Key Facts:

• OCD affects 1-4% of individuals across all age groups

• About half of all adults with OCD first had symptoms in childhood

• Boys often develop symptoms earlier than girls

• Early treatment greatly improves outcomes

What happens with OCD? 

Individuals with OCD get "stuck" on thoughts that feel very important and scary. For example, if someone without OCD has a worrying thought about forgetting to lock the door, they might double-check once and move on. Someone with OCD can't stop thinking about it, worrying they forgot to check properly, and must keep checking over and over until it feels "right."

OCD is very serious and disruptive: 

Unlike typical habits or preferences for order, OCD thoughts and behaviours:

• Take up over an hour each day

• Cause significant distress and anxiety

• Interfere with school, friendships, and family life

• Feel impossible to stop or control

• Often make no logical sense even to the person

Behavioural Signs

• Frequent bathroom requests (often to wash hands or avoid "contamination")

• Checking doors, windows, desks, or supplies repeatedly

• Arranging items in very specific ways

• Tapping, touching, or counting in patterns

• Avoiding certain areas, objects, or activities

• Taking forever to get ready or leave the house

Social and Emotional Signs

• Appearing distracted or "in their head"

• Difficulty with transitions or schedule changes

• Extreme distress when routines are interrupted

• Fatigue (from mental exhaustion or medication effects)

• Seeming oppositional when really overwhelmed

• Social withdrawal or avoiding activities

Behavioural Intervention Examples:

• Competing responses: Giving children something else to do with their hands during high-risk times (fidget toys, stress balls)

• Gradual exposure: Slowly facing fears in a safe way with therapist support

• Response delay: Waiting longer and longer before doing rituals

• Environmental changes: Removing or limiting access to things that trigger behaviours

• Positive reinforcement: Rewarding efforts to resist OCD, not just success

Overlapping behaviours: 

Both ASD and OCD involve repetitive behaviours, making diagnosis complex

Assessment difficulties: 

Standard OCD measures weren't designed for children with autism

Warning signs include:

• Sudden increase in frequency or intensity of repetitive behaviours

• New behaviours that seem driven by anxiety rather than enjoyment

• Aggressive reactions when behaviours are interrupted

• Self-injurious behaviours related to the repetitive actions

• Specific examples: Stacking shoes in piles repeatedly, arranging TV remotes in exact patterns, opening and closing doors/windows compulsively

• Functional interference: Behaviours that suddenly prevent normal activities like eating, sleeping, or learning

Ordering and Arranging:

• Arranging objects (toys, cutlery, clothes) in very specific patterns

• Insisting items be placed in exactly the same spot

• Wanting chairs in fixed arrangements or using same chair/location

• Needing to do activities or chores at exactly the same time each day

Checking and Touching:

• Opening and closing doors, cupboards, or containers repeatedly

• Touching or tapping items in predictable patterns

• Taking specific numbers of steps forward then backward

• Unusual sniffing of items that have no smell

Obsessive Speech Patterns in Verbal Children with IDD: 

For children with some verbal abilities, repetitive speech can indicate obsessive thoughts:

• Repeating the same question or sentence with identical wording

• Asking questions repeatedly until getting a very specific reply

• Talking excessively about particular people, objects, or events

• Making repetitive comments about health, weight, or body concerns

• Excessive focus on time, calendars, or scheduling

• Expressing irrational fears about places, people, or activities

Types of Professional Help:

• Child Psychologists, Psychological Associates or Psychiatrists with OCD specialization

• Clinical Social Workers trained in specialized OCD treatment

What to Look For:

• Specific training in evidence-based OCD treatment for children and adolescents

• Experience with pediatric OCD (ask directly about percentage of practice)

• Willingness to involve family in treatment

• Understanding of how OCD differs from other conditions

• Familiarity with Autism/OCD comorbidity if relevant

• Hoarding symptoms often start in childhood or teen years

• Affects about 1.5-6% of the population

• Often runs in families

• Boys and girls are affected equally

• Different from normal collecting or being messy

Warning Signs:

• Can't throw away homework or school papers from years ago

• Room is so full they can't use their bed properly

• Keeps broken toys or electronics "to fix someday"

• Gets very upset when parents try to clean their room

• Saves food containers, bottles, or packaging

• Can't find important things because of clutter

• Avoids having friends over because of embarrassment

How It Affects Daily Life:

• Trouble sleeping because bed is covered with items

• Can't do homework at their desk

• Family arguments about cleaning

• Embarrassment about their living space

• Difficulty finding clothes, school supplies, or homework

• Safety concerns (fire hazards, can't exit room quickly)

Important Reminders

• Hoarding disorder is a real mental health condition, not laziness

• Children can't just "clean up" on their own

• Throwing away items without the child's consent usually makes things worse

• Progress is slow but possible with proper treatment

• Early intervention leads to better outcomes

If you have concerns about a child/student, ask for support from the School Team which includes a psychological service provider.

Common Areas of Concern:

• Skin (acne, scars, color, texture)

• Hair (thinning, styling, color)

• Nose (shape, size)

• Face features (lips, eyes, teeth)

• Body shape or size of specific parts

• Muscles (not big enough, not defined)

Academic and Social Impact:

• Difficulty concentrating in class due to appearance worries

• Avoiding participation in activities (sports, presentations)

• Social withdrawal and isolation

• Depression and anxiety about being seen by others

• Refusing to attend school 

• Avoiding dating or close friendships

Common Signs:

• Picking at face, hands, arms, or other body areas

• Creating sores, scabs, or scars from picking

• Spending significant time picking (often hours)

• Picking to the point of bleeding or infection

• Difficulty stopping even when aware of damage

• Using tools like tweezers or pins to pick

Common Signs:

• Pulling hair from scalp, eyebrows, eyelashes

• Visible bald spots or thinning areas

• Playing with, examining, or eating pulled hair

• Increasing tension before pulling

• Relief or satisfaction after pulling

These behaviours are hard to stop because they:

• Provide temporary stress relief or calming sensation

• Can become automatic habits

• May help manage difficult emotions

• Often increase during times of stress or boredom

Behavioural Strategies:

• Fidget toys during high-risk times (watching TV, doing homework)

• Wearing gloves or bandages to make picking/pulling harder

• Keeping nails short to reduce damage from picking

• Removing mirrors from certain areas temporarily

• Creating barriers like wearing mittens at night

Examples of Competing Responses:

• Squeeze a stress ball instead of pulling hair

• Use fidget cube during high-risk times

• Hold hands together or sit on hands

• Apply moisturizer to hands when urge to pick arises

• Comb or brush hair instead of pulling

Family Support:

• Avoid criticism or telling child to "just stop"

• Help identify triggers and high-risk times

• Provide alternative activities during these times

• Praise efforts to use coping strategies

• Support treatment participation

• Behaviours cause visible damage (bald spots, sores, scars)

• Child has tried to stop multiple times but can't

• Behaviours interfere with school or social activities

• Child feels distressed or embarrassed about the behaviours

• Secondary infections occur from picking

• Child avoids activities due to visible damage

Treatment Success:

• Most children can learn to significantly reduce these behaviours

• Treatment focuses on building awareness and alternative coping skills

• Family involvement greatly improves outcomes

• Earlier intervention typically leads to better results