How to Recognize Signs of OCD in Children

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Table of Contents

Characteristics

Diagnosis

Causes

Treatment

Coping

Frequently Asked Questions

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OCD in toddlers and children shares similarities with adult OCD, but there are important differences as well.Obsessive-compulsive disorder(OCD) doesn’t just affect adults; in fact, between 0.25% and 4% of children develop OCD.The average age of onset of childhood OCD is approximately 10 years old, although children as young as 5 can be diagnosed.

While OCD in toddlers is rare, it does happen in some cases. A small percentage of children show symptoms around age 3.

If you are concerned about your child’s behavior, knowing the signs of OCD in toddlers and children may help. Learn more about the signs, what triggers OCD in a child, and what you can do to help.

Characteristics of OCD in Toddlers and Children

ObsessionsThoughts, images, or ideas that won’t go away, are unwanted, and are extremely distressing or worryingCompulsionsBehaviors that the child feels they must do repeatedly to relieve anxiety

ObsessionsThoughts, images, or ideas that won’t go away, are unwanted, and are extremely distressing or worrying

Thoughts, images, or ideas that won’t go away, are unwanted, and are extremely distressing or worrying

CompulsionsBehaviors that the child feels they must do repeatedly to relieve anxiety

Behaviors that the child feels they must do repeatedly to relieve anxiety

OCD was formerly classified as an anxiety disorder because the obsessive thoughts characteristic of the condition can lead to severe anxiety. The compulsions or rituals performed are typically an attempt to reduce this anxiety. However, the most recent edition of theDiagnostic and Statistical Manual of Mental Disorders(DSM-5) moved OCD to its own class of “Obsessive-Compulsive and Related Disorders.”

OCD is said to be childhood-onset if obsessions and compulsions occur before puberty. Interestingly, although childhood OCD more commonly affects boys, this trend reverses after puberty.Likewise, boys with childhood-onset OCD appear to be at greater risk for related conditions, including tic disorders.

Children with OCD often have less insight into their obsessions than adults and lack the capacity to understand the irrationality of their thoughts. This, combined with limited and/or developing verbal ability, can make properdiagnosisdifficult.

A child’s obsessions and compulsions often differ from those of adults.

Identifying OCD in Children

The signs and symptoms of OCD in children can be categorized as obsessions and compulsions. Common obsessions among children with OCD include:

Compulsions are often (but not always) related to obsessions. For example, if the child fears germs, they may be compelled to wash their hands repeatedly. Common compulsions among children with OCD include:

OCD can co-exist with (and also be mistaken for) other disorders that include rigid routines and/or repetitive behaviors or rituals, such as:

Understanding the motivations of a child’s behavior is key to a proper diagnosis.

Causes of OCD in Toddlers and Children

What triggers OCD in a child? Although the exact causes of OCD in children are unknown, researchers believe several factors play a role, including brain structure, early trauma, genetics, and stress.

In a recent study, children and adolescents showed a worsening of OCD, anxiety, and depressive symptoms related to the COVID-19 pandemic and associated trauma.

Sudden-Onset OCD

The PANDAS form of OCD has a few key characteristics that help doctors distinguish it from more typical forms of childhood OCD; these include the rapid onset of symptoms. Research has shown that only those children who are genetically predisposed to OCD or tics are vulnerable to developing this form of OCD. The PANDAS form of OCD can require different treatment.

If your child is struggling with OCD, contact theSubstance Abuse and Mental Health Services Administration (SAMHSA) National Helplineat1-800-662-4357for information on support and treatment facilities in your area.

OCD Treatment in Children

Seeking professional treatment is the most effective thing you can do to help your child with OCD. In most cases, the recommended treatment for childhood-onset OCD combines individual or groupcognitive behavioral therapy(CBT) with medications that increase levels ofserotonin, such as selective serotonin reuptake inhibitors (SSRIs).

What Is Serotonin?Serotonin (also known as 5-hydroxytryptamine or 5-HT) is aneurotransmitterthat carries signals between neurons throughout the body. It helps with mood regulation, memory, and other bodily functions. The intestines, not the brain, produce most of the body’s serotonin supply.

What Is Serotonin?

Serotonin (also known as 5-hydroxytryptamine or 5-HT) is aneurotransmitterthat carries signals between neurons throughout the body. It helps with mood regulation, memory, and other bodily functions. The intestines, not the brain, produce most of the body’s serotonin supply.

Cognitive Behavioral Therapy

One of the most popular and effective therapies for OCD is child-modifiedexposure and response prevention therapy(ERP),a type ofcognitive behavioral therapy (CBT). It involves exposing children to the anxiety their obsessions provoke and then preventing the use of rituals to reduce that anxiety. This cycle of exposure and response prevention is repeated until the obsessions and/or compulsions no longer trouble the children.

Exposure Therapy for OCD

Both adults and children with OCD frequently ask others to participate in their compulsions. Family members often oblige to reduce their loved one’s anxiety, especially when the person is a child. For treatment to work, compulsions must stop, and family members must be aware of this.

When undertaking CBT with children, parents must be educated and involved. Research suggests that parental involvement is a strong predictor of CBT success.

Medications

In severe cases of childhood OCD, treatment may include a combination of CBT and medications such as SSRIs to help reduce a child’s anxiety. However, these drugs must be used cautiously in children and adolescents because they can increase the risk of suicide.

If your child is having suicidal thoughts, contact theNational Suicide Prevention Lifelineat988for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911. For more mental health resources, see ourNational Helpline Database.

Three SSRIs are FDA-approved for use in children and adolescents with OCD:

Coping With OCD in Toddlers and Children

Other strategies you can try:

Dealing With Your Teen Who Has OCD

A Word From Verywell

Never give up hope. Although there’s no cure for OCD, many effective treatments are available. If the first strategy doesn’t work, keep trying; sometimes, it’s simply a matter of finding the right therapist or combination of medication and psychotherapy.

With the proper treatment, many children find relief from their symptoms and learn coping strategies to thrive in daily life. If you think your child may have OCD, talk to your physician as soon as possible.

Frequently Asked QuestionsBetween 0.25% and 4% of children develop OCD.Although kids as young as 5 can be diagnosed, the average age of onset is 10. Rarely, OCD occurs in kids even earlier—as young as 3.Childhood OCD occurs more often in boys than in girls, whereas the ratio evens out in adults. The symptoms appear gradually and are more severe in early-onset OCD than in late-onset OCD.Learn More:Early- vs. Late-Onset OCDMany forms of trauma can trigger OCD, including infections. However, researchers have found that physical abuse, sexual abuse, neglect, and family disruption were most likely to activate OCD in kids.The first, most important step is educating yourself and other family members. It’s also important to stay involved with your child’s OCD treatment, keep the environment positive and accepting, resist enabling compulsions, and remain open to new treatment options.There is no single factor that causes OCD. It is the result of a complex interaction of influences, including genetics, experiences, personality, environment, and stress.OCD is a chronic condition, so childhood OCD rarely just goes away on its own. According to one study, only around 4% of people with OCD experience a remission in their symptoms without treatment.However, symptoms may improve over time as a person ages and with appropriate treatment. Learning effective coping skills can also help people cope with symptoms that may worsen during times of stress. One recent meta-analysis found that 62% of children and teens with OCD were able to achieve remission with treatment.Research has found that maladaptive parenting is associated with OCD. Two factors in particular, overprotection and rejection, are linked to an increased risk for OCD.However, it is important to remember that OCD is likely linked to multiple influences, including genetics and stressful life events.

Between 0.25% and 4% of children develop OCD.Although kids as young as 5 can be diagnosed, the average age of onset is 10. Rarely, OCD occurs in kids even earlier—as young as 3.

Childhood OCD occurs more often in boys than in girls, whereas the ratio evens out in adults. The symptoms appear gradually and are more severe in early-onset OCD than in late-onset OCD.Learn More:Early- vs. Late-Onset OCD

Childhood OCD occurs more often in boys than in girls, whereas the ratio evens out in adults. The symptoms appear gradually and are more severe in early-onset OCD than in late-onset OCD.

Learn More:Early- vs. Late-Onset OCD

Many forms of trauma can trigger OCD, including infections. However, researchers have found that physical abuse, sexual abuse, neglect, and family disruption were most likely to activate OCD in kids.

The first, most important step is educating yourself and other family members. It’s also important to stay involved with your child’s OCD treatment, keep the environment positive and accepting, resist enabling compulsions, and remain open to new treatment options.

There is no single factor that causes OCD. It is the result of a complex interaction of influences, including genetics, experiences, personality, environment, and stress.

OCD is a chronic condition, so childhood OCD rarely just goes away on its own. According to one study, only around 4% of people with OCD experience a remission in their symptoms without treatment.However, symptoms may improve over time as a person ages and with appropriate treatment. Learning effective coping skills can also help people cope with symptoms that may worsen during times of stress. One recent meta-analysis found that 62% of children and teens with OCD were able to achieve remission with treatment.

Research has found that maladaptive parenting is associated with OCD. Two factors in particular, overprotection and rejection, are linked to an increased risk for OCD.However, it is important to remember that OCD is likely linked to multiple influences, including genetics and stressful life events.

Childhood Anxiety Symptoms Parents Should Know About

20 SourcesVerywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Krebs G, Heyman I.Obsessive-compulsive disorder in children and adolescents.Arch Dis Child.2015;100(5):495-9. doi:10.1136/archdischild-2014-306934Garcia AM, Freeman JB, Himle MB, et al.Phenomenology of early childhood onset obsessive compulsive disorder.J Psychopathol Behav Assess. 2009;31(2):104-111. doi:10.1007/s10862-008-9094-0Mathes BM, Morabito DM, Schmidt NB.Epidemiological and clinical gender differences in OCD.Curr Psychiatry Rep. 2019;21(5):36. doi:10.1007/s11920-019-1015-2Kalra SK, Swedo SE.Children with obsessive-compulsive disorder: are they just “little adults”?.J Clin Invest. 2009;119(4):737-746. doi:10.1172/JCI37563Boileau B.A review of obsessive-compulsive disorder in children and adolescents.Dialogues Clin Neurosci. 2011;13(4):401-411. doi:10.31887/DCNS.2011.13.4/bboileauCedars Sinai.Obsessive-compulsive disorder (OCD) in children.Sinopoli VM, Burton CL, Kronenberg S, Arnold PD.A review of the role of serotonin system genes in obsessive-compulsive disorder.Neurosci Biobehav Rev. 2017;80:372‐381. doi:10.1016/j.neubiorev.2017.05.029Barzilay R, Patrick A, Calkins ME, Moore TM, Gur RC, Gur RE.Association between early‐life trauma and obsessive compulsive symptoms in community youth.Depress Anxiety. 2019;36(7):586-595. doi:10.1002/da.22907OCD Working Group of the Psychiatric Genomics Consortium, Burton CL, Lemire M, et al.Genome-wide association study of pediatric obsessive-compulsive traits: Shared genetic risk between traits and disorder.Transl Psychiatry. 2021;11(1):91. doi:10.1038/s41398-020-01121-9Nissen JB, Højgaard DRMA, Thomsen PH.The immediate effect of COVID-19 pandemic on children and adolescents with obsessive compulsive disorder.BMC Psychiatry. 2020;20(1):511. doi:10.1186/s12888-020-02905-5Jaspers-Fayer F, Han SHJ, Chan E, et al.Prevalence of acute-onset subtypes in pediatric obsessive-compulsive disorder.J Child Adolesc Psychopharmacol.2017;27(4):332-341. doi:10.1089/cap.2016.0031Sigra S, Hesselmark E, Bejerot S.Treatment of PANDAS and PANS: A systematic review.Neurosci Biobehav Rev. 2018;86:51-65. doi:10.1016/j.neubiorev.2018.01.001Yano JM, Yu K, Donaldson GP, et al.Indigenous bacteria from the gut microbiota regulate host serotonin biosynthesis.Cell. 2015;161(2):264-276. doi:10.1016/j.cell.2015.02.047Hezel DM, Simpson HB.Exposure and response prevention for obsessive-compulsive disorder: A review and new directions.Indian J Psychiatry.2019;61(Suppl 1):S85-S92. doi:10.4103/psychiatry.IndianJPsychiatry_516_18Walczak M, Esbjorn BH, Breinholst S, Reinholdt-Dunne ML.Parental involvement in cognitive behavior therapy for children with anxiety disorders: 3-year follow up.Child Psychiatry Hum Dev. 2017;45(3):444-454. doi:10.1007/s10578-016-0671-2Cooper WO, Callahan ST, Shintani A, et al.Antidepressants and suicide attempts in children.Pediatrics. 2014;133(2):204-10. doi:10.1542/peds.2013-0923Vidal-Ribas P, Stringaris A, Rück C, Serlachius E, Lichtenstein P, Mataix-Cols D.Are stressful life events causally related to the severity of obsessive-compulsive symptoms? A monozygotic twin difference study.Eur Psychiatry. 2015;30(2):309-316. doi:10.1016/j.eurpsy.2014.11.008Melkonian M, McDonald S, Scott A, Karin E, Dear BF, Wootton BM.Symptom improvement and remission in untreated adults seeking treatment for obsessive-compulsive disorder: A systematic review and meta-analysis.Journal of Affective Disorders. 2022;318:175-184.doi:10.1016/j.jad.2022.08.037Liu J, Cui Y, Yu L, et al.Long-term outcome of pediatric obsessive-compulsive disorder: A meta-analysis.Journal of Child and Adolescent Psychopharmacology. 2021;31(2):95-101.doi:10.1089/cap.2020.0051Krebs GC, Hannigan LJ, Gregory AM, Rijsdijk FV, Maughan B, Eley TC.Are punitive parenting and stressful life events environmental risk factors for obsessive-compulsive symptoms in youth? A longitudinal twin study.Eur Psychiatry. 2019;56:35-42. doi:10.1016/j.eurpsy.2018.11.004

20 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Krebs G, Heyman I.Obsessive-compulsive disorder in children and adolescents.Arch Dis Child.2015;100(5):495-9. doi:10.1136/archdischild-2014-306934Garcia AM, Freeman JB, Himle MB, et al.Phenomenology of early childhood onset obsessive compulsive disorder.J Psychopathol Behav Assess. 2009;31(2):104-111. doi:10.1007/s10862-008-9094-0Mathes BM, Morabito DM, Schmidt NB.Epidemiological and clinical gender differences in OCD.Curr Psychiatry Rep. 2019;21(5):36. doi:10.1007/s11920-019-1015-2Kalra SK, Swedo SE.Children with obsessive-compulsive disorder: are they just “little adults”?.J Clin Invest. 2009;119(4):737-746. doi:10.1172/JCI37563Boileau B.A review of obsessive-compulsive disorder in children and adolescents.Dialogues Clin Neurosci. 2011;13(4):401-411. doi:10.31887/DCNS.2011.13.4/bboileauCedars Sinai.Obsessive-compulsive disorder (OCD) in children.Sinopoli VM, Burton CL, Kronenberg S, Arnold PD.A review of the role of serotonin system genes in obsessive-compulsive disorder.Neurosci Biobehav Rev. 2017;80:372‐381. doi:10.1016/j.neubiorev.2017.05.029Barzilay R, Patrick A, Calkins ME, Moore TM, Gur RC, Gur RE.Association between early‐life trauma and obsessive compulsive symptoms in community youth.Depress Anxiety. 2019;36(7):586-595. doi:10.1002/da.22907OCD Working Group of the Psychiatric Genomics Consortium, Burton CL, Lemire M, et al.Genome-wide association study of pediatric obsessive-compulsive traits: Shared genetic risk between traits and disorder.Transl Psychiatry. 2021;11(1):91. doi:10.1038/s41398-020-01121-9Nissen JB, Højgaard DRMA, Thomsen PH.The immediate effect of COVID-19 pandemic on children and adolescents with obsessive compulsive disorder.BMC Psychiatry. 2020;20(1):511. doi:10.1186/s12888-020-02905-5Jaspers-Fayer F, Han SHJ, Chan E, et al.Prevalence of acute-onset subtypes in pediatric obsessive-compulsive disorder.J Child Adolesc Psychopharmacol.2017;27(4):332-341. doi:10.1089/cap.2016.0031Sigra S, Hesselmark E, Bejerot S.Treatment of PANDAS and PANS: A systematic review.Neurosci Biobehav Rev. 2018;86:51-65. doi:10.1016/j.neubiorev.2018.01.001Yano JM, Yu K, Donaldson GP, et al.Indigenous bacteria from the gut microbiota regulate host serotonin biosynthesis.Cell. 2015;161(2):264-276. doi:10.1016/j.cell.2015.02.047Hezel DM, Simpson HB.Exposure and response prevention for obsessive-compulsive disorder: A review and new directions.Indian J Psychiatry.2019;61(Suppl 1):S85-S92. doi:10.4103/psychiatry.IndianJPsychiatry_516_18Walczak M, Esbjorn BH, Breinholst S, Reinholdt-Dunne ML.Parental involvement in cognitive behavior therapy for children with anxiety disorders: 3-year follow up.Child Psychiatry Hum Dev. 2017;45(3):444-454. doi:10.1007/s10578-016-0671-2Cooper WO, Callahan ST, Shintani A, et al.Antidepressants and suicide attempts in children.Pediatrics. 2014;133(2):204-10. doi:10.1542/peds.2013-0923Vidal-Ribas P, Stringaris A, Rück C, Serlachius E, Lichtenstein P, Mataix-Cols D.Are stressful life events causally related to the severity of obsessive-compulsive symptoms? A monozygotic twin difference study.Eur Psychiatry. 2015;30(2):309-316. doi:10.1016/j.eurpsy.2014.11.008Melkonian M, McDonald S, Scott A, Karin E, Dear BF, Wootton BM.Symptom improvement and remission in untreated adults seeking treatment for obsessive-compulsive disorder: A systematic review and meta-analysis.Journal of Affective Disorders. 2022;318:175-184.doi:10.1016/j.jad.2022.08.037Liu J, Cui Y, Yu L, et al.Long-term outcome of pediatric obsessive-compulsive disorder: A meta-analysis.Journal of Child and Adolescent Psychopharmacology. 2021;31(2):95-101.doi:10.1089/cap.2020.0051Krebs GC, Hannigan LJ, Gregory AM, Rijsdijk FV, Maughan B, Eley TC.Are punitive parenting and stressful life events environmental risk factors for obsessive-compulsive symptoms in youth? A longitudinal twin study.Eur Psychiatry. 2019;56:35-42. doi:10.1016/j.eurpsy.2018.11.004

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Krebs G, Heyman I.Obsessive-compulsive disorder in children and adolescents.Arch Dis Child.2015;100(5):495-9. doi:10.1136/archdischild-2014-306934Garcia AM, Freeman JB, Himle MB, et al.Phenomenology of early childhood onset obsessive compulsive disorder.J Psychopathol Behav Assess. 2009;31(2):104-111. doi:10.1007/s10862-008-9094-0Mathes BM, Morabito DM, Schmidt NB.Epidemiological and clinical gender differences in OCD.Curr Psychiatry Rep. 2019;21(5):36. doi:10.1007/s11920-019-1015-2Kalra SK, Swedo SE.Children with obsessive-compulsive disorder: are they just “little adults”?.J Clin Invest. 2009;119(4):737-746. doi:10.1172/JCI37563Boileau B.A review of obsessive-compulsive disorder in children and adolescents.Dialogues Clin Neurosci. 2011;13(4):401-411. doi:10.31887/DCNS.2011.13.4/bboileauCedars Sinai.Obsessive-compulsive disorder (OCD) in children.Sinopoli VM, Burton CL, Kronenberg S, Arnold PD.A review of the role of serotonin system genes in obsessive-compulsive disorder.Neurosci Biobehav Rev. 2017;80:372‐381. doi:10.1016/j.neubiorev.2017.05.029Barzilay R, Patrick A, Calkins ME, Moore TM, Gur RC, Gur RE.Association between early‐life trauma and obsessive compulsive symptoms in community youth.Depress Anxiety. 2019;36(7):586-595. doi:10.1002/da.22907OCD Working Group of the Psychiatric Genomics Consortium, Burton CL, Lemire M, et al.Genome-wide association study of pediatric obsessive-compulsive traits: Shared genetic risk between traits and disorder.Transl Psychiatry. 2021;11(1):91. doi:10.1038/s41398-020-01121-9Nissen JB, Højgaard DRMA, Thomsen PH.The immediate effect of COVID-19 pandemic on children and adolescents with obsessive compulsive disorder.BMC Psychiatry. 2020;20(1):511. doi:10.1186/s12888-020-02905-5Jaspers-Fayer F, Han SHJ, Chan E, et al.Prevalence of acute-onset subtypes in pediatric obsessive-compulsive disorder.J Child Adolesc Psychopharmacol.2017;27(4):332-341. doi:10.1089/cap.2016.0031Sigra S, Hesselmark E, Bejerot S.Treatment of PANDAS and PANS: A systematic review.Neurosci Biobehav Rev. 2018;86:51-65. doi:10.1016/j.neubiorev.2018.01.001Yano JM, Yu K, Donaldson GP, et al.Indigenous bacteria from the gut microbiota regulate host serotonin biosynthesis.Cell. 2015;161(2):264-276. doi:10.1016/j.cell.2015.02.047Hezel DM, Simpson HB.Exposure and response prevention for obsessive-compulsive disorder: A review and new directions.Indian J Psychiatry.2019;61(Suppl 1):S85-S92. doi:10.4103/psychiatry.IndianJPsychiatry_516_18Walczak M, Esbjorn BH, Breinholst S, Reinholdt-Dunne ML.Parental involvement in cognitive behavior therapy for children with anxiety disorders: 3-year follow up.Child Psychiatry Hum Dev. 2017;45(3):444-454. doi:10.1007/s10578-016-0671-2Cooper WO, Callahan ST, Shintani A, et al.Antidepressants and suicide attempts in children.Pediatrics. 2014;133(2):204-10. doi:10.1542/peds.2013-0923Vidal-Ribas P, Stringaris A, Rück C, Serlachius E, Lichtenstein P, Mataix-Cols D.Are stressful life events causally related to the severity of obsessive-compulsive symptoms? A monozygotic twin difference study.Eur Psychiatry. 2015;30(2):309-316. doi:10.1016/j.eurpsy.2014.11.008Melkonian M, McDonald S, Scott A, Karin E, Dear BF, Wootton BM.Symptom improvement and remission in untreated adults seeking treatment for obsessive-compulsive disorder: A systematic review and meta-analysis.Journal of Affective Disorders. 2022;318:175-184.doi:10.1016/j.jad.2022.08.037Liu J, Cui Y, Yu L, et al.Long-term outcome of pediatric obsessive-compulsive disorder: A meta-analysis.Journal of Child and Adolescent Psychopharmacology. 2021;31(2):95-101.doi:10.1089/cap.2020.0051Krebs GC, Hannigan LJ, Gregory AM, Rijsdijk FV, Maughan B, Eley TC.Are punitive parenting and stressful life events environmental risk factors for obsessive-compulsive symptoms in youth? A longitudinal twin study.Eur Psychiatry. 2019;56:35-42. doi:10.1016/j.eurpsy.2018.11.004

Krebs G, Heyman I.Obsessive-compulsive disorder in children and adolescents.Arch Dis Child.2015;100(5):495-9. doi:10.1136/archdischild-2014-306934

Garcia AM, Freeman JB, Himle MB, et al.Phenomenology of early childhood onset obsessive compulsive disorder.J Psychopathol Behav Assess. 2009;31(2):104-111. doi:10.1007/s10862-008-9094-0

Mathes BM, Morabito DM, Schmidt NB.Epidemiological and clinical gender differences in OCD.Curr Psychiatry Rep. 2019;21(5):36. doi:10.1007/s11920-019-1015-2

Kalra SK, Swedo SE.Children with obsessive-compulsive disorder: are they just “little adults”?.J Clin Invest. 2009;119(4):737-746. doi:10.1172/JCI37563

Boileau B.A review of obsessive-compulsive disorder in children and adolescents.Dialogues Clin Neurosci. 2011;13(4):401-411. doi:10.31887/DCNS.2011.13.4/bboileau

Cedars Sinai.Obsessive-compulsive disorder (OCD) in children.

Sinopoli VM, Burton CL, Kronenberg S, Arnold PD.A review of the role of serotonin system genes in obsessive-compulsive disorder.Neurosci Biobehav Rev. 2017;80:372‐381. doi:10.1016/j.neubiorev.2017.05.029

Barzilay R, Patrick A, Calkins ME, Moore TM, Gur RC, Gur RE.Association between early‐life trauma and obsessive compulsive symptoms in community youth.Depress Anxiety. 2019;36(7):586-595. doi:10.1002/da.22907

OCD Working Group of the Psychiatric Genomics Consortium, Burton CL, Lemire M, et al.Genome-wide association study of pediatric obsessive-compulsive traits: Shared genetic risk between traits and disorder.Transl Psychiatry. 2021;11(1):91. doi:10.1038/s41398-020-01121-9

Nissen JB, Højgaard DRMA, Thomsen PH.The immediate effect of COVID-19 pandemic on children and adolescents with obsessive compulsive disorder.BMC Psychiatry. 2020;20(1):511. doi:10.1186/s12888-020-02905-5

Jaspers-Fayer F, Han SHJ, Chan E, et al.Prevalence of acute-onset subtypes in pediatric obsessive-compulsive disorder.J Child Adolesc Psychopharmacol.2017;27(4):332-341. doi:10.1089/cap.2016.0031

Sigra S, Hesselmark E, Bejerot S.Treatment of PANDAS and PANS: A systematic review.Neurosci Biobehav Rev. 2018;86:51-65. doi:10.1016/j.neubiorev.2018.01.001

Yano JM, Yu K, Donaldson GP, et al.Indigenous bacteria from the gut microbiota regulate host serotonin biosynthesis.Cell. 2015;161(2):264-276. doi:10.1016/j.cell.2015.02.047

Hezel DM, Simpson HB.Exposure and response prevention for obsessive-compulsive disorder: A review and new directions.Indian J Psychiatry.2019;61(Suppl 1):S85-S92. doi:10.4103/psychiatry.IndianJPsychiatry_516_18

Walczak M, Esbjorn BH, Breinholst S, Reinholdt-Dunne ML.Parental involvement in cognitive behavior therapy for children with anxiety disorders: 3-year follow up.Child Psychiatry Hum Dev. 2017;45(3):444-454. doi:10.1007/s10578-016-0671-2

Cooper WO, Callahan ST, Shintani A, et al.Antidepressants and suicide attempts in children.Pediatrics. 2014;133(2):204-10. doi:10.1542/peds.2013-0923

Vidal-Ribas P, Stringaris A, Rück C, Serlachius E, Lichtenstein P, Mataix-Cols D.Are stressful life events causally related to the severity of obsessive-compulsive symptoms? A monozygotic twin difference study.Eur Psychiatry. 2015;30(2):309-316. doi:10.1016/j.eurpsy.2014.11.008

Melkonian M, McDonald S, Scott A, Karin E, Dear BF, Wootton BM.Symptom improvement and remission in untreated adults seeking treatment for obsessive-compulsive disorder: A systematic review and meta-analysis.Journal of Affective Disorders. 2022;318:175-184.

doi:10.1016/j.jad.2022.08.037

Liu J, Cui Y, Yu L, et al.Long-term outcome of pediatric obsessive-compulsive disorder: A meta-analysis.Journal of Child and Adolescent Psychopharmacology. 2021;31(2):95-101.

doi:10.1089/cap.2020.0051

Krebs GC, Hannigan LJ, Gregory AM, Rijsdijk FV, Maughan B, Eley TC.Are punitive parenting and stressful life events environmental risk factors for obsessive-compulsive symptoms in youth? A longitudinal twin study.Eur Psychiatry. 2019;56:35-42. doi:10.1016/j.eurpsy.2018.11.004

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