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Typically, parents or caregivers do not seek medical attention until their child’s behavior becomes disruptive to the child’s life. For example, children who obsessively wash their hands may develop a form of eczema (skin inflammation) that requires medical attention. Or, children who obsessively brush their teeth may damage the gums, causing bleeding. A greater percentage of children are first diagnosed with obsessive-compulsive disorder (OCD) sometime between the ages of 7 and 12 years.

Before diagnosing OCD, a physician will perform a complete physical examination and compile a thorough medical history. The medical history will include information regarding complications during the pregnancy and delivery of the child. Other developmental parameters such as height, weight, vaccinations, recent infections, and eating and sleep habits are also compiled. The physician will ask the child about the nature of the obsessions and compulsions. Consultation with parents, family and teachers may help reveal behavioral patterns that will lead to a more accurate diagnosis.

If a primary care physician suspects that OCD is present, the child will be referred to a child and adolescent psychiatrist or other mental health professional. These experts may ask the child or parents questions such as:

• Does the child have repeated unwanted thoughts that seem senseless?
  
  
• Does the child do things repeatedly in a way that seems excessive?
  
  
• Does the child have worries, thoughts, images or feelings that are upsetting?
  
  
• Does the child check things over and over again?
  
  
• Does the child count to a certain number or do things a certain number of times?
  
  
• Does the child collect things others might throw away?
  
  
• Does the child insist that things have a certain order or arrangement?
  
  
• Does the child have elaborate rituals prior to bedtime?

There is no specific laboratory test to diagnose OCD. It is usually diagnosed in children who have obsessive thoughts and/or who perform compulsive actions. In order for the diagnostic criteria to apply, the obsessive-compulsive thoughts should appear for more than an hour each day and cause marked distress and interruption of a child’s lifestyle.