Research on the effectiveness of cognitive-behavioral therapy, and in particular, exposure with response prevention for Obsessive-Compulsive Disorder (OCD), has only been systematically evaluated in children and adolescents ages 7–17. These treatments do not address the unique characteristics of young children with OCD. This paper discusses clinical considerations for treating OCD in young children (ages 5–8), including cognitive developmental differences, family context, unique symptom correlates, and initial contact with the mental health system. A family-based treatment program consisting of psychoeducation about OCD in young children, parent education, and exposure with response prevention for young children and their parents is described. Issues to consider regarding implementation of this treatment, research with a young population, and future directions for research are presented.