The following compulsions have been identified as the most common in children and adolescents:

• grooming rituals, including hand washing, showering, and teeth brushing
• repeating rituals, including going in and out of doorways, needing to move through spaces in a special way, checking to make sure that an appliance is off or a door is locked, and checking homework
• rituals to undo contact with a "contaminated" person or object
• touching rituals
• rituals to prevent harming self or others
• ordering or arranging objects
• counting rituals
• hoarding and collecting things
• cleaning rituals related to the house or other items

Signs of OCD in Children

Recognizing OCD in children is often difficult because they become adept at hiding the behaviors. It's not uncommon for a child to engage in ritualistic behavior for months, or even years, before parents know about it. Also, many children do not engage in their rituals at school, so parents may think that this is just a phase their child is going through.

"Kids try to contain their thoughts or behaviors, and this creates anxiety," says David Sheslow, PhD, a pediatric psychologist. "Children experience embarrassment and sometimes feel like they are 'going crazy.' They try to keep it quiet and to blend it into the normal routine of their lives until they can't contain it anymore. This is when the parents become concerned. Even then, parents typically know of only some of their child's ritual thoughts and behaviors.

"The child may ask the parent to join him in the ritualistic behavior: first the child has to do something and then the parent has to do something else. If a child says, 'I didn't touch something with germs, did I?' the parent might have to respond, 'No, you're OK,' and the ritual will begin again for a certain number of times," Dr. Sheslow explains. "Initially, the parents might not notice what is happening. Tantrums, overt signs of worry, and difficult behaviors are common when parents fail to participate in their child's rituals. It is often this behavior, as much as the OCD itself, that brings families into treatment."

Parents can look for the following possible signs of OCD:

• raw, chapped hands from constant washing
• unusually high rate of soap or paper towel usage
• high, unexplained utility bills
• a sudden drop in test grades
• unproductive hours spent doing homework
• holes erased through test papers and homework
• requests for family members to repeat strange phrases or keep answering the same question
• a persistent fear of illness
• a dramatic increase in laundry
• an exceptionally long amount of time spent getting ready for bed
• a continual fear that something terrible will happen to someone
• constant checks of the health of family members
• reluctance to leave the house at the same time as other family members

Environmental and stress factors can signal the onset of OCD. These can include ordinary developmental transitions (such as starting school) as well as significant losses (such as the death of a loved one or moving).