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Pay attention to fears of contamination. Note any excessive preoccupation with symmetry, order, and exactness. Watch for compulsions to keep loved ones safe. Notice any obsession about causing intentional harm.
Some children with OCD have obsessions about cleanliness and become afraid of being contaminated, contracting diseases, and becoming ill. They may worry about close person-to-person contact or develop fears of dirt, food, or certain places or things they believe are unsanitary or infectious. Although it can be hard to observe an obsession, you can be on the look out for the compulsions that can result from an obsession with cleanliness:  Your child may avoid certain locations, such as public restrooms, or certain situations, such as social events, because they fear contamination. Your child may become strangely habitual. For example, they may eat the same food over and over again because it is supposedly contamination-free. Your child may begin to impose cleansing rituals on you and other members of your family in an attempt to ensure complete sanitation. Your child may even develop compulsions that seem contrary to an obsession with cleanliness. For example, they may refuse to bathe due to a fear of contamination. Some children with OCD develop obsessions with symmetry and order; they need processes to be “done right” and items to be arranged “correctly.” As a result:   Your child may develop very precise ways of handling, arranging, or aligning objects; they may do this in a highly ritualized way. Your child may become very anxious when items are not arranged correctly; they may panic or believe something terrible will happen. Your child may have trouble concentrating on schoolwork or other things because they are so preoccupied with these matters, which seem so inessential to you. Children with OCD can obsess about themselves or others being harmed. This obsession may manifest itself in a variety of compulsive behaviors:  Your child may become very overprotective toward family members and close friends. Your child may try to make sure everyone is safe by checking and rechecking that doors are locked, appliances are turned off, and no gas leaks are present. Your child may devote several hours a day to performing ritualized tasks aimed at making sure that everyone is safe. Children with OCD may have violent intrusive thoughts, and they might become very worried that they will give into these thoughts and hurt themselves or others intentionally. They may begin to hate themselves or believe that they are bad people. As a result:   Your child may be overcome with guilty feelings. They may seek forgiveness, confessing their thoughts to others and seeking reassurances of their love and affection. Your child may become emotionally exhausted and preoccupied with these thoughts. Though the anxieties may be mostly internal, you can be alert for signs of increased anxiety, depression, or exhaustion. Your child may draw or write about the violent behaviors over and over.