When you as an adult worry about something — perhaps a teenage son is out past curfew, or you're awaiting results on a medical test — you may choose to occupy your mind with a so-called “mindless activity,” an action that in its simplicity or repetition serves to calm you. Perhaps you rearrange the spices in your kitchen cabinet or stack papers on your desk at work, anything to ease your worry about when your son will get home or what your lab results might be.

These efforts to deflect anxiety about specific issues in your life are considered healthy coping strategies. Typically, your anxious state ends when the cause of worry is gone. At that point the tasks of arranging spices or desk papers return to their previous status as occasional chores.

When Ordering Becomes Obsessive

Like you, a child with OCD attempts to gain control over his anxiety by ordering his environment. His strategy, like yours, includes arranging or rearranging objects to create order. But that is where the similarity between your strategy and his ends. That's because the anxiety he experiences is not tied to any specific, identifiable cause. For him, the compulsion called ordering takes the form of a need to exert control over his environment to an extreme degree and on a nearly constant basis.

The Need for Certainty

The need for certainty, also called a need to know obsession, takes the form of a desire to erase all doubt or uncertainty from life. For a child with OCD, persistent, disproportionate self-doubt can manifest in his need to check and recheck all kinds of things in his environment. Has he locked the door (to ward off intruders)? Did he remember to line up his stuffed animals in the correct order (to prevent an accident befalling a family member)? If the answer to any of these questions is “no,” his anxiety level can become unbearable.

Daniel, age eight, explained how he turned his need for certainty into a morning ritual. After he'd lined up and arranged his things just so, he would open his bedroom door, turn back around to face his furniture and belongings, and speak out loud the words, “Now everything is exactly as I want it.” Only then could Daniel go to school.

Endless Questions

In another manifestation of this obsessive need for certainty, your child may ask a litany of questions that seem out of proportion to a situation or topic. His questions can be about something as straightforward as the weather forecast or the correct definition of a word. Another common behavior is a constant need to apologize, often, for things he (incorrectly) believes he's done. Did he say a swear word? Did he forget to say thank you to Aunt Mary?

This OCD behavior can be a real problem at school. Twelve-year-old Nancy's need to know caused her to constantly interrupt her seventh grade teacher during class, sometimes asking the same question over and over again. Her awareness that she asks too many questions didn't even help Nancy. It led her to frequently apologize, again interrupting class to express her relentless need for certainty.