We often think of OCD as a disorder that only affects adults, but even young children can have Obsessive-Compulsive Disorder (OCD). Despite their best efforts, children with OCD cannot stop their disturbing thoughts, images, and urges, no matter how hard they try, which significantly impacts a child's behavior.

Toddlers may show more subtle signs of compulsive thinking or behavior, which often can be very normal. However, the more typical forms of obsessive and compulsive behavior can still be observed. Due to their limited communication skills, OCD can be nearly undetectable in young children.

Understanding Obsessive Compulsive Disorder in Children

A child with OCD may be overly preoccupied with obsessive thoughts concerning dirt, germs, illness, order, exactness, and symmetry. Excessive hand washing, grouping objects, and repeated checking, sequencing, or counting are typical examples of compulsive behaviors.

Children with OCD often experience intrusive thoughts about something bad happening or have aggressive thoughts. These unwanted thoughts lead to compulsions or rituals, which they believe will alleviate their fears.

Most children develop OCD-related behaviors gradually, but some may show sudden onsets. When OCD suddenly develops, PANS/PANDAS should be considered, and healthcare providers also evaluate for related conditions such as autism spectrum disorder. This condition can appear due to a misdirected immune response caused by environmental factors, infection, or other possible triggers. PANS/PANDAS leads to sudden psychiatric symptoms, including OCD, tic disorder, rage, restricted eating, and separation anxiety, among others.

Childhood OCD Symptoms Checklist

OCD in very young children can be challenging to diagnose accurately, as many young children exhibit obsessive and repetitive behaviors that may not be indicative of OCD and reflect a normal developmental stage. Intrusive thoughts and repetitive behaviors may indicate early onset OCD, which requires careful assessment and intervention.

Here are the symptoms of OCD to monitor closely.
Excessive cleaning or hand washing
Constantly checking and rechecking things (e.g. doors, locks, appliances)
Unreasonable insistence on symmetry and orderliness
Repetitive or obsessive counting or organizing of objects
Intense fear of germs or contamination
Intrusive and persistent thoughts or images that are upsetting to the child
Difficulty focusing on anything else due to obsessive thoughts or compulsive behaviors
Tantrums or disruptive behaviors when routine or order is disrupted
Avoidance of certain activities or situations due to anxiety
A need for things to be “just right,” even if it means repeating behaviors over and over again.
Signs of eating disorders
Time consuming routines like having a bedtime ritual

It is important to note that some of these behaviors may be normal in young children and only become concerning if they are persistent, interfere with daily activities, or cause significant distress. If you suspect your child may have OCD, it is important to seek the advice of a qualified mental health professional for an accurate diagnosis and appropriate treatment recommendations. If these symptoms are persistent and interfere with daily activities, they may indicate childhood OCD, and you may need professionals involved.

Assessing a child's symptoms is crucial for an accurate diagnosis. Here are common obsessions and compulsions you need to observe:

OCD in Toddlers: Common Obsessions

Fear of germs or contamination
Fear of something bad happening to loved ones
Concern with order and symmetry
Intrusive OCD thoughts about being harmed
Fixation on specific colors or numbers
Fear of making mistakes
Worry about things being “just right”
Obsession with specific routines or rituals

OCD in Toddlers: Common Compulsions

Repetitive hand washing
Organizing or arranging objects
Touching or tapping objects
Repetitive checking (doors, lights, etc.)
Counting rituals
Specific bedtime routines
Asking repeated questions for reassurance
Avoiding certain items or areas
Repeating words or phrases

Steps to Take If Your Toddler Shows Signs of Childhood Onset OCD

To diagnose OCD in toddlers, a mental health professional conducts a clinical interview. At the intake, the clinician assesses if obsessive compulsive behaviors are present and how they impact the child’s life. Unfortunately, psychological or laboratory tests for OCD do not exist, which frustrates parents. However, a QEEG brain map and PEMF are proven to help in diagnosing OCD and other mental health disorders.

Getting help early on is the first step. Parents shouldn’t ignore or reinforce a child’s obsessions or compulsions. These behavioral habits become more difficult to break the longer they persist.

Children may become habituated to obsessive and compulsive behaviors to cope with stress. However, the severity of OCD can be lessened, and, in some cases, its progression can be stopped by breaking those behaviors before they become ingrained. Early intervention is crucial to treat OCD effectively and prevent the behaviors from becoming ingrained.

Can a Child Outgrow OCD?

OCD is not something you outgrow as a child. But through the right therapy and treatment, children can overcome it, especially when you address it when they are young. However, their symptoms can worsen during stressful life events, hormonal transitions, or developmental changes. Symptoms can worsen with the wrong treatment, including anxiety psychotherapy or psychiatric medication.

Symptoms of OCD in children is known to wax and wane, which can confuse parents. However, a child’s obsessions and compulsions can be successfully managed by getting an OCD diagnosis early on and getting the right support. Furthermore, the child with OCD should also be diagnosed with other mental disorders such as ADHD, autism, tic disorders and anxiety disorder.

How Does OCD Impact Preschool?

A child's OCD can impact learning and processing. For example, children with OCD are typically slow to process information and exhibit perfectionistic tendencies. Their mental rituals can also cause them to have focusing difficulties.

OCD may increase emotionality or rigidity in children. Most signs and symptoms are more subtle and are misinterpreted as a processing, focus, or behavioral issue. Children with OCD may also experience severe anxiety, which can further impact their learning and social interactions.

I also recall observing Brendon, a preschool five-year-old who showed behaviors that were often mistaken for noncompliance. Brendon felt the need to repeatedly line up his crayons and books in a specific order before moving on to the next activity, and he would become visibly distressed if asked to stop. His teachers saw this as resistance to following directions, not realizing it was OCD.

With the right diagnosis, PEMF therapy, and parent ERP coaching, Brendon was able to manage his OCD relatively quickly. Early intervention made a difference, helping him break these patterns before they became deeply ingrained and allowing his brain to settle into a calmer state.

Science-Backed OCD Treatments for Toddlers

The treatment of OCD involves a combination of traditional and holistic approaches. While medication benefits some adults, children don’t. Effective treatments for pediatric OCD include Cognitive Behavioral Therapy (CBT) and Exposure and Response Therapy (ERP). In some cases, selective serotonin reuptake inhibitors (SSRIs) may be prescribed to manage OCD symptoms in children.

Parents must participate in ERP therapy sessions and their processes to support their children with OCD. Family therapy is also highly suggested. A child’s obsessions and compulsions should not be suppressed or reinforced but instead tolerated in line with the exposure therapy process.

The First Step to Treat OCD: Regulating the Nervous System

Treating OCD, especially in young children, begins with calming the brain and regulating the nervous system. When a child’s brain is in a calm, regulated state, they’re better able to process emotions and learn new coping strategies. Without addressing the underlying nervous system dysregulation, the brain remains stuck in a heightened state, reinforcing compulsive behavior as a way to cope with underlying anxiety.

My approach focuses on calming the brain first—through methods like PEMF therapy, neurofeedback, and supportive co-regulation with parents and caregivers. This isn’t just about symptom management; it’s about resetting the brain’s response to stress. With a regulated nervous system, children can break free from the cycle of OCD behaviors and engage more fully in therapeutic work.

Pediatric Obsessive Compulsive Disorder Therapies

The child’s response to triggers changes through psychoeducation, CBT, and ERP, resulting in fewer compulsions and obsessions. In addition, as the individual learns that stopping rituals doesn’t result in any harm, therapeutic exposures repeated over time decrease associated anxiety.

1. Cognitive Behavioral Therapy 

Cognitive behavior therapy (CBT) aims to change how the mind works on the conscious level. For example, in cognitive behavioral therapy, the child’s perceptions of a situation are more closely connected to their reactions than the actual situation. By working through their misperceptions, the child achieves relief. Through this method, their negative thinking patterns are reframed into positive ones through talk and behavioral therapy.

2. Exposure and Response Therapy

On the other hand, ERP is a type of cognitive behavior therapy (CBT) that involves exposing the child to their common OCD triggers. This way, they learn to become uncomfortable enough to ignore their triggers.

The first step is to identify all their triggers. Afterward, the therapist exposes the child to situations that trigger obsessions and compulsions. The process is usually gradual until they reach the point where they are dealing with moderate and severe triggers. (Gordon et al., 2023)

Rather than avoiding uncomfortable feelings, the therapy teaches the child how to handle them. Short-term exposure increases children’s anxiety, but long-term exposure lessens it. 

Cognitive restructuring involves evaluating perceived threats associated with each obsession and testing limits. Often, OCD symptoms subside or disappear when the right therapy and treatment methods are used. 

3. Play Therapy

Play is a natural way for toddlers to communicate and process emotions, especially when they can’t yet express complex feelings in words. Through play, children feel safe to explore their anxieties, make sense of their compulsions, and learn coping strategies in a way that feels familiar and enjoyable. It turns therapy into a comforting, non-threatening experience. (Myrick et al., 2012)

Natural Solutions for OCD in Toddlers

Other effective holistic therapies are Neurofeedback and Biofeedback, EFT/Tapping, massage, Reiki, CALM PEMF™, and magnesium supplementation. These science-backed natural methods for treating OCD are great in aligning the nervous system.

If you’re looking for ways to ease OCD symptoms at home and explore natural solutions, my Natural OCD Thought Tamer Kit is here to help. This parent kit offers essential guidance for you and your child to build self-regulation skills, empowering you to manage OCD effectively. With calming brain tools to regulate the nervous system, you’ll have what you need to tame the OCD monster for good! Learn more here. 

Citations:

Myrick, A. C., & Green, E. J. (2012). Incorporating play therapy into evidence-based treatment with children affected by obsessive compulsive disorder. International Journal of Play Therapy, 21(2), 74–86. https://doi.org/10.1037/a0027603 

Gordon, C., Gasbarro, A., Wendell, V., Fischer, S., Hardin, R., & Marino, J. (2023). Assessing exposure and response prevention readiness for clients with obsessive compulsive disorder and co-occurring conditions: A decision-making model and case example. Professional Psychology: Research and Practice, 54(4), 305–313. https://doi.org/10.1037/pro0000516