Understanding the Link Between ADHD and OCD in Children

What Are ADHD and OCD?

Attention-deficit/hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD) are two common neurodevelopmental conditions that affect children and teens in distinct yet sometimes overlapping ways.

ADHD is characterized by persistent patterns of inattention, hyperactivity, and impulsivity that interfere with functioning at home, school, or in social settings. Children with ADHD may have trouble focusing, sitting still, or completing tasks without distraction.

OCD, on the other hand, involves unwanted, intrusive thoughts (obsessions) and repetitive behaviors or mental rituals (compulsions) that a child feels driven to perform to reduce anxiety. These behaviors are often time-consuming and distressing.

While ADHD is more externally visible—often marked by restlessness or acting out—OCD can present as more internal, involving repetitive thinking and rituals that may not be immediately obvious to others.

Signs and Behaviors of ADHD

Children with ADHD may show:

• Trouble focusing or paying attention
  
  
• Frequent daydreaming
  
  
• Forgetfulness and disorganization
  
  
• Fidgeting or constant movement
  
  
• Difficulty waiting their turn or interrupting others
  
  
• Impulsive decision-making or risky behavior
  
  

These symptoms can vary depending on the child’s age and may be more obvious in structured settings like school.

Signs and Behaviors of OCD

OCD behaviors in children may include:

• Repeating words, actions, or questions
  
  
• Excessive handwashing or cleaning
  
  
• Needing things to feel “just right” (e.g., symmetry, order)
  
  
• Intrusive fears about harm, germs, or bad outcomes
  
  
• Avoidance of certain people, places, or objects
  
  
• Mental rituals like counting or praying
  
  

Children often feel distressed or anxious if they can’t complete a compulsion or if their routines are disrupted.

How Are ADHD and OCD Similar?

Despite being very different conditions, ADHD and OCD can look similar in certain ways:

• Trouble focusing or maintaining attention
  
  
• Difficulty completing tasks
  
  
• Restlessness or appearing distracted
  
  
• Problems with organization
  
  
• Emotional outbursts or frustration
  
  

These overlapping traits can lead to confusion or misdiagnosis, especially when a child is struggling in school or at home. Both conditions also commonly co-occur with anxiety, which can further complicate the picture.

Key Differences Between ADHD and OCD

Feature

ADHD

OCD

Core issue

Impulsivity and inattention

Obsessive thoughts and compulsions

Thought process

Spontaneous or scattered

Repetitive and distressing

Behavior

Impulsive, disorganized

Controlled, repetitive

Triggers

External (distraction, stimulation)

Internal (obsessions, anxiety)

Age of onset

Often before age 7

Often emerges in late childhood or early adolescence

Task difficulty

Trouble initiating or finishing due to boredom or inattention

Trouble due to perfectionism or compulsions

Understanding these differences can help families and providers pinpoint the right diagnosis and avoid mistaking OCD rituals for ADHD distraction—or vice versa.

Can ADHD and OCD Happen Together?

Yes—ADHD and OCD can co-occur, especially in children. Studies show that up to 25.5% of pediatric OCD patients also meet criteria for ADHD.  This comorbidity is linked to more severe symptoms, earlier onset of OCD, and greater challenges in school and emotional regulation as supported by research. When both are present, symptoms can interact in complex ways. For example, a child may be impulsive (from ADHD) but also feel compelled to perform rituals in a specific way (from OCD). Parents might notice increased frustration, avoidance, or school refusal.

Other OCD subtypes like harm OCD or contamination OCD in children can complicate focus and behavior.

Diagnosing ADHD and OCD: What Parents Should Know

Diagnosis begins with a comprehensive evaluation by a child psychologist or psychiatrist. This may include:

• Clinical interviews with the child and caregivers
  
  
• Questionnaires and behavior checklists
  
  
• Observations in school or therapy
  
  
• Rule-outs for other conditions (e.g., anxiety, tics, autism)
  
  

Because ADHD and OCD can overlap or mimic each other, getting the right diagnosis is key. Neurobiological similarities exist between these conditions. Misdiagnosis is common, especially when OCD-related distractions are mistaken for inattention. Clinicians may also explore family history, as both conditions are highly heritable. 

How ADHD and OCD Affect Daily Life

Both ADHD and OCD can impact many areas of a child’s life, including:

• Home routines: Trouble getting ready, following instructions, or transitioning between tasks
  
  
• School performance: Poor focus, difficulty completing assignments, test anxiety, or frequent rituals
  
  
• Friendships: Impulsivity or social misunderstandings with ADHD; avoidance or rigidity with OCD
  
  
• Emotional health: Frustration, low self-esteem, or anxiety from not meeting expectations

When both conditions co-occur, families may feel overwhelmed by competing challenges. Targeted strategies and support can make a big difference.

Treatment and Support: What Works for Families

Evidence-based treatments for ADHD and OCD include:

• Cognitive behavioral therapy (CBT): Helps children manage intrusive thoughts and reduce compulsive behaviors in OCD; also effective for teaching executive functioning and impulse control for kids with ADHD. Learn more about cognitive behavioral therapy for ADHD and OCD.
  
  
• Behavioral parent training: Gives caregivers tools to reinforce positive behavior and reduce conflicts.
  
  
• School accommodations: IEPs and 504 plans can support attention, organization, and test-taking.
  
  

Research also shows that personalized care plans and family involvement are critical to long-term success. Therapists may also address co-occurring conditions like anxiety or tics.

Tips for Home and School

• Create predictable routines and visual schedules
  
  
• Use checklists and timers for tasks
  
  
• Break tasks into small, manageable steps
  
  
• Offer praise for effort, not just outcomes
  
  
• Communicate regularly with teachers and school counselors
  
  
• Help your child build self-awareness around triggers, coping skills and developmentally appropriate psycho-education.
  
  

When to Seek Professional Help

If your child’s symptoms interfere with daily life, school performance, or emotional well-being, consider seeking an evaluation. Child therapists who specialize in treating both ADHD and OCD and can guide you through next steps. 

Frequently Asked Questions

How can I tell if my child has ADHD, OCD, or both?
Look for the pattern and purpose behind behaviors. ADHD-related actions are usually impulsive and inattentive, while OCD behaviors are repetitive and anxiety-driven. If unsure, a professional assessment is the best way forward.

Can symptoms change as my child grows?
Yes. Younger children with ADHD may appear more hyperactive, while older kids may struggle more with focus and planning. OCD symptoms may shift from visible rituals to more internal obsessions during adolescence.

What should I do if my child is struggling at home or school?

Start by talking to your child’s teacher or pediatrician. You can also contact Handspring Health for a free consultation and guidance on treatment options.

Next Steps

ADHD and OCD can each pose challenges, but with the right support, your child can thrive. Understanding the differences—and the overlap—can help you seek appropriate care and build helpful routines at home and school.

If you're concerned about your child’s focus, behaviors, or emotional well-being, we’re here to help. Explore Handspring Health’s online resources or schedule a free intake consultation today.