We all worry sometimes, and a certain amount of anxiety or fear is normal. If you find that your child's worrying is very distressing or if it is interfering with his/her functioning at school or with friends, then it may indicate a more serious problem. Certain rituals are a part of normal development whereas other behaviors may need to be brought to your pediatrician's attention (or need other professional help). For example, toddlers can have very rigid routines around eating, bathing and bedtime. But if you find that your seven-year-old needs to be tucked in "just right," or your teenager is always organizing and reorganizing his or her room, there might be something else at play.
The hallmark features of obsessive compulsive disorder (OCD) include having distressing thoughts/feelings (obsessions) and/or rituals/repeated behaviors (compulsions). Very young children may only have compulsions, and they may not even express much distress about their symptoms.
Behaviors that are suspicious for an OCD diagnosis include spending long, unproductive hours on homework, retracing over letters or rereading paragraphs. Dramatic increase in laundry and toilets overflowing from excessive use of paper may warn of contamination fears. Long, rigid bedtime rituals, exaggerated needs for reassurance, or requests for family members to perform certain acts to make the child "safe" may all indicate a child who has OCD. Hoarding of useless objects, such as fingernail clippings or used bandages should be differentiated from normal childhood collecting of rocks, baseball cards or sentimental treasures.
It is important to distinguish between normal developmental rituals/superstitions and possible OCD behaviors. Although ritualized behaviors are common for the young child around times of transition, OCD-related behaviors are typically excessive and occur at a later than expected age. If your child becomes distressed when prevented from doing that behavior and the behavior takes up a lot of his/her time, it's more likely a symptom of OCD.
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