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Understanding OCD in Children


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By Dr. Erin Kardel

When people think of Obsessive Compulsion Disorder (OCD), their first thought is often of compulsions (or rituals) such as excessive hand washing or repetitive actions. However, OCD is much more than just compulsions.

OCD is driven by obsessions that create anxiety and/or discomfort, and compulsions develop as a way of temporarily reducing anxiety. Symptoms of OCD can be very similar to other conditions such as Attention Deficit Hyperactivity Disorder (ADHD), Autism spectrum disorders, and other anxiety disorders and can be difficult to diagnose. For example, a child who may appear to be distracted or off-task in class would often be labeled as having ADHD, while obsessions and compulsions can cause distractions in the classroom and make a child appear to be off-task or defiant.

OCD often begins in childhood and causes severe anxiety in those affected. The disorder is characterized by both obsessions and compulsions that take up a lot of mental energy and can lead to academic and social struggles.

Obsessions are intrusive and unwanted thoughts, images, or urges that occur repeatedly and are difficult for children to control. Common obsessions children with OCD exhibit include:

• Worrying about germs, getting sick, or dying.
• Extreme fears about bad things happening or doing something wrong.
• Feeling that things have to be just right.
• Disturbing and unwanted thoughts or images about hurting others, hurting oneself, or engaging in inappropriate sexual behaviors.
• Scrupulosity, or excessive worry about doing the morally right thing and/or excessive religiosity.

Compulsions, or rituals, are behaviors that a child feels he or she has to do to get rid of the unpleasant feelings, anxiety, and distress caused by the obsessive thoughts he or she is experiencing. Common compulsions include:

• Excessive checking (such as re-checking that the door is locked).
• Excessive washing and/or cleaning.
• Repeating actions until they are “perfect.”
• Ordering or arranging things.
• Mental compulsions (excessive praying, replaying events in their head).
• Frequent confessing or apologizing.
• Repeating lucky words or numbers.
• Excessively seeking reassurance.

Because compulsions only temporarily alleviate anxiety rather than addressing the root of the anxiety, obsessions, and compulsions increase gradually over time without treatment. OCD is diagnosed when these obsessions and compulsions become so time-consuming for a child that they negatively interfere with his or her daily life.

There are treatment options available to help children with OCD lead full and productive lives. The best treatment option is for a child with OCD to meet with a licensed mental health professional who uses a type of cognitive behavior therapy (CBT) called exposure and response prevention (ERP). ERP helps children learn to gradually face their fears (exposure) without giving in to their compulsions (response prevention). Through this process, children acquire the skills to tackle their OCD and develop the ability to tolerate uncomfortable feelings and thoughts rather than perform rituals. Antidepressants that also address anxiety (e.g., Zoloft, Prozac) have been found helpful in reducing OCD symptoms in children and teens where the child’s symptoms are particularly severe or have not been helped by ERP alone. In addition to individual ERP treatment, there are many support groups and group therapy options available for children and teens, as well as their family members

When a child suffers from OCD, often the whole family is affected. Parents can play a critical role in their child’s treatment by learning how to encourage their child’s regular practice of exposure, gradually reducing accommodation of OCD behaviors, helping to decrease avoidance and progressively lessoning reassurance provided to the child. There are many great resources available online for parents which address pediatric OCD including The International OCD Foundation and the Child Mind Institute.

For additional information or to learn about services, including individual therapy and groups, offered for OCD, contact NeuroScience, Inc.


Dr. Erin Kardel, a well-respected and highly credentialed clinician, earned her Doctoral Degree in Clinical Psychology from The George Washington University and her Master’s Degree in Clinical Psychology from American University. Today, Dr. Kardel is a licensed Clinical Psychologist at NeuroScience, Inc. (NSI), a Herndon, VA-based practice where she specializes in Cognitive Behavioral Therapy (CBT) and also serves as an investigator for NSI’s qualitative and medication research studies. Her CBT treatment emphasizes behavioral interventions, such as exposure and response prevention (ERP), and biofeedback, as well as collaboration with families, schools, and health providers to ensure patient-first success.

As an expert in CBT and mindfulness-based cognitive behavior therapy (MBCBT), Dr. Kardel’s work experience and specialized training make her an asset to the NeuroScience, Inc. team. Dr. Kardel is an expert in multiple areas, including OCD, phobias, panic disorder, generalized anxiety disorder, adjustment disorder, social anxiety disorder, depression, ADHD, trichotillomania, and insomnia.

Dr. Kardel has worked with children, adolescents, and adults in a variety of settings throughout her career and she is ready to help you or your loved ones meet their goals.

To schedule a consultation or appointment with Dr. Erin Kardel, please call (703) 787-9090. NeuroScience is located at 106 Elden St., Herndon, VA 20170. Learn more, including what insurances NeuroScience accepts, by connecting onlineFacebook, and Twitter.


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