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When It's Not Just a Tantrum: The Subtle Signs of OCD in Toddlers
Based on facts, either observed and verified firsthand by the reporter, or reported and verified from knowledgeable sources.
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To most parents, a toddler's insistence on the "right" plate or bedtime routine seems like a normal developmental quirk or just the latest cause of a meltdown.
However, for some children, these behaviors may be an early sign of obsessive-compulsive disorder (OCD), a condition often thought to affect only older children or adults.
"OCD is characterized by the presence of obsessions—persistent, unwanted, distressing … thoughts—and compulsions are repetitive behaviors that one engages in to resolve the distress," clinical child psychologist Dr. Kendra Read, Ph.D., told Newsweek.
"For very young children, it can be difficult to tease apart what is typical from what's concerning, because many toddlers naturally prefer sameness or repetition," Read said.
Stock image: A crying boy sits in a high chair with cereal puree on a plate.
Stock image: A crying boy sits in a high chair with cereal puree on a plate.
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How Early Can OCD Appear?
While OCD most often emerges between ages 8 and 12 or during late adolescence, the International OCD Foundation says that it can be diagnosed in preschool-aged children.
Research published in the Journal of the American Academy of Child & Adolescent Psychiatry estimates that about 1 to 3 percent of children and adolescents have OCD, with early-onset cases sometimes appearing before age 5.
Read, who is also the vice president of Therapy at Brightline, said the key to distinguishing OCD from typical toddler behavior lies in three factors:
Distress: how upset the child becomes when they can't perform the behavior.
Impairment: whether it interferes with daily activities—for the child or the family.
Persistence: whether symptoms have lasted for weeks or months.
For example, a bedtime ritual that stretches beyond an hour must be restarted if steps are "wrong," and causes significant upset if interrupted may be more than just a habit.
Other red flags include excessive washing, and avoidance of certain toys or places due to fears and rituals that seem illogical or disconnected from the situation.
The Role of Parents and Environment
Parental "accommodation"—structuring the household to prevent a child's distress—can unintentionally reinforce compulsive behaviors.
"Essentially, this means structuring the world in a way to do things OCD's way: [for example], always getting a new fork or plate when requested related to concerns about contamination; performing a bedtime ritual the same way to the point that it becomes a multi-hour experience," Read said.
In some cases, the child may not be very distressed, but the parents are exhausted from living life by OCD's rules, she added.
Family history matters, too: OCD and anxiety often run in families, and temperamental similarities can make certain behaviors more likely to emerge.
What Parents Can Do
Even without a formal diagnosis, parents can start supporting their child by acknowledging feelings ("I can see this makes you feel worried"); giving the anxiety a nickname ("Worry Monster"); and gently encouraging small steps that go against the compulsion—always in a safe context.
"For preschool-aged kids, I like to draw out a quick adventure map on a piece of paper that has bravery stops along the way and a treasure chest—usually a trip to the ice-cream place—at the end," Read said. "You know your kid best, including what motivates them."
If concerns persist, Read recommended a professional evaluation, which typically involves caregiver interviews, teacher input and behavioral observations.
Evidence-based treatments such as cognitive behavioral therapy (CBT) with exposure and response prevention (ERP) have been shown to be highly effective, even in young children.
"OCD and anxiety disorders are not lifetime disorders," Read said. "Given the support of effective intervention … even if your child meets criteria at one point, the goal for treatment is … to get to the point where they no longer meet criteria with supportive, evidence-based intervention."
