tend to be more identifiable with OCD. Other symptoms include a lack of executive functioning skills, problems with transitioning, and avoiding school work:
How are OCD and ADHD the Same?
OCD and ADHD are distinct mental health disorders with similar symptoms and problems. However, one of the most distinct similarities between these two is they affect the same part of the brain, particularly the frontostriatal area or the front lobe of the brain.
Repetitive behaviors often manifest as acts performed in response to intrusive thoughts or fears in children with OCD, and these behaviors can also be connected to symptoms of ADHD, highlighting the complexity of how both conditions can interact and influence one another in patients.
The biology of OCD and ADHD is that it impacts the frontal lobes or the job management of the brain that helps to organize thinking and behavior. For OCD, it is the orbito-frontostriatal region and the frontoparietal area for ADHD. The deficits in cortical inhibition or disinhibition may facilitate the perseverative, compulsive behaviors seen in OCD patients and also explain the impulsive, inattentive, and disinhibited behavior of ADHD patients (Brem et al., 2014).
Similar Symptoms of OCD and ADHD
Another similarity between children and teens with OCD and ADHD is that they both have difficulty paying attention. ADHD kids with attention issues can’t sustain their focus for long. Those with OCD, on the other hand, may be inattentive because they are so preoccupied with their obsessions and compulsions that they don’t have the chance to focus on the things happening around them.
OCD and ADHD can also trigger major depressive disorder, stress, anger, and anxiety disorders, thus worsening their symptoms. They may also display physical symptoms such as sleep problems and gastrointestinal issues. As a result, children and kids with these conditions may have strained relationships with family and peers.
OCD and ADHD are often misdiagnosed because they share several similar symptoms when you have inattention, hyperactivity, and impulsivity coupled with intrusive thoughts. For instance, ADHD symptoms such as difficulty in maintaining attention might be mistaken for OCD because the individual is caught in a cycle of anxiety-driven thoughts.
Here’s a detailed examination of how OCD symptoms and ADHD symptoms are interrelated:
Inattention
Inattention is one of the most common symptoms of ADHD. It is because an ADHD mind gets distracted by many random thoughts. On the other hand, if a child has OCD, they may exhibit inattention due to their minds getting filled with obsessive thoughts.
Hyperactivity
Hyperactivity is another primary symptom of children with ADHD, and it is commonly characterized by fidgeting and having endless energy running around the room in an effort to disperse anxious energy. For those with OCD, hyperactivity might be exhibited by behaviors such as pacing back and forth, flapping the arms, nail picking, and hair pulling.
Transitioning
A child with ADHD and OCD often has problems transitioning or shifting to another activity. For a kid with ADHD, it's because they are too hyperfocused on doing the task that interests them. For those with OCD, it's because they are intricately working on something to make it look perfect or completing a mental ritual before moving on to another task, which may take a very long time.
Aggressive or disruptive behavior
ADHD children act impulsively, which is why they are regarded as disruptive. This means that they don't necessarily think through the consequences of their actions and act impulsively. On the other hand, those with OCD have the compulsion to do something to address their anxiety or distress. They may become upset and angry when their fear causes emotional dysregulation, or they are stopped from completing a ritual.
Inability to focus at school or when doing homework
Children with ADHD tend to lose focus or can't concentrate on school activities that don't interest them because their brains are under-stimulated. They always seem to zone out or daydream instead of doing the task until an adult helps them get back on track. Children with OCD, on the other hand, will do their homework but keep repeating what they started or have frequent erasures. They are slow to or never finish because they feel they must do it perfectly.
Difficulty getting started on a task
Children with ADHD experience problems starting a task because they think it is too complicated or involves many complex steps. They also just may simply be distracted. Children with OCD, on the other hand, will exhibit rigidity. They overfocus on doing the task correctly. Hence, they won't start working on it.
Meltdowns
Meltdowns may happen in children with ADHD when they get frustrated due to failing to accomplish a task or chore assigned to them or wanting to avoid it altogether. Those with OCD experience meltdowns when they are overloaded by fearful thoughts and compulsions that make them feel out of control.
How are ADHD and OCD Different?
ADHD is largely an externalizing disorder. It means the condition affects how a child or teen relates outwardly to the people around them and their environment. As a result, kids and teens with ADHD may display inattention and disruptive or impulsive behaviors. Even when a child is inattentive, their behaviors can be quite observable.
On the other hand, OCD is a type of internalizing disorder. It means that children and teens with OCD turn inward when responding to anxiety triggered by their environment. Kids and teens with OCD exhibit repetitive obsessive and compulsive thoughts. Their intrusive thoughts can be easily hidden until compulsive behaviors show up.
Treatment for OCD and ADHD
Pharmacology is not the only route to treat OCD and ADHD. There are natural solutions for OCD and ADHD, particularly brain-based tools such as neurofeedback and PEMF. OCD treatment often involves a careful combination of SSRIs for OCD and stimulants for ADHD, addressing potential interactions and the impact on symptoms. Treatment options for these disorders may include noninvasive brain regulation techniques, which work to normalize the situational imbalance between cognitive persistence and cognitive flexibility (Colzato et al., 2022).
Neurofeedback
Neurofeedback helps treat OCD and ADHD by reinforcing the subconscious and teaching the brain to alter its behavior. It trains the brain to produce brain waves that induce concentration, calming the mind and putting it in a focused state. When performed regularly on ADHD kids, it results in increased motivation and focus, as well as reduced impulse control and distractibility.
Neurofeedback helps children with OCD in almost the same way. Children get better control of the intrusive thoughts and sensations that hijack their brains. A recent study shows that neurofeedback can help reduce obsessions and compulsions without using medication or causing harmful side effects (Barzegary et al., 2011).
PEMF Therapy
PEMF (Pulsed Electromagnetic Field) therapy can support children with ADHD and OCD by promoting calm and enhancing brain function. For ADHD, PEMF therapy may improve focus, reduce hyperactivity, and help regulate impulsivity by stimulating neural pathways that manage attention and behavior.
In OCD, PEMF therapy can help ease anxiety, reduce obsessive thoughts, and support emotional balance by calming overactive areas of the brain linked to fear responses. This non-invasive therapy helps the nervous system self-regulate, making it a beneficial tool for managing both ADHD and OCD symptoms.
In my Ridgefield CT clinic, I’ve seen firsthand how effective PEMF therapy can be in helping kids with ADHD and OCD find calm, focus, and emotional balance. That’s why I developed a portable PEMF device—to make this powerful, non-invasive tool available for families to use anytime, anywhere. Learn more about it here.
Exposure and Response Prevention (ERP)
Exposure and Response Prevention (ERP) works by gradually exposing children with OCD to their fears or triggers in a controlled way, allowing them to face anxiety without engaging in compulsive behavior. Over time, this process reduces the power of obsessive thoughts. For children with both OCD and ADHD, ERP can also help build impulse control by teaching them to pause and resist automatic reactions, supporting overall emotional regulation.
For individuals with severe OCD, concentrated exposure treatment serves as an intensive form of ERP. This method involves repeated and consistent exposure to anxiety-inducing situations within a condensed timeframe, enabling individuals to quickly diminish their anxiety levels and resist engaging in compulsive behaviors.
Cognitive Behavioral Therapy CBT
Cognitive Behavioral Therapy (CBT) helps kids with ADHD and OCD by teaching them skills to manage their thoughts and behaviors. For ADHD, CBT focuses on improving organization, impulse control, and focus. For OCD, it helps kids identify and challenge obsessive thoughts and reduce compulsive behavior. CBT empowers children to manage symptoms in both areas by building coping strategies promoting better emotional and behavioral regulation.
The BrainBehaviorReset™ Program
I created the BrainBehaviorReset™ program as the result of 30 years of clinical experience and dedicated research into what truly works for children—without relying on medications. It is a 6-week intensive program especially effective for children facing challenges with OCD and ADHD, as it addresses the root of their struggles—nervous system dysregulation.
For kids with ADHD, this means working on focus, impulse control, and calming the overstimulated brain. For those with OCD, it’s about helping them manage anxiety, reduce compulsions and obsessions, and find a sense of calm in a mind that often feels out of control.
Using a tailored combination of neurofeedback, PEMF, CBT, ERP, and nutritional support, we focus on calming the brain first because real progress can be hard to achieve without a steady foundation. This approach doesn’t just target symptoms; it empowers kids with the skills to regulate emotions and behavior naturally.
With our support, your child can gain better focus, experience fewer intrusive thoughts, and feel more balanced in their everyday life. We’re with you and your family every step of the way—because there’s always hope for brighter, more balanced days ahead. To get started, take our FREE Solutions Matcher.
What are the ADHD like symptoms of obsessive compulsive disorder?
OCD can present with ADHD-like symptoms, including difficulty focusing due to intrusive thoughts, restlessness from anxiety, and trouble starting or completing tasks because of perfectionism or compulsive rituals. Children with OCD may appear distracted or inattentive, as their minds are often preoccupied with obsessions, making it challenging to stay engaged in activities or follow instructions. Additionally, they may have meltdowns or show frustration when routines are disrupted, which can resemble impulsivity and emotional dysregulation often seen in ADHD.
Can my child have ADHD and OCD?
Yes, comorbid OCD and ADHD can happen, meaning a child may have both. For example, one study involving 94 teens and children diagnosed with OCD discovered that 25.5% also have ADHD. These findings suggest that children with OCD should also get screened for ADHD because some symptoms may be partly due to ADHD. Screening for ADHD helps the child get the right kind of treatment (Masi et al., 2006). Making sure you get an ADHD assessment from a professional who also understands OCD is important.
What constitutes severe OCD?
Severe OCD is characterized by intense, frequent obsessions and compulsions that consume a significant amount of time (often several hours a day) and severely impact daily functioning, relationships, and quality of life. The symptoms are often difficult to control, causing substantial distress and interfering with the person’s ability to carry out routine activities.
Can SSRIs (selective serotonin reuptake inhibitors) help?
While SSRIs (Selective Serotonin Reuptake Inhibitors) are sometimes prescribed, especially for managing OCD-related anxiety, they are not FDA-approved for ADHD. SSRIs and other stimulant medications come with serious considerations, especially in children and teens, including a black box warning about the risk of increased suicidal thoughts and behavior. Treatment seeking OCD patients often rely on pills for instant relief, but they can also cause side effects like agitation, impulsivity, and insomnia, which can be particularly challenging for children with ADHD. Read more about the effects of SSRIs in this blog.
What are the related disorders associated with OCD and ADHD?
Children with childhood ADHD often experience co-occurring conditions, such as tic disorders and Tourette syndrome, which typically emerge in early childhood for tic disorders and Tourette's disorder. Clinicians must specify the presence or history of a tic disorder when diagnosing OCD, as it can alter the diagnostic classification to tic-related OCD. Managing these conditions alongside ADHD can be challenging, as they may influence each other and require specialized support.
What are the DSM-5 diagnostic criteria for identifying OCD and ADHD in children?
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), outlines specific criteria for diagnosing both Obsessive-Compulsive Disorder (OCD) and Attention-Deficit/Hyperactivity Disorder (ADHD).
OCD Diagnostic Criteria:
- Obsessions: Recurrent, persistent thoughts, urges, or images that are intrusive and cause significant anxiety or distress.
- Compulsions: Repetitive behaviors or mental acts performed in response to obsessions, aimed at reducing distress or preventing a feared event, though these actions are not connected in a realistic way to the feared outcomes.
- The obsessions or compulsions are time-consuming (e.g., take more than one hour per day) or cause significant impairment in social, occupational, or other important areas of functioning.
ADHD Diagnostic Criteria:
- Inattention: Six or more symptoms (for children up to age 16) or five or more (for adolescents 17 and older and adults) persisting for at least six months, such as difficulty sustaining attention, not following through on instructions, or being easily distracted.
- Hyperactivity and Impulsivity: Six or more symptoms (for children up to age 16) or five or more (for adolescents 17 and older and adults) persisting for at least six months, such as fidgeting, talking excessively, or interrupting others.
- Several inattentive or hyperactive-impulsive symptoms were present before age 12.
- Symptoms are present in two or more settings (e.g., at home, school, or work) and interfere with social, academic, or occupational functioning.
Accurate diagnosis is crucial for effective treatment, as the management strategies for OCD and ADHD differ significantly. Understanding these criteria helps in identifying the specific challenges a child may face and in developing appropriate interventions.
Dr. Roseann is a mental health expert in Neurodivergence who is frequently in the media:
- BCIA: Calming the OCD Brain with Neurofeedback and ERP Therapy
- Helping Children Thrive Podcast Benefits of Neurofeedback for children with ADHD
- Scary Mommy What Is Self-Regulation In Children, And How Can You Help Improve It?
Always remember… “Calm Brain, Happy Family™”
Disclaimer: This article is not intended to give health advice and it is recommended to consult with a physician before beginning any new wellness regime. *The effectiveness of diagnosis and treatment vary by patient and condition. Dr. Roseann Capanna-Hodge, LLC does not guarantee certain results.
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Dr. Roseann is a Children’s Mental Health Expert and Licensed Therapist who has been featured in/on hundreds of media outlets including The Mel Robbins Show, CBS, NBC, PIX11 NYC, Today, FORBES, CNN, The New York Times, The Washington Post, Business Insider, Women’s Day, Healthline, CNET, Parade Magazine and PARENTS. FORBES called her, “A thought leader in children’s mental health.”
She coined the terms, “Re-entry panic syndrome” and “eco-anxiety” and is a frequent contributor to media on mental health.
Dr. Roseann Capanna-Hodge has three decades of experience in working with children, teens and their families with attention-deficit hyperactivity disorder (ADHD), autism, concussion, dyslexia and learning disability, anxiety, Obsessive Compulsive Disorder (OCD), depression and mood disorder, Lyme Disease, and PANS/PANDAS using science-backed natural mental health solutions such as supplements, magnesium, nutrition, QEEG Brain maps, neurofeedback, PEMF, psychotherapy and other non-medication approaches.
She is the author of three bestselling books, It’s Gonna Be OK!: Proven Ways to Improve Your Child's Mental Health, The Teletherapy Toolkit, and Brain Under Attack. Dr. Roseann is known for offering a message of hope through science-endorsed methods that promote a calm brain.
Her trademarked BrainBehaviorResetⓇ Program and It’s Gonna be OK!Ⓡ Podcast has been a cornerstone for thousands of parents facing mental health, behavioral or neurodevelopmental challenges.
She is the founder and director of The Global Institute of Children’s Mental Health, Neurotastic™Brain Formulas and Dr. Roseann Capanna-Hodge, LLC. Dr. Roseann is a Board Certified Neurofeedback (BCN) Practitioner, a Board Member of the Northeast Region Biofeedback Society (NRBS), Certified Integrative Mental Health Professional (CIMHP) and an Amen Clinic Certified Brain Health Coach. She is also a member of The International Lyme Disease and Associated Disease Society (ILADS), The American Psychological Association (APA), Anxiety and Depression Association of America (ADAA) National Association of School Psychologists (NASP), International OCD Foundation (IOCDF).
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