ADHD and OCD in Childhood – The Chicken, the Egg or Both

ADHD and OCD in Childhood, James Wiley MD, Focus MD

Article by: James Wiley, MD ~ FocusMD

Obsessive Compulsive Disorder is not rare in childhood and it is more common in children with ADHD. Few parents come to Focus-MD clinics concerned that their child has OCD. They are more worried about social skills issues and disruptive behavior at school and meltdowns and tantrums at home. Often a teacher or some other professional will have suggested that the child has ADHD, ODD-Oppositional Defiant Disorder or ASD, Autism Spectrum Disorder or Asperger’s Disorder (no longer diagnosed). These observations are a great place to start. When we listen to the voices of people who know the child well and then take the time to look carefully at the presenting symptoms, we are more likely to get the diagnosis right. Remember that sometimes OCD occurs with ADHD and sometimes OCD diagnosis alone best explains the patient’s symptoms. In other words, the diagnosis can be either or both. To make matters more confusing some patients have other conditions tagging along. Mood disorders, anxiety and tics are all more common in these kids. At Focus-MD we find that when we look at the whole child, including their struggles and their strengths, we are better able to arrive at a correct diagnosis or combination of diagnoses that make sense to parents. Helping you put the pieces of the behavior puzzle together is what we strive to do every day. 

How to spot OCD

Just because your child’s room is a mess doesn’t mean that he/she doesn’t have OCD. Remember both neat freaks and hoarders have OCD. The neat are obsessed with cleanliness and order while hoarders are obsessed that they may need that half used ketchup packet tomorrow.  One compulsively cleans, the other compulsively holds on to trash. Look for these common symptoms

Symptoms of OCD

  1. Counting
  2. Lining things up
  3. Sorting
  4. Making things symmetrical
  5. Checking behavior—asking the same question over and over even when the answer  is known or verifying that the door is locked a certain number of times. This is also called Need to Know.
  6. Need to Tell—will start stories all over from the  beginning if narrative gets out-of-order or they forget a detail.  Will need you to listen to the detail that is in their mind no matter if it doesn’t matter.
  7. Persistent thoughts
  8. Rituals – having to do things in a certain order.
  9. Food aversion due to texture or one food touching another or having to eat foods in a certain order.
  10. Sensory issues — loud noises, tags in clothes, the way under wear or socks fit or feel, texture of clothes or other fabrics.
  11. Picking at fingers, biting nails, twirling or pulling out hair, eye lashes or eyebrows.

In reading below you will see that OCD impairments can look a like with ADHD problems.

Functional Impairment in OCD compared to ADHD

Functional Impairment in OCD compared to ADHD = FocusMD

OCD compared to ODD

  • OCD kids are often defiant but they don’t tend to be vindictive or spiteful like ODD kids.
  • Once they have their way, they’re happy again though they’ll remember a grudge!
  • In OCD it’s ‘my way or the highway’.
  • In ODD it’s ‘anyway but your way’.

OCD compared to ASD

  • OCD kids have more reciprocal interaction than ASD kids.
  • Their social skills issues are not a lack of interpersonal connection but rather that things have to be a certain way on certain things.
  • They will talk about or engage other things but on certain topics/procedures but they are very inflexible.
  • ASD kids are happier with parallel interaction if any at all.

If you would like more information concerning ADHD. ADHD treatment, diagnosis, and resources, please visit

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