The most successful treatments for children with OCD are behavioral therapy and medication. Cognitive-behavioral psychotherapy (CBT) helps children learn to change their thoughts and feelings by first changing their behavior. CBT involves exposure, or exposing the child to his fears to decrease his anxiety about it. For example, a child who is afraid of dirt might be exposed to something he considers dirty until he no longer fears it.

For exposure to be successful, it is often combined with response prevention, in which the child's rituals or avoidance behaviors are blocked. For example, the child who fears dirt must not only stay in contact with the dirty object, he also must not be allowed to wash repeatedly. Some treatment plans involve having the child "bossing back" the OCD, giving it a nasty nickname, and visualizing it as something the child can control.

Behavioral treatment with children works best when the whole family is involved, according to Dr. Sheslow. "Treating children from a behavioral perspective requires a high degree of cooperation," he says. "Without a considerable amount of family support, you won't have a high rate of success. Because cognitive behavioral treatments often provoke considerable anxiety, a good deal of support is needed. As well, it is important to find a therapist who knows about how to treat OCD. OCD can worsen if not treated in a consistent, logical, and supportive manner."

Medication is often combined with CBT to get more complete and lasting results. Research shows that selective serotonin reuptake inhibitors (SSRIs) are most effective in children with OCD. These include medications such as fluoxetine, fluvoxamine, paroxetine, and sertaline. Another medication that may be prescribed is clomipramine. Most experts agree that medication should be used to treat children as a second choice to CBT. "Medication often can reduce the impulse to engage in ritualistic behavior. Therapy will help the child and family learn strategies to manage the waxing and waning of OCD symptoms," Dr. Sheslow says.

"Many children can do well with CBT alone, others will need a combination of behavioral therapy and medication. It's important to use the treatments appropriately to avoid the long-term adverse effects of OCD on children's development," Dr. March says.

How Can I Help My Child?

Parents and children should understand that OCD is never the child's fault. Once a child is in treatment, parents are encouraged to participate, to learn more about OCD, and modify their expectations and be supportive. You need to realize that kids get better at different rates and day-to-day comparisons of your child's behaviors should be avoided. Small improvements should be recognized and praised.

"It is rare to find a child with OCD without finding a family with OCD," Dr. Sheslow says.

Your entire family should be educated and supportive at all times. The more personal criticism can be avoided, the better. Members of your family should keep in mind that it's the OCD that is causing the problem, not the child. Family routines should be kept as normal as possible, family members should learn strategies to approach members with OCD, and if your child is on medication, the regime should never waver.

It's not surprising that many people keep this disorder hidden. "This is not something that people want to advertise; there's an embarrassment about it," says Dr. Sheslow, who explains that OCD is different from other disorders, such as a fear of dogs, for example. Other disorders are easier for people to talk about than OCD.

Updated and reviewed by: Lori Kasmen, PsyD
Date reviewed: October 2001
Originally reviewed by: Paul Robins, PhD