OCD and anxiety therapy for children and teenagers

Children and teenagers are not just small adults

OCD and anxiety present differently in younger clients. A child's intrusive thoughts may look like rigid routines or frequent reassurance-seeking from parents. A teenager's social anxiety may look like avoiding school entirely. ARFID may look like extreme pickiness that isn't about behavior at all. Selective mutism may look like shyness, until you realize your child hasn't spoken at school in months.

Getting it right requires a therapist who understands child development, who knows how to engage younger clients in treatment, and who knows how to work with families, not around them.

I work with children starting at age 4 through late adolescence, using evidence-based approaches adapted for each child's developmental level. I involve parents and families as active partners throughout treatment, because what happens at home matters as much as what happens in the therapy room.

Taking the first step is often the hardest part. Reach out. I'd love to hear what's going on.

What I treat in children and teenagers

Anxiety Disorders in Children & Teenagers

Anxiety is the most common mental health condition in children and teenagers, and it's also one of the most treatable. At Untangled, I treat the full range of childhood and adolescent anxiety disorders:

• Separation Anxiety Disorder. Fear of being away from parents or caregivers, often driving school refusal, sleep difficulties, and physical complaints.

• Social Anxiety Disorder. Intense fear of judgment or embarrassment in social situations, which can lead to school avoidance, isolation, and difficulty making friends.

• Generalized Anxiety Disorder (GAD). Persistent worry about a wide range of things including school, health, family, and the future.

• Panic Disorder. Recurrent panic attacks and fear of future attacks, often leading to avoidance of activities or situations.

• Specific Phobias. Intense fear of particular objects or situations including animals, needles, vomiting, storms, and more.

• Perfectionism. Anxiety driven by impossibly high standards, fear of failure, or fear of making mistakes. Very common in academically high-achieving kids and teens.

  Approaches used: CBT, ERP, ACT, SPACE, family involvement

OCD in Children & Teenagers

OCD in children often looks different from adult OCD. It can show up as:

• Repetitive reassurance-seeking ("Are you sure nothing bad will happen?")

• Rigid routines or rituals that cause meltdowns if disrupted

• Avoidance of certain objects, places, or activities

• Frequent trips to the nurse or complaints of stomachaches with no medical cause

• Intrusive thoughts that a child may not be able to articulate but that cause clear distress

• Behavioral changes at school, including decreased focus, withdrawal, or outbursts

OCD in teenagers can look more like the adult version, with intrusive thoughts, mental compulsions, and reassurance-seeking, but is often complicated by social anxiety, identity concerns, and the pressure of school and relationships.

I treat all OCD subtypes in children and teenagers, using ERP adapted for age and developmental level. Younger children respond especially well to playful, engaging approaches to exposure work. Treatment always includes parents, both to help them understand what OCD is and isn't, and to coach them in responding in ways that help rather than accidentally reinforce the cycle.

Approaches used: ERP, CBT, ACT, SPACE, parent coaching

Selective mutism is an anxiety disorder in which a child who is capable of speaking is consistently unable to speak in certain social situations, most commonly at school, despite speaking normally at home or in other comfortable settings. It is not defiance, shyness, or a language delay. It is anxiety.

Selective mutism is most common in young children and is often first noticed when a child starts school. Left untreated, it can persist into adolescence and significantly impact social development, academic performance, and self-confidence.

Treatment for selective mutism is behavioral, focused on gradually increasing a child's comfort and verbal participation in anxiety-provoking situations through carefully structured exposures. Parent and school involvement are essential, and I collaborate directly with teachers and school staff as part of treatment.

Early intervention produces the best outcomes, but selective mutism can be treated at any age.

Approaches used: CBT, ERP, graduated exposure, parent coaching, school collaboration

Selective Mutism

School Anxiety & School Refusal

When getting to school becomes a daily battle, or stops happening altogether, the whole family feels it. School refusal is almost always driven by anxiety, and the longer avoidance continues, the harder it becomes to reverse.

At Untangled, school anxiety and refusal is a dedicated specialty. Treatment involves real-world exposures, home visits when needed, SPACE-based parent coaching, and direct collaboration with schools to build a coordinated return plan.

I often begin by working with parents first, before the child is ready to engage in therapy, through SPACE. This alone can shift the patterns at home and begin changing the dynamic that keeps school refusal going.

ARFID (Avoidant/Restrictive Food Intake Disorder)

ARFID is a feeding disorder characterized by highly restricted eating, not driven by body image concerns, but by anxiety. Children and teenagers with ARFID may:

• Eat only a very limited range of foods based on texture, color, smell, or appearance

• Experience intense fear or disgust responses to new or unfamiliar foods

• Avoid eating in social situations (school lunch, restaurants, family meals)

• Have significant nutritional deficiencies or growth concerns as a result of restricted intake

ARFID is not picky eating. It is a real, recognized anxiety-based condition that causes genuine distress and impairment, and it responds to evidence-based treatment.

Treatment at Untangled focuses on the anxiety and avoidance driving ARFID, using graduated exposure to feared foods and situations alongside CBT and ACT. Family involvement is essential, and collaboration with pediatricians and dietitians is common.

Who this is for: Children, teenagers, and young adults. (Adult ARFID is also treatable, reach out to discuss.)

Approaches used: CBT, ERP, ACT, graduated food exposure, family involvement, provider collaboration

Body Dysmorphic Disorder (BDD) in Teenagers

Body Dysmorphic Disorder is a condition in which a person becomes preoccupied with a perceived flaw in their appearance, one that others typically cannot see or consider minor. In teenagers, BDD often involves the skin, hair, nose, or overall appearance, and can involve hours spent checking, comparing, or attempting to fix the perceived flaw.

BDD is closely related to OCD, it involves the same cycle of intrusive, distressing thoughts and compulsive behaviors aimed at reducing anxiety. It responds to the same evidence-based treatment: ERP and CBT.

BDD in teenagers is often missed or mistaken for typical adolescent self-consciousness. It is not. When preoccupation with appearance is causing significant distress, interfering with school, social life, or daily functioning, it is worth treating.

Approaches used: ERP, CBT, ACT

→ BDD in adults is addressed on the OCD and Anxiety pages.

PANS / PANDAS

PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) and PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) are conditions in which OCD symptoms, anxiety, and other neuropsychiatric symptoms appear suddenly or worsen dramatically, often following a strep infection or other immune trigger.

Children with PANS/PANDAS may experience:

• Sudden, severe onset of OCD symptoms or intense anxiety

• Emotional dysregulation including rage, crying, and extreme irritability

• Sensory sensitivities

• Separation anxiety or regression

• Tics

• Cognitive changes including difficulty concentrating, handwriting changes, or memory issues

PANS/PANDAS requires a team approach. The medical side, identifying and treating the underlying infection or immune trigger, is managed by a pediatrician, immunologist, or PANS/PANDAS-informed physician. The behavioral and psychological side, the OCD, anxiety, and emotional dysregulation, is where I come in.

I provide CBT and ERP treatment for the OCD and anxiety symptoms associated with PANS/PANDAS, in close collaboration with your child's medical team. Treating the behavioral symptoms alongside the medical treatment produces the best outcomes.

Important note: If you suspect your child has PANS/PANDAS, a medical evaluation is an essential first step. I am happy to collaborate with your child's physician and to discuss what therapy involvement looks like.

Approaches used: ERP, CBT, ACT, family involvement, medical team collaboration

Taking the first step is often the hardest part. Reach out. I'd love to hear what's going on.

Q: How young is too young for therapy?
A: I work with children starting at age 4. Treatment for very young children looks quite different from teen or adult therapy, it is play-based, engaging, and heavily family-focused. Young children can make remarkable progress with the right approach.

Q: My child won't talk to a therapist. What do I do?
A: This is very common. I can start by working with you as the parent through SPACE, which can shift the patterns at home and sometimes makes your child more open to their own therapy over time. You do not have to wait for your child to be willing before something can change.

Q: My child has been diagnosed with PANS/PANDAS. Do you treat that?
A: I treat the OCD and anxiety symptoms associated with PANS/PANDAS, in collaboration with your child's medical team. Medical treatment of the underlying cause is handled by your physician. I handle the behavioral and psychological piece.

Q: My teenager refuses to come to therapy. Can you still help?
A: Yes. SPACE-based parent work can be a powerful starting point. Teenagers who initially refuse often become more open once the dynamic at home shifts.

Q: Do you collaborate with my child's school?
A: Yes. I work directly with school staff, including counselors, teachers, social workers, and administrators, to coordinate care and build return-to-school plans when needed.

Q: Do you take insurance?
A: Untangled is an out-of-network, private-pay practice. I provide superbills after each session for potential out-of-network reimbursement through your insurance.

How I work with families — not just the child

Children and teenagers don't heal in isolation. The family system, how parents respond to anxiety, how siblings interact, and what happens at home between sessions, is a powerful factor in whether treatment works.

At Untangled, families are involved from the start. Here is what that looks like in practice:

Starting with parents when needed. When a child or teenager is not yet ready or willing to engage in therapy, I can begin by working with parents alone through SPACE (Supportive Parenting for Anxiety, OCD, and Related Disorders). This evidence-based approach helps parents respond to their child's anxiety in ways that reduce it over time. In many cases, parent work alone produces meaningful change, and often opens the door for the child's own engagement in treatment.

Common questions about Child & Teen Therapy

Parent coaching throughout treatment. Even when a child is engaged in individual therapy, parents receive coaching throughout the process. Understanding what OCD and anxiety are, how to respond at home, and how to support exposures between sessions makes treatment significantly more effective.

Family sessions. When the whole family dynamic needs attention, or when a parent's own anxiety is affecting their child's recovery, family sessions are part of the work.

Collaboration with schools. I work directly with teachers, school counselors, social workers, and administrators. A coordinated response between home and school makes a significant difference, particularly for school refusal, selective mutism, and social anxiety.

Collaboration with other providers. I collaborate with pediatricians, psychiatrists, occupational therapists, and other involved providers. For PANS/PANDAS and ARFID especially, a team approach is essential.

Adress:

PHONE: +1 630-394-5878

Serving Naperville, Aurora, Bolingbrook, Wheaton, Warrenville, Lisle, Woodridge & surrounding suburbs · Telehealth in IL & IA · © 2025 Untangled OCD and Anxiety Specialists

Links:

EMAIL: jelena@untangledocd.com

ADDRESS: 640 South Washington St. Suite 212 Naperville, IL, 60540, United States

LICENSED IN: Illinois & Iowa | Indiana coming soon

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I offer in-person sessions in the Naperville area and telehealth across Illinois and Iowa. If you need a home visit for school refusal, anxiety support, or family coaching, I can do that. If you need intensive sessions, I can do that too.