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Childhood ADHD vs. OCD: What to Know

Medically Reviewed by Smitha Bhandari, MD on May 25, 2022

ADHD and OCD are two brain-based disorders that sometimes get confused for each other. They can have similar or overlapping symptoms and affect your child’s behavior at home or school.

It’s possible that your child may have one condition but be misdiagnosed with the other. It’s also possible for your child to have both at the same time.

How ADHD and OCD Look Similar

ADHD, or attention deficit hyperactivity disorder, is one of the most common childhood conditions. Over 6 million children have been diagnosed with it, and boys are more likely to have it than girls. It affects brain development and activity, making it hard to pay attention, sit still, or have self-control. Doctors usually diagnose ADHD in childhood, and it may last well into adulthood.

Common symptoms may include:

  • Trouble paying attention
  • Impulsive behavior
  • Hyperactivity

Most kids have a combination of symptoms. But as your child grows, these behaviors may change.

While many young children can have some of those behaviors, they can be more extreme and lasting in those with ADHD. For them, symptoms tend to get worse and often affect their ability to perform well at school, play, and home.

Childhood OCD, or obsessive-compulsive disorder, is marked by a pattern of repetitive thoughts or fears (obsessions) that may turn into repetitive behaviors (compulsions). OCD affects around 2.2 million Americans and occurs across all genders. Your child’s symptoms may start when they’re a teenager or a young adult. Severe OCD can interfere with daily activities and cause a lot of stress and anxiety.

Trying to control their urges or thoughts may actually worsen your child’s stress. So they may simply give in to their urges.

OCD obsessions usually follow a theme. For example, your child might fear germs, so they might wash their hands a lot. With both obsessions and compulsions, your child might make up rules or rituals to ease their stress and anxiety around these themes.

They Have Similar Causes

Brain chemistry. Research shows that in both ADHD and OCD, the frontal lobe, in the front of the brain behind the forehead, is affected. This part helps your child:

  • Organize
  • Plan
  • Pay attention
  • Make decisions
  • Control impulses
  • Delay pleasure and reward

Genetics. Family history and genes might play a role in both ADHD and OCD. With ADHD, studies show there’s over a 90% chance that adults who have it will pass it to their children.

According to research, OCD also runs in families. Genes are more likely to play a bigger role if OCD starts in childhood rather than adulthood.

They Share Symptoms

Focus and attention. Both conditions affect your child’s ability to perform and focus on tasks for school or other things. One of ADHD’s main symptoms is trouble paying attention. With OCD, obsessive and compulsive behaviors are often time-consuming and take away focus your child may need for schoolwork and other tasks.

Relationship problems. ADHD symptoms like forgetfulness, impulsive and hyperactive behavior, and poor organizational skills can make it hard to find and keep friends and other close relationships.

With OCD, your child’s obsessions and compulsions may upset family and friends. This is because if your child has strict routines, repetitive behaviors, or rituals they follow as part of their OCD, these may disrupt daily life, and in turn, test your patience.

Sleep issues. Trouble sleeping is a common issue for children with ADHD and OCD. According to research, up to 50% of parents whose children have ADHD report their kids have this problem. But it may differ depending on the type of ADHD your child has. If they have the combined type with both hyperactivity and impulsivity, research shows that they’re more likely to have poor sleep and stay up late.

With OCD, one small 2018 study found that nearly 70% of the participants had sleep issues similar to early-stage insomnia, a condition that makes it hard to fall and stay asleep.

How Are Childhood ADHD and OCD Different?

While the two conditions can be similar, they differ in basic brain function and usually produce opposite reactions.

Physical differences in the brain. If your child has ADHD, the frontal lobe of their brain is more likely to mature slowly, usually a few years later, than those who don’t have ADHD. With OCD, there’s a delay in the communication between the frontal lobe and other structures of the brain.

Also, brain activity in the frontal lobe of a child with ADHD largely dips in what is known as hypometabolism. If your child has OCD, this part of their brain is usually hyperactive and fuels “obsessive” thoughts.

Opposing symptoms. Experts consider ADHD to be an “externalizing disorder.” This means that changes in brain activity may cause your child to act out and project their emotions through behaviors such as hyperactivity and impulsivity. They’re prone to act without really thinking through the consequences for themselves or those around them.

If your child has ADHD, they might:

  • Daydream a lot
  • Forget things often
  • Misplace items
  • Squirm or fidget
  • Talk too much
  • Make careless mistakes
  • Take unnecessary risks

Meanwhile, OCD is an “internalizing disorder.” This means that when your child’s OCD is triggered, they tend to turn their emotions inward. They become obsessive with intrusive thoughts or fears, stay cautious, and avoid risks or impulsive behaviors. This can cause psychological stress for your child.

If your child has OCD, they might:

  • Fear contaminants like dirt or germs
  • Have doubts or fears about facing uncertainty
  • Need for things to be orderly and symmetrical
  • Have aggressive or horrific thoughts about losing control and harming themselves or others
  • Have unwanted or unpleasant thoughts about aggression or about sexual or religious subjects

Because both conditions include trouble with attention and focus, it’s easy to misdiagnose OCD with ADHD. To diagnose OCD correctly, your child’s doctor will check to see if they struggle to keep up with strict routines and compulsive rituals, both of which are well-known OCD symptoms.

Can Your Child Have ADHD and OCD at the Same Time?

Studies show that about one in five children tend to have both OCD and ADHD.

Studies also show that children with OCD are more likely to have ADHD at the same time, compared to adults diagnosed with OCD. But as your child grows, their ADHD symptoms may disappear and get replaced with more adult patterns of OCD.

Treatment Options for ADHD and OCD in Children

Both conditions respond well to cognitive behavioral therapy and medications. If your child has ADHD and OCD, the doctor may combine the treatments for both disorders.

Behavior therapy. For ADHD, behavior therapy can improve overall behavior, self-control, and self-esteem. If your child has OCD, it can help reduce their fears or unwanted thoughts. Exposure response prevention, also known as exposure therapy, is a type behavior therapy that’s found to ease OCD symptoms.

Medications. For ADHD, medications known as stimulants (methylphenidate or dexamphetamine) are the first line of treatment, if your child requires it. They activate your child’s frontal lobe to improve ADHD symptoms.

For OCD, your child’s doctor may prescribe a class of medicines called selective serotonin reuptake inhibitors (SSRIs). These medications raise chemicals called serotonin in the brain to improve symptoms.

If your child has both ADHD and OCD, research shows that stimulants used for ADHD can help improve obsessive-compulsive symptoms, whereas SSRIs used for OCD are found to improve attentiveness.

Other ADHD treatment options include:

  • Parent coaching
  • Support from their teachers and other school staff

Other OCD treatment options include:

  • Family therapy. This may include you and your child’s teachers in the treatment process.
  • Antibiotics. These are given if your child’s OCD is linked with an infection.

With a proper combination of treatments, ADHD and OCD symptoms can improve. If a treatment is not working for your child, let their doctor know. They may suggest treatments that work better.

Long-Term Outlook

ADHD and OCD are usually considered to be lifelong conditions, but it’s possible to manage them.

If your child has ADHD, there’s about a 50% chance that they will “outgrow” their symptoms with proper treatment and care. But for some, they may never go away. About one in four children with ADHD may not need any treatment as adults. This is because stimulant medications used for ADHD can help your child’s frontal lobe develop and mature over time.

By contrast, if your child is diagnosed with OCD, research shows that for around 40%, symptoms go away as they reach adulthood. Therapy and medications can help manage their obsessions and compulsions. But if your child has other conditions along with OCD, it might make it harder to bring their symptoms under control.

Show Sources

SOURCES:

American Academy of Child and Adolescent Psychiatry: “ADHD & the Brain.”

Anxiety and Depression Association of America: “Understanding Anxiety.”

CDC: “What is ADHD?” “Data and Statistics About ADHD.”

Children and Adults with Attention-Deficit/Hyperactivity Disorder: “Is ADHD Hereditary?”

Child and Adolescent Psychiatry and Mental Health: “The mediating role of internalizing and externalizing symptoms in the relationship between childhood trauma and suicidality among adolescents: a structural equation model.”

Cleveland Clinic: “Obsessive-Compulsive Disorder.”

International OCD Foundation: “OCD and ADHD Dual Diagnosis Misdiagnosis and the Cognitive ‘Cost’ of Obsessions,” “What Causes OCD?” “Obsessive Compulsive Disorder in Children and Teenagers.”

Mayo Clinic: “Obsessive-compulsive disorder (OCD).”

Nemours KidsHealth: “ADHD.”

Scandinavian Journal of Psychology: “Sleep disturbances in treatment-seeking OCD-patients: Changes after concentrated exposure treatment.”

Sleep Foundation: “ADHD and Sleep.”

StatPearls: “Obsessive-Compulsive Disorder,” “Attention Deficit Hyperactivity Disorder.”

United Brain Association: “The impact of OCD on relationships.”

Cedars Sinai: “Obsessive-Compulsive Disorder (OCD) in Children.”

JAMA Network: “Sleep Problems in Children With Attention-Deficit/Hyperactivity Disorder.”

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