Is your child insisting it has to be just so?

Is your child:

  • Washing hands too much? To the point that skin is cracked or bleeding?
  • Experiencing extreme anxiety if things are not just so?
  • Often checking things, like whether his toys are lined up properly?
  • Always sitting in the same place at the dinner table?
  • Doing repetitive rituals that don’t serve a function?
  • Repeatedly ‘checking’ for germs; often saying, “I have to!”
  • Not letting it go when things aren’t perfect?
  • Leaving her locker a mess but organizing stuffed animals like a science?
  • Being unable to leave the house unless everything is in order?
  • Seeming to never be happy; always finding something that’s not quite right?


It is one thing to be a bit of a neat freak or to be a tad too organized. It is another when having things out of order causes extreme distress. Your child may obsess about cleanliness or germs. She may wash her hands or use sanitizer repetitively. He or she may have repetitive rituals that do not seem to serve a purpose. Your child may be constantly ‘checking’ for germs or potential dangers. The child may insist on his or her toys being sorted in a perfect order. If the little sister comes in and moves things around, the child may have a meltdown.

The child may say “But I have to,” as he insists on cleaning or organizing something over and over again. He may be scared to go certain places or to eat certain things based on these worries and concerns.

She may have to complete a ritual or routine before just being able to leave the house. You may often be late to places because of your child’s need to be ready or prepared in order to alleviate anxiety.


Repetitive, non-functional routines or rituals used to relieve anxiety are referred to clinically as ‘compulsions.’

The underlying problem could be obsessive compulsive disorder (OCD) [1] or an obsessive compulsive personality type.

OCD is characterized by obsessions over something, such as germs, and corresponding compulsions are used to relieve the anxiety. Extreme anxiety and perseverative, obsessive thinking are often the result if compulsions are not carried out.

For example, a child might feel extremely anxious if he is not allowed to wash his hands 5 times before leaving the house. This compulsive routine may be alleviating the obsessive worry that his hands are covered in germs.

It is important to differentiate this symptom from a child’s rigidity or need to have things a certain way for the comfort of routine. If your child’s rigidity is related more to a specific interest and does not necessarily serve the purpose of relieving anxiety, then you may be looking at an autism spectrum disorder.


If your child has compulsive behavior that is impacting day-to-day functioning, it is important that you seek professional help. Consider a combination of psychotherapy and medication to treat these symptoms.

At home, support your child with warmth and patience. Do not punish compulsive behaviors.

Work with a professional to expose your child very gradually to feared stimuli like germs. Cognitive Behavioral Therapy is a modality with considerable research to support its effectiveness.

CBT can be paired with exposure response prevention treatments that are slowly introduced in a gradual manner, giving anxiety time to dissipate within the situation. For example, a child with OCD may work to gradually touch something with germs and not wash hands.

The child is going to be slowly and gradually presented with the obsession but be unable to complete the compulsive ritual or thinking pattern.

Then, CBT can address understanding obsessions and anxiety, recognizing worry and fears, and developing healthy and appropriate coping strategies. OCD treatment is generally individual therapy, but parents or family members may be involved to the practice exposure with response prevention.


If your child is struggling with a similar problem, not directly addressed in this section, see the list below for links to information about other related symptom areas.

  • Rigid behavior: compulsions can be related to rituals and routines associated with autism and other neurodevelopmental disorders
  • Perseverating: compulsions that stem from repetitive thought patterns can be symptomatic of anxiety or autism
  • Attachment: compulsions can result from excessive anxiety; children reacting to unstable environmental situations may try to execute some level of control over their lives through rituals and routines


Children who have significant problems in this area may have any of the following potential disabilities. *Note, this information does not serve as a diagnosis in any way. See the ‘Where to Go for Help’ section for professionals who can diagnose or provide a referral.

  • Anxiety: excessive worry that has an impact on day-to-day functioning can result in compulsions
  • Depression: depressed mood, or, in children, irritability that is pervasive; decreased interest in activities that used to be enjoyable may result in compulsions
  • Attachment Disorder (Trauma and Attachment Disorders): emotional symptoms like anxiety and depression as well as rigidity and extreme behaviors that stem from challenges in attachment to primary caregivers (death of a parent, change of caregivers, abuse in the home) can lead to compulsive behavior
  • Autism Spectrum Disorder: deficits in social communication and restricted interests or behaviors that may lead to a preference for routine, repetitive, and compulsive behavior
  • PTSD (Trauma and Attachment Disorders): reaction to a traumatic situation with fear and need for things that are predictable and comfortable can lead to compulsive behavior


If your child is struggling with this symptom to the point that it is getting in the way of his learning, relationships, or happiness, the following professionals could help; they may offer diagnosis, treatment, or both.

  • CLEAR Child Psychology: to obtain a customized profile of concerns for your child or consult ‘live’ with a psychologist
  • Psychotherapist or Play Therapist: to treat emotional symptoms and anxiety. Cognitive Behavioral Therapy is the best practice treatment for OCD. This approach teaches child to remain calm while not carrying out compulsive routine
  • Psychologist or Neuropsychologist: to consider a full assessment to look at symptoms in mental health context

These professionals may recommend or administer the following tests for this symptom:


[1] Huebner, Dawn. (2007). What to do when your brain gets stuck: A kid’s guide to overcoming OCD.

[2] Huebner, Dawn (2005). What to do when you worry too much: A kid’s guide to overcoming anxiety (What to do guides for kids).


[3] Zelinger, Laurie & Zelinger, Jordan (2014). Please explain anxiety to me.

[4] Cook, Julia (2012). Wilma jean and the worry machine.

[5] Peters, Daniel B. (2013). From worrier to warrior: A guide to conquering your fears.


[6] Culbert, Timothy &  Kajander, Rebecca (2007). Be the boss of your stress (Be the boss of your body®).


[7] Kroncke, Willard, & Huckabee (2016). Assessment of autism spectrum disorder: Critical issues in clinical forensic and school settings. Springer, San Francisco.

Image Credit:
Description: Child washing hands from water tap at school
Stock Photo ID: #156410816 (Big Stock)
By: supparsorn
Previously Licensed on: June 6, 2017
Stylized by Katie Harwood exclusively for CLEAR Child Psychology

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