Obsessive compulsive disorder (OCD): How to help your child

By SickKids staff

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Learn how to avoid enabling your child's OCD and use limits, consistency and praise to improve symptoms over time.

Key points

Make sure that parents and caregivers take a consistent approach in helping a child manage their OCD.
Accommodation and enabling OCD reinforce the disorder rather than weaken it.
Rewards and brief praise provide important incentives for children to work through their OCD.
Do not model or encourage OCD behaviours in your child.
If you have OCD symptoms, seek your own treatment and be open with your child about it.

Introduction

Helping your child

Managing your child's OCD at home

Set limits

While it is difficult to see your child in distress, it is more difficult for them to recover from OCD if you do not set limits. For instance, if your child tells you that you cannot enter their room unless you change your clothing, a good response is, "I know this is difficult for you, but this is your OCD. I am not going to change my clothes before I enter your room."

Your child will likely experience a "meltdown" or outburst when you start to consistently set limits, but they will also become used to your consistency. Over time, putting boundaries in place will actually help your child feel less anxious.

Be firm

You need to be clear with your child that you are not allowing their OCD to rule and follow through on what you say to them. Remind your child that this is not about hurting or punishing them but about not allowing OCD to control their life or the life of the family.

Being firm means that you will follow through on what you communicate to your child. For example, if you tell them the water is being turned off after 10 minutes, then turn the water off when the time is up. It is very important to be clear and then follow through.

Make sure that your child's other caregivers take the same approach

It is very important for a child with OCD to receive consistent messages from all their caregivers, both inside and outside your immediate family. Inconsistency can make a child with OCD more anxious, confused and insecure.

It is a good idea to agree in advance how you and your child's other caregivers will respond to OCD situations. For instance, if your goal is to reduce a child's repetitive behaviours, you might decide to allow a child to repeat something three times. All caregivers must follow through on this decision and agree on the consequences for your child if they do not obey the rule. If one caregiver is more lenient than others, it can confuse the child and cause them to be distrustful of the process. This inconsistency could then cause the system to break down and fuel the OCD rather than decrease it.

Do not accommodate or enable OCD

Accommodating OCD means that you are taking part in a child's rituals or changing your behaviour to allow them to happen. With accommodation, the main motivation is to not upset your child rather than uphold a ritual that you believe is necessary.

Accommodation can include:

changing your clothes because your child tells you they will be upset if you do not
giving your child 10 kisses instead of just one
allowing your child to take their own cutlery from the drawer
rewashing only the affected child's dishes and using a separate dish towel
wiping furniture before your child sits down
allowing your child to use different soap or barring other family members from a washroom so the affected child can be the only person to use that washroom
giving excessive reassurance
changing your plans because of OCD

When you accommodate isolated symptoms of OCD, you eventually start enabling the disorder. This approach only helps to strengthen or prolong the disorder rather than weaken it. When you enable an obsession, for instance, you essentially reinforce an irrational thought and give it value rather than challenge and discredit it.

Accommodating and enabling OCD send a message to your child that their behaviour is acceptable. Only by refusing to accommodate the disorder can you give your child an incentive to try and fight it.

Praise and reward your child's efforts for managing their OCD

Tackling OCD is challenging, especially when it is more severe. Your child needs to be praised for their efforts and hard work. Praise is one form of a reward that tends to act as an incentive for children to work towards challenging their OCD.

A good way to offer praise is in the form of a simple, clear and concise statement such as "I'm very proud of your effort. You did a great job tackling your OCD". This type of statement only needs to be said once, however. Be careful not to repeat the praise, as it can easily turn into excessive reassurance.

Reinforcements or rewards can also provide an incentive for children to challenge some of their OCD behaviours. You could, for instance, decide that your child can earn rewards for achieving an agreed goal, such as washing hands only once. Some rewards to consider include:

points towards a favourite game
time to play electronics
your child's choice of a movie on family night
a movie pass
your child's choice of special family activities

Be aware of your own OCD behaviours

If you have OCD, or experience some mild symptoms, you already know how challenging it is. As a result, it is important not to model, encourage or have your child take part in or reinforce your own OCD behaviours.

Children will often be able to recognize a parent's OCD and will often accommodate it to maintain peace and avoid upsetting their parent and "triggering" a ritual. As a result, it is vital to be aware of how your own behaviours may affect your child and take care not to engage children in any of your rituals. For instance, asking a child to make sure they wash their hands "extra well" or to unnecessarily check something a number of times can both encourage OCD-type behaviours and engage the child in your rituals.

If you have OCD, seek your own help and be honest and open about this with your child. Family therapy can help the child understand that they can refuse to take part in your rituals and still feel safe and loved.

Play a role in your child's treatment

As a parent, it is vital that you are involved in your child's treatment for OCD. You do not need to sit in on a treatment session with your child, but you should understand what your child is learning and how to manage situations between sessions.

You should also learn which exposure response prevention (ERP) methods you can do with your child at home to help your child benefit from the treatment and stop any of your own enabling behaviours.

Resources

Last updated: July 19th 2016