Obsessive-Compulsive Disorder and Tic Disorders

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Children with obsessive-compulsive disorder (OCD) and tic disorders (sometimes called Tourette’s syndrome) have symptoms that can be disruptive and embarrassing, and even interfere with daily functioning. Duke’s behavioral health team has expertise and experience in successfully treating these disorders to improve your child’s and family’s quality of life.

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When to Seek Help for OCD and Tic Disorders

Obsessive Compulsive Disorder
Obsessive-compulsive disorder (OCD) is characterized by unwanted, intrusive, distressing thoughts and compulsive behaviors. These thoughts or actions may be performed to neutralize obsessions or reduce distress/anxiety. OCD behaviors can begin appearing as early as age four but most often become noticeable around age seven or eight. Common obsessions include fears of germs or contamination or obsessions related to perfectionism. Common compulsions include excessive washing or cleaning, checking behaviors, and repeating or counting.

Tic Disorders
A child with a tic disorder has a strong urge to make a movement or sound and satisfies the urge by performing the tic. Some of the most common vocal tics are grunts, whistles, and repetition of certain words. Motor tics might include repetitive movements of the face, such as blinking, opening the mouth wide, or scrunching the nose. Your child may also have twitches in the arms or legs, or experience the urge to perform a sequence of movements. Tics are typically first noticed in early childhood, and many children outgrow them.

When to Seek Help
Children may outgrow these repetitive behaviors or fearful thoughts on their own, but if they persist or create disruption in your child’s life or family life, we can help. If you are concerned about your child’s behavior, talk to your primary care doctor. They may refer you to a behavioral health specialist who can offer solutions.

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Duke Health offers locations throughout the Triangle. Find one near you.

Comprehensive Evaluation

Diagnosing Tic Disorders

Our team will ask about the types of repetitive behaviors your child performs, how often they are occurring, how much time they consume, and how much distress or impairment they are causing for your child or your family.  

Diagnosing OCD

When assessing OCD, we will ask whether your child has obsessions or compulsive behaviors and whether these obsessions and/or compulsions are time-consuming, get in the way of important activities, or cause distress for you or your child. 

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After gathering information about your child's history and your goals for treatment, we tailor a plan that’s right for your family. It may include therapy, medication, or a combination of the two.

Habit Reversal Therapy for Tics

Habit reversal therapy teaches your child to recognize the feeling or signal that happens just before they perform the tic. Our providers work with your child to choose a competing response to neutralize the tic urge. The urge will go away, but it takes focus and training to change the pattern of tics. For example, if your child repeatedly flaps their elbows up and down, the competing action might be to hold their elbows at their side until the urge goes away.

Cognitive Behavioral Therapy with Exposures for OCD

Cognitive behavioral therapy exposes children to what they typically avoid. For example, if a child has a hand-washing compulsion, we ask the child to touch something that triggers the urge to wash and then have them not wash. They’ll learn that the anxious feeling usually fades. This therapy in combination with medications has proven to have the greatest success. 


Our psychiatrists work with your family to provide evidence-based medications for your child, when appropriate. We evaluate the risks of side effects versus the benefits of a particular medication and make a decision together about the best course of action for your child. We are skilled at managing and adjusting doses that will be most effective for your child. 

Stress Management

Stress, lack of sleep, and hunger may all trigger and worsen tics and OCD. Know that your own stress, anger, and frustration also can increase your child’s stress. We’ll help you and your child use stress management techniques to lessen the effects of stress on your family. If life circumstances cause a flare-up in your child’s behavior, we are happy to see your child to refresh strategies for coping with these disorders. 

Consistently Ranked Among the Nation’s Best Hospitals

Duke University Hospital is proud of our team and the exceptional care they provide. They are why we are once again recognized as the best hospital in North Carolina, and nationally ranked in 11 adult and 9 pediatric specialties by U.S. News & World Report for 2023–2024.

Why Choose Duke

A Team of Specialists Dedicated to Your Child
Our team of pediatric psychiatrists, psychologists, social workers, nurse practitioners, and nurses focuses on engaging you and your child in the therapy process. We understand that seeking help can be difficult, and our goal is to provide a safe environment for your family to learn new ways to reduce and manage the symptoms of OCD and tic disorders.

Families Are Involved at Clinic and at Home
Families get involved both at our clinic and with home “assignments” to support and reinforce what your child is learning during therapy. Parents receive guidance on how best to support their child’s progress in treatment.

Tailored Treatments for Your Child
Our specialists are sensitive to the strain these illnesses can cause in children who have serious or chronic physical illnesses. If your child’s OCD or tics become worse with the added stress of a physical illness, we can tailor treatment to address these concerns.

Research-Based Treatments
We have participated in national clinical trials that have defined techniques most likely to help children and families who are struggling with these disorders.

This page was medically reviewed on 10/03/2022 by