My daughter has developed rituals, like lining things up and tapping the car door. Is this an early sign of OCD?

Possibly, but obsessive-compulsive disorder, or OCD, is much more than having little rituals. In OCD, the rituals rule, to the point of interfering with daily life; the person gets anxious and upset if anything gets in the way of them. OCD usually starts in adolescence or early adulthood, but it occasionally begins in childhood. Sometimes rituals can be very comforting to children. They can give the day structure and predictability, and ease transitions, such as entering and leaving school. And some rituals, like a morning cuddle in bed with Mommy and Daddy, can be good for the whole family! If your daughter's rituals come before playing with friends or are getting in the way of homework, or if she seems upset if she can't do them, I might be concerned. Ditto if she seems worried, sad, or is having trouble in school. If any of that is going on, give your doctor a call. 

Claire McCarthy, M.D., is an assistant professor of pediatrics at Harvard Medical School in Boston. Send her your health questions at Parenting.com/momsquad.

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