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Children with obsessive-compulsive disorder may feel driven to wash their hands repeatedly, check something several times, count to a certain number, repeat words in their head or avoid certain situations because resisting the compulsion causes anxiety.
Over time, these obsessive thoughts and rituals can interfere with school, sleep, friendships and family life. They can also be difficult for children to understand or explain, especially when the thoughts and urges feel like something they have to obey.
One way families can make these experiences easier to talk about is by giving OCD a name, like the “OCD Monster.” The metaphor helps children see that the intrusive thoughts, fears, urges and compulsions are symptoms of OCD, not a reflection of who they are.
For Dr. Steve Tutty is a licensed clinical psychologist specializing in child, forensic and neuropsychology, he has more than 25 years of clinical and forensic practice and more than 20 years of experience teaching, researching and publishing in clinical psychology.
Dr. Tutty has evaluated and treated more than 2,300 children and adolescents, including children with ADHD, autism and twice exceptionality. His work focuses on determining why a child is struggling before drawing conclusions about what their symptoms mean.
With childhood OCD, that might mean looking at the thoughts and compulsions themselves, how often they occur, how upsetting they are and the ways they affect a child’s daily life.
Recognizing the Signs of OCD in Children
Repetitive behaviors alone do not mean that a child has OCD. Children can have routines, worries and strong preferences for many reasons.
OCD may be more likely when unwanted thoughts or compulsions take up a significant amount of time, cause notable discomfort or interfere with everyday life.
Obsessions can involve fears about contamination, illness, harm, mistakes or something bad happening. Compulsions can include washing, checking, counting, arranging objects, seeking reassurance, mentally reviewing events or repeating words in the mind. Some are easy for parents to see, while others happen almost entirely in the child’s thoughts.
Compulsions often provide temporary relief from the uncertainty caused by an obsession. For example, a child who repeatedly checks a locked door may worry that someone will get inside if they do not check. Checking might ease that fear briefly, but once the doubt returns, the urge to check comes back with it.
That cycle helps explain elements of the “OCD Monster” metaphor. A child may know that a ritual is frustrating or exhausting and still feel unable to stop. Understanding the fear or uncertainty behind the ritual can help parents see why the behavior keeps happening instead of focusing only on the behavior itself.
Seeing More Than the Symptoms
Dr. Tutty’s approach to pediatric psychology looks beyond the behavior adults notice first. His evaluations consider a child’s physical, cognitive, emotional, and social development, from the prenatal period through the child’s current age.
His background in child neuropsychology also helps him identify cognitive and learning differences that could be contributing to a child’s difficulties. When appropriate, testing can assess areas such as memory, language processing, executive functioning (e.g., planning, organizing, executing, etc.), and emerging personality traits.
Dr. Tutty recalls working with a middle-school student named Joey, whose parents and teachers initially viewed his refusal to show his work as defiance. A comprehensive evaluation revealed something very different: Joey had dysgraphia, very superior cognitive ability and visual memory that was about twice as strong as his auditory memory.
Those findings changed how the adults around him understood and supported him. Teachers paired spoken information with visual cues, including pictures, videos and physical objects. Joey also received voice-to-text accommodations instead of having to write everything by hand.
His workload was reduced so he could demonstrate his knowledge without completing repetitive problems. He also moved into an advanced learner track and began teaching material he had already mastered to peers in small groups.
Joey did not have OCD, but his story shows why Dr. Tutty looks beyond the behaviors. With OCD, a repeated behavior or ritual might be a clue, but understanding the thought, fear or urge behind it gives parents and clinicians more useful information about what the child is experiencing and forecasting.
Supporting Children Without Feeding Their Fears
Childhood OCD often affects the whole family because parents naturally want to help when their child is struggling and the behaviors (e.g., checking, washing, counting, etc.) often disrupts the family routines.
A child might ask the same question repeatedly because reassurance brings temporary relief. Their family may change plans to avoid a trigger, remove things the child is afraid of from the home or take part in rituals because it calms the child down.
When these responses become routine, they can unintentionally reinforce OCD, a pattern known as family accommodation. Parents might not notice it at first because they are trying to calm their upset child, but eventually, more of the family’s day begins to revolve around avoiding their child’s OCD triggers or helping their child complete the compulsive acts even if the relief is temporary.
In contrast, children suffering from OCD, and their family members, can benefit from cognitive behavioral therapy (CBT), particularly exposure and response prevention (ERP), which is one of the most effective treatments for OCD. ERP teaches children to gradually face situations, thoughts or feelings that trigger their fears while resisting the compulsions they would normally use to feel better.
When parents are involved in treatment, they can learn when and how OCD is driving their child’s need for reassurance, while responding in a consistent way to support the skills their child learned in therapy to practice at home and at school.
Putting Evidence Before Assumptions
As a scientist-practitioner, Dr. Steve Tutty has spent more than two decades conducting clinical research in areas including depression, ADHD and telephone-based mental health treatment. He brings that research into his clinical work, using evidence-based psychology to help guide evaluation and treatment decisions.
“Evidence based care is applying science into clinical practice, rather than just providing talk therapy,” he said. Tutty stated that “while talking with a counselor or a psychologist can be helpful for validating your experience, skills are needed between sessions to promote lasting change.”
In 2000, Dr. Tutty and other researchers published a pilot study examining telephone counseling alongside antidepressant treatment in primary care. He later contributed to randomized research on telephone psychotherapy for depression and research involving children with ADHD. His work has appeared in journals like JAMA, Journal of Consulting and Clinical Psychology, General Hospital Psychiatry, Behavior Therapy, and Journal of Developmental and Behavioral Pediatrics.
For families dealing with childhood OCD, that evidence-based perspective matters. Simply telling a child to stop a ritual or reassuring them that their fear will not come true does not stop the OCD cycle. The goal is to understand how OCD is affecting the child and their world, the worse-case scenarios they are entertaining, and how carefully crafted exposure and response prevention experiments can reject the OCD monster.
Separating the Child From the “OCD Monster”
Dr. Steve Tutty’s interest in working with children began during a master’s-level internship at a sexual abuse clinic. During the internship, a supervisor pulled him aside and told him she had never seen children become so comfortable with a clinician.
More than 25 years later, earning a child’s trust remains an important part of his work.
“Trust is the foundation of every relationship, and without it, there is no depth, connection, respect, or understanding, which hinders growth,” he said.
For children with OCD, trust can make it easier to talk about thoughts and behaviors they find frightening or embarrassing.
Children may be afraid to tell an adult about an intrusive thought, admit how often they check something or explain why they feel they have to repeat a ritual. They might also worry that others will think they are strange, bad or responsible for thoughts they cannot control.
A trusting relationship gives the child room to be honest without feeling judged. It also allows the child psychologist to understand what is actually happening behind the curtain, rather than only seeing the behavior on the surface.
Children with OCD do not have to be defined by intrusive thoughts or compulsions. With the right support, they can learn to notice when OCD is driving their thoughts or behavior and how not to feel captive to such demands.
Taming the “OCD Monster,” then, is not about eliminating every unwanted thought. It is about helping a child recognize when that part of their brain takes over without their permission, flushing out the worst-case scenario fears, and respond with carefully crafted experiments to achieve a healthy balance.
Dr. Tutty and his team are currently providing mental health services – counseling and testing/evaluation services – for children, teens, and young adults in Manhattan, New York (Manhattan Child Psychology – https://manhattanchildpsychology.com/), over the next several years, before concluding four decades of service.
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