What Parents and Youth Should Know About OCD
Obsessive-Compulsive Disorder (OCD) is often misunderstood and can get confused for anxiety or even attention problems. OCD is more common than previously thought and can be quite disruptive and distressing. About 1 in 50 children experience OCD (an estimate of about 2%).¹ And for the majority of individuals, symptoms of OCD first appear between ages 6 and 12.² OCD can really interfere with daily life, including school, social life and friendships, family life, and sports or other extracurricular activities. While the good news is that Exposure and Response Prevention (ERP) is highly effective for treating OCD, we also know that many children and teens with OCD do not receive this gold standard treatment.³
What is OCD?
OCD is characterized by “obsessions” and/or “compulsions.” Obsessions are thoughts or fears that are difficult to ignore and cause distress or discomfort. Compulsions are rituals or routines that often stem from the intrusive thoughts or fears. Youth with OCD, might feel that their uncomfortable feelings from obsessions temporarily get better after engaging in a compulsion. Unfortunately, the relief is only short-term, and this cycle of OCD can keep youth stuck. Although OCD most often includes both obsessions and compulsions, some youth have symptoms that are predominantly one or the other. A common example of OCD symptoms might be intense fears about germs or contamination, along with cleaning and washing rituals. Still, OCD can look pretty different across lots of youth. Other examples of obsessions might be concern for harm, fear of something bad happening, concern for illness, concern with doing things right, fear of doing something embarrassing, and many others. Compulsions in OCD can also vary—it might be checking locks or backpacks, extensive showering or getting ready rituals, counting, rereading or rewriting, compulsions related to symmetry or arranging things in a certain way, or even tapping or stepping compulsions. It may be useful to think about obsessions as a false alarm signaling danger when there aren’t actually high levels of danger. Compulsions are a response to the perception of danger. Once again, there is good news. We have effective treatment that can disrupt the OCD cycle and help get youth unstuck.
What can help?
Expert guidance based on a large body of research recommends Exposure and Response Prevention (ERP) as the gold standard treatment for OCD.³ ⁴ There are also medications that can be effective in reducing symptoms, typically alongside therapy. For more severe OCD, experts may recommend combined treatment (e.g., ERP and medication together).³ ERP is a specific type of Cognitive-Behavioral Therapy (CBT) that includes exposures. Exposure involves gradually facing fears or obsessions, while preventing or resisting compulsions. With practice, anxiety becomes less intense and confidence grows. A psychologist or therapist can work closely with a family to develop a plan that is the right pace for each individual child or teen.
What does effective treatment (ERP) look like?
The cornerstone of ERP is exposure, though ERP for youth includes other important components.⁵ First, effective treatment will include age-appropriate information about OCD and the rationale for engaging in exposure. Typically called “psychoeducation,” this component of treatment is critical for empowering youth and parents in both understanding the cycle of OCD and engaging in ERP to disrupt that cycle. An evidence-based approach to treating OCD also includes mapping out a “hierarchy” or “ladder” of OCD symptoms. This hierarchy guides treatment by detailing symptoms in an order that allows treatment to progress gradually, beginning with easier exposure steps and climbing the ladder to more difficult challenges as treatment continues and confidence builds. ERP for youth may also include cognitive strategies similar to other CBT interventions, but specific for OCD. Finally, sometimes supporting parents in reducing any accommodation of OCD is needed. A psychologist can work with a family to create a treatment plan with these components. It is important for youth and parents to be aware that ERP is the gold standard treatment for OCD and look or providers who are trained in this approach. Accessing effective treatment is important as it is uncommon for OCD to improve without treatment.⁵
Professional support is available
Brave Minds Psychology Center for Child Anxiety offers evidence-based therapy to support children, teens, young adults, and parents in learning to manage anxiety in order to thrive. Gold standard treatment (ERP) is available for children, teens, and young adults with OCD. Based in Southern California, telehealth services are available for residents across the states of California and Illinois. In-person services are available in Temecula, CA. Contact us for a free consultation.
**The information provided in this post is intended for educational and informational purposes only and does not constitute professional mental health advice, diagnosis, or treatment. It is essential to consult with a qualified mental health professional for any specific concerns or needs.
References
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2. Geller, D.A., & March, J. (2012). Practice parameter for the assessment and treatment of children and adolescents with obsessive-compulsive disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 51(1), 98–113. https://doi.org/10.1016/j.jaac.2011.09.019
3. Farrell, L. J., Waters, A. M., Storch, E. A., Simcock, G., Perkes, I. E., Grisham, J. R., Dyason, K. M., & Ollendick, T. H. (2023). Closing the Gap for Children with OCD: A Staged-Care Model of Cognitive Behavioural Therapy with Exposure and Response Prevention. Clinical child and family psychology review, 26(3), 642–664. https://doi.org/10.1007/s10567-023-00439-2
4. McGuire, J. F., Piacentini, J., Lewin, A. B., Brennan, E. A., Murphy, T. K., & Storch, E. A. (2015). A META-ANALYSIS OF COGNITIVE BEHAVIOR THERAPY AND MEDICATION FOR CHILD OBSESSIVE-COMPULSIVE DISORDER: MODERATORS OF TREATMENT EFFICACY, RESPONSE, AND REMISSION. Depression and anxiety, 32(8), 580–593. https://doi.org/10.1002/da.22389
5. McGuire, J. F., Wu, M. S., Choy, C., & Piacentini, J. (2018). Editorial Perspective: Exposures in cognitive behavior therapy for pediatric obsessive-compulsive disorder: addressing common clinician concerns. Journal of child psychology and psychiatry, and allied disciplines, 59(6), 714–716. https://doi.org/10.1111/jcpp.12818
