How to Treat OCD in Children and Teens

Obsessive-Compulsive Disorder (OCD) is a chronic mental health condition characterized by persistent, unwanted thoughts (obsession) and repetitive behaviors (compulsions). These obsessions and compulsions can interfere significantly with daily activities and cause distress.

A vast, often missing component in treating Obsessive Compulsive Disorder (OCD) in children and adolescents is explaining what OCD is and how it affects the brains of kids and their parents. That means understanding how OCD impacts a child’s behavior and how easy it is to inadvertently accommodate or feed into a child’s obsessions and compulsions. 

That means well-meaning parents accidentally providing too much comfort or saying things that feed their intrusive thinking and repetitive behaviors instead of decreasing OCD symptoms. This is called accommodation and means that parents are feeding the “OCD monster.” 

Supporting and Treating OCD 

A highly experienced mental health professional should spend much of the first session not only evaluating your child's or teen's OCD but also explaining what obsessions and compulsions look like. A therapist can talk about the neuroscience of OCD, and what areas of the brain are affected, how OCD treatments work and what it looks like. 

It is essential to discuss what family members should expect and paint the picture of the work done in OCD therapy. Mental health professionals can offer family therapy as well. You may think it is time consuming, but OCD did not appear overnight, and you will not disappear in a snap. The daily life of living with a person with repeated questioning that can go on for hours a day, can be very draining, and parents need to know what to say and do to help their child break the cycle. 

OCD Treatment for Kids and Teens

Cognitive-Behavioral Therapy (CBT):

1. Exposure and Response Prevention(ERP):
   ERP is a specific type of CBT that is considered the gold standard for OCD treatment. It involves gradually exposing individuals to situations that trigger their obsessions and feared situations while helping them to refrain from engaging in their compulsive behaviors. Over time, this helps reduce the anxiety associated with the obsession and the need to perform compulsions.
2. Cognitive Therapy:
   This focuses on identifying and challenging irrational or maladaptive thoughts that contribute to OCD symptoms. It helps individuals develop healthier thinking patterns and reduce the intensity of their obsessions and compulsions.
3. Acceptance and Commitment Therapy (ACT)
   ACT is a form of psychotherapy that encourages individuals to accept their thoughts and feelings rather than fighting or feeling guilty about them. Commitment therapy also involves commitment to behavioral changes aligned with personal values.
4. Mindfulness-Based Cognitive Therapy (MBCT)
   MBCT combines cognitive therapy techniques with mindfulness strategies to help individuals become more aware of their thoughts and feelings and manage them without getting overwhelmed.
5. Family Therapy
   Family therapy can be beneficial, especially for children and adolescents with OCD. It helps the members of the family understand the disorder and learn how to support their loved one without enabling compulsive behavior.

Relaxation Techniques for OCD symptoms

Relaxation technique can be beneficial for managing the anxiety and stress associated with Obsessive-Compulsive Disorder (OCD). These techniques help calm the mind and body, reducing the intensity of obsessive thoughts and compulsive urges. Here are several effective relaxation techniques:

1. Deep Breathing Exercises:

• Diaphragmatic Breathing: Also known as “belly breathing,” this technique involves taking slow, deep breaths, expanding the diaphragm rather than shallow chest breathing. It helps activate the body's relaxation response.
• 4-7-8 Breathing: Inhale for a count of 4, hold your breath for a count of 7, and exhale slowly for a count of 8. Repeat several times.

2. Progressive Muscle Relaxation (PMR):

• PMR involves tensing and then relaxing different muscle groups in the body systematically. Start from your toes and work your way up to your head, focusing on the sensations of tension and relaxation.

3. Mindfulness Meditation:

• Body Scan: Focus on each part of your body, from toes to head, noticing any sensations without judgment.
• Focused Attention: Concentrate on your breath, a mantra, or a specific object, gently bringing your mind back to the present whenever it wanders.

4. Visualization and Guided Imagery:

• Imagine yourself in a peaceful, calming place (e.g., a beach, forest, or meadow). Visualize detailed aspects of this environment, engaging all your senses.

5. Yoga and Tai Chi:

• These practices combine physical movement, controlled breathing, and mindfulness to promote relaxation and reduce stress. Gentle yoga poses and Tai Chi movements can help calm the mind and improve overall well-being.

How to Address Treatment-Resistant OCD

Treatment resistant patients can be a challenge, but several strategies can be considered. First, take a step back and understand what's happening. A thorough assessment is the key to giving us a good lay of the land to chart an effective treatment course.

A randomized controlled trial looked at treating obsessive compulsive disorder in young people who haven't responded well to previous treatments. They found that when these kids received specialized therapy, like CBT, with or without medication changes, their symptoms got a lot better. But they also discovered that many kids hadn't been getting the right kind of therapy before, which made their OCD worse. The study suggests that giving the proper treatment can help kids with OCD feel better (Krebs et al., 2014).

I once worked with a remarkable young girl named Emily, who had been battling OCD for years. Despite trying different medications and therapies, she felt like she was hitting a wall. This is true for most treatment resistant patients. But you know what? We didn't give up. We looked closely at her treatment plan, considered all the puzzle pieces, and decided to try something new.

We incorporte and tread OCD with ERP therapy into her sessions. Exposure therapy might sound intimidating, but consider it taking small steps outside your comfort zone, one at a time. Giving parents the tools to not accommodate the OCD is critical and making them understand the treatment plan in its entirety helps. 

For Emily, it meant gradually facing her fears, whether it was touching a “contaminated” object or resisting the urge to perform her rituals. Over time, those small victories added up. She began to reclaim control over her life, one brave step at a time.

What is OCD Therapy Like?

A mental health professional who uses Cognitive Behavioral Therapy and Exposure Response and Prevention Therapy (ERP)   to treat OCD will spend time at every session helping a child or teen and their parents understand why OCD thoughts and compulsions form a neurological habit and exactly how to use neuroscience to “talk back” to OCD. 

Once they know the negative reinforcement cycle, kids with obsessive compulsive disorder have the power to break OCD habituation. They learn to take control of their OCD instead of OCD being in control. 

Developing OCD typically doesn't happen overnight, although it can with sudden onset due to PANS/PANDAS/AE, so most of the time, it will take many weeks and months to get intrusive thoughts and compulsive behaviors to a more manageable level or to even within a normal range. 

What is the Best Treatment for OCD in Children and Teens? 

In my clinic in Ridgefield,CT use a combination of two science-backed approaches, such as response prevention therapy and neurofeedback, with our in-person and virtual clients. In terms of the most effective type of psychotherapy, the efficacy of prevention therapy for obsessive compulsive disorder is well documented. It is designed to give clients the education and skills to control their thoughts and sensations that have hijacked their brains. 

Unlike talk therapy, which over-focuses on feelings, ERP teaches one to reign in those runaway thoughts. I can’t tell you how many kids (and adults) with severe OCD have found the most value in ERP in helping them break free from intrusive thinking and not connect to feelings first. 

One pediatric study looked at how different treatments help kids with OCD. They studied 112 kids who either took medicine, talked to a therapist, did both, or took a fake pill. They found that kids who had milder obsessive compulsive symptoms understood their problem better, had fewer behavior issues, and got less help from their families improved the most with any treatment. 

But if a kid had a family member with obsessive compulsive disorder, talking to a therapist alone didn't help as much. This means kids might need a mix of therapy and other treatments. This pediatric OCD study shows that each kid with OCD requires different kinds of help, and it's essential to consider their family history when deciding on treatment (Garcia et al., 2010).

Response Prevention Therapy for Obsessive Compulsive Disorder

Exposure and response prevention (ERP) is a type of cognitive therapy that’s considered the gold standard of treatment for children and adolescents with OCD. Its systematic methods have a lot of research to show how effective ERP is in reducing and even eliminating a child’s OCD symptoms. 

Exposure and response prevention requires heavy parental involvement and practice at home, helping your child break the obsessive compulsive disorder cycle. That means teaching your child how to cope with anxiety disorder, intrusive thoughts, and compulsions instead of accidentally reinforcing them by what we say and do. 

And when you combine calming the nervous system with OCD therapy such as ERP, children with OCD can get better. We don’t talk enough about OCD success stories but at my Ridgefield, CT clinic, we help kids, adults and families tackle OCD every day.

We walk parents through this and teach them how to respond to OCD-driven behaviors and what to say to their children. Parents are often unsure of what to say to their child with OCD, and it’s so hard to see a child in distress, and gaining these tools is a game changer. A good ERP therapist empowers the child and family members with OCD tools to tamp down that OCD tyrant! 

Neurofeedback for OCD in Children and Adolescents

If one’s nervous system is stress-activated, then a child with severe OCD can’t think, pay attention, or take action in a way that stops their OCD. Instead, their stress-hijacked brain gets stuck in a looping thought and behavioral pattern. That is why neurofeedback for OCD is so powerful because it calms the CNS at a subconscious level so a person isn’t in a constantly activated state. 

Neurofeedback calms the nervous system and moves a child to a more relaxed, parasympathetic state, and when that happens, the person with OCD can have the bandwidth to take action and think differently. 

We use brain-based therapies to calm the nervous system so that a person can respond to all stimuli more healthily. That means fewer obsessions, compulsions, irritated and angry behaviors, worried and negative thoughts, calm thinking, engaged behaviors, and an ability to think and act without getting stuck.

Aside from neurofeedback, there are great natural treatments for obsessive compulsive disorder, such as supplements, herbs, and ERP. If you are looking for information on natural solutions and treatments for OCD, then download The Natural OCD Thought Tamer Kit.