Why Is My Child’s OCD Getting Worse at School? A Parent’s Guide

With school back in session, you might notice your child’s obsessive-compulsive disorder (OCD) flaring up. They might engage in extensive rituals before they get on the school bus, perform an hour’s worth of compulsions when they get home, or refuse to go to school altogether.

So, what causes OCD to get worse at school, and why? Here’s what you need to know about the worsening of OCD in children during back-to-school season, what you can do to be a supportive parent, what types of OCD treatment are available, and more.

Why does my child’s OCD get worse at school specifically?

A child’s obsessive-compulsive disorder worsening when going back to school is often caused by a mix of factors, ranging from changes in routine to loss of predictability.

“OCD thrives on uncertainty because uncertainty is exactly what compulsions are trying to eliminate,” says Matthew Murray, PhD, Director of Specialty Clinical Programs at Charlie Health. “New teachers, new classrooms, and new schedules mean a child can’t rely on the routines that kept their anxiety manageable over the summer.”

If you’re a parent dealing with this, you’re far from the only one, as Dr. Murray frequently sees it in practice. “Clinically, we see this play out almost every August and September, especially for kids who have contamination fears, harm OCD, or ‘just right’ checking rituals,” he says.

What triggers OCD to get worse?

When going back to school, the following factors might trigger a flare-up of OCD in your child.

• Fresh social landscape: “For kids with OCD, the fresh social landscape can also pose some challenges,” Dr. Murray says. For example, he says they might worry, “Did I say the wrong thing?” “Did I offend someone?” or, “Did I look at them the ‘right’ way?”
• Leaving parents: Summer often means spending more time with you. Going back to leaving you for the day can be a trigger. “Fears of something bad happening to loved ones and harm OCD themes can also increase as children have to leave their parents for the school day,” says Brittany Johnson, LPC, a Charlie Health Primary Therapist.
• Academic perfectionism: If your child struggles with perfectionism, Dr. Murray says they might feel pressure to get everything “right,” feel the need to rewrite sentences over and over until they are “perfect,” or re-read something multiple times before they move on.
• Potential germ exposure: A school presents countless high-touch surfaces, which can feel scary for kids. “If your child has more contamination-focused OCD, shared desks, doorknobs, cafeteria trays, and bathrooms can feel like a minefield,” Dr. Murray says.
• Food-related fears: When your child is used to your cooking and “safe foods” at home, eating at school can introduce new uncertainties and fears. For example, OCD might lead your child to have a fear of choking, allergies, or contaminated food, all of which can make it difficult for your kid to eat at school, says Johnson.
• Reduced downtime for rituals and compulsions: Kids have far more downtime in the summer to engage in their OCD compulsions. However, back in class, kids are forced to sit in uncomfortable situations where they can’t necessarily complete their compulsions, Johnson says.

Does an OCD flare-up mean the OCD will stay heightened?

Just because your child’s OCD worsened at the beginning of school, it doesn’t necessarily mean it’s going to stay like this — but it’s important to keep an eye on it.

“Think of it less like a light switch and more like a fever that spikes with a new infection. It’s the body and brain’s initial reaction to a stressor, not a permanent new baseline,” says Dr. Murray. Many kids’ symptoms will settle somewhat once their routines stabilize and that alarm system learns that the new environment isn’t actually dangerous.

However, make sure to pay attention to how long the flare-up lasts and how significantly it is affecting your child’s daily life. Dr. Murray says to take this signal seriously if the spike doesn’t settle within a few weeks or continues to escalate rather than subside.

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How can parents respond without accommodating the OCD?

There’s a fine line between comforting your child and enabling their compulsions, fueling OCD.

“The best thing parents can do for their children with OCD is to support them and validate their feelings while being careful not to engage in any of their compulsions or accommodations they seek,” says Johnson.

Here’s an example: “If your kid is compelled to ask you ten times whether their backpack is contaminated, answering, ‘no,’ for the tenth time does not reduce their anxiety long-term,” Dr. Murray says. Rather, it feeds OCD reassurance and fuels the OCD cycle.

“Instead, prioritize validating how they feel without validating the compulsion. You might say something like, ‘I can see you’re really anxious about this. I’m not going to answer that question again, but I’m here with you while the anxious feeling passes,’” Dr. Murray adds.

Although it can be hard to see your child struggle with such intense anxiety, and you’ll feel tempted to give them the reassurance they want, you ultimately have to remember that reassurance only provides temporary relief and can reinforce the OCD cycle over time.

Providing positive reinforcement is key in this process, too. “Praise their willingness to sit with uncertainty, which is what recovery from OCD is all about,” Dr. Murray explains. “Saying, ‘I noticed you didn’t ask me to check that again; that was really brave,’ reinforces the skill you actually want to grow.”

One final tip: encourage your child to name their OCD to externalize it. Johnson says in practice, she’s found it helpful for kids to refer to their OCD as the “OCD bully” to help kids separate themselves from it. “I’ve worked with many children who feel bad about themselves because of their OCD, or feel that they are punished or put down because of it. Blaming the ‘OCD bully’ can help empower the child to fight back against it,” she explains.

How your child’s school can help

You aren’t required to let your child’s school know about their OCD, but if your child’s symptoms are interfering with their ability to learn, participate in school, or attend regularly, communicating with the school can help them get the support they need.

Parents can request a meeting with a school counselor or a 504 plan coordinator, Dr. Murray says.

You can discuss things such as a plan for what to do when a compulsion interferes with learning time (“ideally some form of discreet, agreed-upon signal or a brief break rather than public reassurance or accommodation,” Dr. Murray says) or, “a request that staff avoid repeated reassurance like ‘your hands are clean,’ since well-meaning teachers could unintentionally reinforce compulsions.”

Additionally, you can let your child know that a school counselor or psychologist is a safe person to talk to at school when they’re feeling overwhelmed by their OCD and struggling with anxiety.

Lastly, it’s important to clarify that the goal is gradual independence, not permanent workarounds. “For example, extra time on an assignment because of genuine checking rituals may be reasonable short-term, but the long-term goal is building tolerance, not building in unlimited accommodation,” Dr. Murray says.

When to seek treatment for OCD in children?

It’s important to consider treatment when your child’s obsessive-compulsive disorder symptoms are not subsiding or if they are worsening. Focus not just on the presence of symptoms, but how the symptoms are impacting function in and out of school.

Dr. Murray says the following are red flags:

• If OCD is costing your child time, friendships, or sleep
• If OCD is affecting your family’s harmony
• If rituals consume school mornings
• If your child is refusing to attend school (school refusal)

In these cases, it’s also important to reach out to a therapist (or a clinic) with specialized expertise in OCD. Working with a clinician specializing in OCD can make a huge difference.

What are the best treatments for OCD in children?

Exposure and response prevention therapy (also known as ERP) is considered the gold standard for OCD treatment.

In ERP, a therapist will guide your child through gradually facing situations that trigger their obsessions while resisting the urge to perform compulsions or engage in reassurance-seeking behaviors. Ultimately, this teaches your child that they can sit with and tolerate discomfort and uncertainty. Over time, this reduces the severity of obsessions and the urge to carry out compulsions.

Additionally, family therapy can play an important role. “It’s important for family members to learn what OCD is and how to help their loved ones through it,” Johnson says. “When working with children, it is very important to have a plan on how to help parents decrease the accommodations they are giving and the parts they are playing in their child’s compulsions.”

In some cases of more severe OCD in children, medication may play a role in treatment. The FDA has approved the following medications for treating OCD in children.

• Prozac (generic: fluoxetine) for children 7 and older
• Luvox (generic: fluvoxamine) for children 8 and older
• Zoloft (generic: sertraline) for children 6 and older
• Anafranil (generic: clomipramine) for children 10 and older

When is more intensive treatment needed for OCD?

“If weekly therapy isn’t keeping pace with how quickly symptoms are escalating, that’s the moment to look at more intensive support,” according to Dr. Murray.

For children with more severe OCD, weekly therapy might not be enough to get symptoms under control. Johnson suggests considering a higher level of care if your child is missing a lot of school, isolating frequently, and unable to keep up with hygiene or other responsibilities.

More intensive treatment options include intensive outpatient programs (IOPs) and partial hospitalization programs (PHPs). Both provide care multiple days a week, combining individual therapy, group sessions, and multiple care modalities. The main difference between IOP and PHP is the amount of time and level of structure involved:

Treatment for OCD in children at Charlie Health

Charlie Health is a virtual behavioral health provider delivering more than once-weekly treatment for kids, teens, and adults facing serious mental health conditions and substance use disorders.

Our virtual Intensive Outpatient Program (IOP) treats OCD in children with clinical expertise, group connection, and measurement-based care to support long-term healing. We combine therapy modalities like exposure and response prevention with other interventions, like family therapy and medication management when needed.

With the right support, managing your child’s OCD is possible. Fill out the form below to start today.