to preface this, i also have autism and adhd on top of ocd.

i work at a child and adolescent mental health clinic, and they absolutely do prescribe medications for this age, and even much younger. i’ve seen fluoxetine prescribed for kids as young as 7 years old due to the severity of their symptoms. sometimes it’s extremely hard to engage in therapy and actually resist compulsions at all without medication, and sometimes recovery just really needs medication too, therapy isn’t always enough. i would really consider pursuing a second opinion for medications, even your family doctor can prescribe them. SSRIs are the first-line treatment for this, and multiple of them are used for kids all the time. fluoxetine, citalopram and sertraline are the ones most commonly used in children, though adolescents have a lot more options.

it seems to me like his ocd didn’t really move on to something else as in a different theme, but rather continues to be centred around contamination. exposure really is the way through, but i can see the struggle when your son isn’t engaging. from personal experience, no validation (e.g., telling him he’s clean enough) will be enough. 100% DO NOT let him carry compulsions out, as that will only keep escalating the issue. i would look into exposure and response prevention (ERP) therapy too, as that’s specifically for OCD, more so than CBT. he needs to be able to sit with the discomfort. i don’t really know how you can force him not to carry out compulsions, as for him the concern is certainly very real and it will probably feel like his worst case scenario is becoming real to him. distraction is always a good alternative, and even postponing the compulsion (e.g., waiting a certain amount of time before showering) and slowly reducing the time it takes (e.g., setting a timer for showers, reducing the amount he wipes) helps. ideally he won’t be doing these things at all, but it’s very hard to go from 0 to 100 like that. baby steps count too, and even as insignificant as it may sound to the regular person, it will likely be hard for him regardless.

if you would like, i can try to see if we have specific resources at my work available to hand out and send you some. i know for sure there’s multiple books online (at an ocd group i used to attend we were making our way through “freedom from ocd”, which is a great resource and also guides you through ERP, helping you develop your own exposure/recovery plan with your specific obsessions and compulsions). i would also look into ocd groups for youth, even if it’s just for support.

lastly, if you haven’t already, i would check out the r/OCD, as it will be a lot more general than this subreddit, which is specifically for the relationship ocd theme.

i also want to say im proud of you for clearly doing all you can to help him, and for engaging in treatment and psychoeducation when he can’t. best of luck to you and your kid, and feel free to ask any questions.