It’s not uncommon for children to be diagnosed with both OCD and ADHD. Rogers Behavioral Health’s Dr. Amanda Heins, supervising psychologist for OCD and Anxiety Center residential care for adolescents, explains how symptoms can overlap and even reinforce each other, and how to support children who are experiencing both.
How common is it for a child to have OCD and ADHD?
It’s a lot more common than people realize. Research shows roughly 30% or more of individuals with one condition also have the other. OCD and ADHD affect some of the same areas of the brain, which helps explain why they can occur together. Yet, many clinicians can miss the co-occurring diagnosis. This can be especially true when OCD and ADHD symptoms are happening more in the mind, like replaying thoughts, trying to make things feel “just right,” or getting easily distracted.
How does having OCD and ADHD affect a child’s daily life?
While every individual’s experience is unique to them, we often see an overall increase in symptom severity. Children diagnosed with OCD and ADHD are generally overstimulated internally, which can make school, family life, and friendships more challenging.
How do OCD and ADHD symptoms overlap and reinforce each other?
When OCD and ADHD occur together, it can be difficult to manage daily responsibilities if they’re not properly treated.
For example, inattention is a hallmark symptom of ADHD. Let’s say Samantha gets easily distracted, has trouble staying focused, forgets things, and struggles to keep her day-to-day life consistently organized. In addition to ADHD, Samantha is also living with OCD and experiences intrusive thoughts, which pull her attention inward. Together, these symptoms make daily responsibilities feel overwhelming and, without treatment, can interfere with her ability to function day to day.
What are some common myths or misconceptions about co-occurring OCD and ADHD?
The biggest misconception is assuming the behavior equals the intention. A child may look like they’re not trying or being defiant, but their ability to slow down and think through the impact of what they might say or do is underdeveloped. We can teach and practice these skills in treatment.
What does residential treatment look like for a child with OCD and ADHD?
One of the biggest benefits of our residential program for children diagnosed with OCD and ADHD is that we see them from the moment they wake up until they go to bed. This provides our team with a unique opportunity to understand behaviors. It’s especially helpful in the evening when many families say symptoms tend to worsen.
As we implement treatment for OCD, we’re able to notice what other challenges may remain or arise. For example, if a child is sincerely trying to do exposure and response prevention therapy (ERP), but is unable to stay on task, not due to avoidance, ADHD may be part of the picture. In that case, our team may consider medication for ADHD. Medication in combination with teaching coping skills is very successful.
The length of residential treatment gives us time to identify the right medication and dose while monitoring the effectiveness. This is a huge advantage and can be quite stressful and time consuming at an outpatient level of care, which can cause families to give up on ADHD medications too quickly.
How can parents and teachers support children with OCD and ADHD?
I have several recommendations for supporting kids with OCD and ADHD:
1. Start with understanding
Ask kids where they notice symptoms showing up during their day. Of course, we have to make sure they have an understanding of their symptoms. If they can’t provide feedback, share what you’re noticing. I’ll ask a child I’m working with, “From the moment you get up, walk me through your day and tell me where you notice OCD or ADHD demanding your attention or slowing you down?” Listen and try to understand their experience.
2. Match strategies to needs
ADHD-friendly tools, such as timers, structured seating, movement breaks, and reducing distractions help with focus. For OCD, ERP and cognitive restructuring, which involves recognizing and challenging unhelpful thoughts, help children feel more in control.
3. Focus on skill-building
Both ADHD and OCD respond to learning and practicing new skills, not just managing behavior. Teach kids to pause and read the room before acting. Praise efforts and behavior you want to see more of, while maximizing learning moments when things didn’t go quite as planned.
How can we reduce shame or stigma for children with OCD and ADHD?
It’s important to help children understand their diagnoses and how they relate to them and their experience. Everyone has strengths and challenges. Knowing yours is a way to take the power back because then you can choose how to handle them.
Awareness helps kids realize that they’re not lazy, incapable, or unintelligent. As we embrace a growth mindset in treatment, it helps empower kids to lean into their symptoms in a different way and be in control. This shift can restore confidence and hope. Reinforce that there are going to be moments when they feel like they have it all figured out and then a new curve ball comes in and they have to adapt. That’s not bad. It’s life and we all need to learn to embrace those learning moments and continue to grow.
Click here to read Dr. Heins’ blog about common ADHD signs in children and teens.
Click here to read Dr. Heins’ blog about ADHD and secondary mental health challenges.
Rogers provides mental health treatment for children and teens
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