Can it be OCD?

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MENTAL HEALTH IN EARLY CHILDOOD

Can it be OCD?
A Parent’s Guide to Childhood OCD
Jenny Duffy 3/6/2013

What is OCD?

Think about when you’re listening to music on a CD and then that CD begins to skip. The same word or instrumental piece is repeated again and again and again. The only way to make the skipping stop is to go over to the CD player and hit the stop button or change it to the next song. Now imagine if this was happening in your mind. You are thinking about some things and then one thought keeps repeating over and over. You can’t get past that thought, and to make matters worse it’s an upsetting thought like “Someone’s going to break into the house”. You realize that the only way to make the thought go away is to do something. You might go check the lock on the front door. But after your check it, the thought is still repeating in your mind. So you check it again. No luck, the thought is still there. You keep checking the lock until the thought leaves. Finally, you can think about other things and you feel safe. But later on just as you are getting ready to go to bed the thought invades your mind again. Just like earlier, it keeps repeating with no indication of leaving. Knowing that you were able to get some peace earlier, you return to the door to check the lock. By the time your mind is clear and you climb into bed you realize that 30 minutes has passed. You had checked the lock over and over again and time was no issue. The only important issue was getting rid of that thought. Obsessive Compulsive disorder is an anxiety disorder which consists of obsessions (unwanted and repeated thoughts, sensations, ideas, images, feelings) and compulsions(rituals or behaviours that the person feels compelled to perform in attempt to get rid of the unwanted feelings or to prevent something bad from happening) (Wagner, 2009). Like that skipping CD, When OCD causes the brain to get stuck on a certain thought or urge and the only way to ward off that thought or chase away that fear is to perform a ritual. However, performing these rituals provides relief that is only temporary and not performing these rituals causes great anxiety (PubMed Health, 2013). While OCD was once thought of as a disorder only affecting adults, it is now apparent that young children can have OCD. According to the American Academy of Child and Adult Psychiatry, about 1 in 200 children and teenagers in the United States have OCD (AACAP, 2011). It is unclear as to why OCD occurs. “Scientists understand that OCD is a neurobiological illness, caused by an imbalance in certain brain chemicals” (OCF Chicago, 2006, p.11). OCD happens more often when another family member has OCD which suggests that there is a genetic element to the disorder. In rare cases, OCD can be caused by a bacterial infection (streptococuus or ‘strep’) (March, Mulle, 2010). OCD is not the result of a certain parenting style, and it is not a sign of misbehavior or lack of self control(OCF Chicago, 2006). “Stress does not cause OCD, although a stressful event or life change can trigger its onset” ((OCF Chicago, 2006, p.11).

What are the Symptoms?

Children who experience OCD may or may not realize that their fears are irrational and that their behaviour isn’t truly helpful. Children may realize something is wrong but try to hide their symptoms out of fear and shame. Since rituals are usually performed in a particular order and are often repeated, they can be quite time-consuming. A child who spends a lot of time in their room or by themselves may be doing so because they are involved in rituals. People who have OCD often fall into one of the following categories:
    

Washers are afraid of contamination. They usually have cleaning or hand-washing compulsions. Checkers repeatedly check things (oven turned off, door locked, etc.) that they associate with harm or danger. Doubters and sinners are afraid that if everything isn’t perfect or done just right something terrible will happen or they will be punished. Counters and arrangers are obsessed with order and symmetry. They may have superstitions about certain numbers, colors, or arrangements. Hoarders fear that something bad will happen if they throw anything away. They compulsively hoard things that they don’t need or use. (Segal, Smith, 2013, para. 6)

Common obsessions include:
      

Fear of dirt or contamination by germs. Fear of causing harm to another. Fear of making a mistake. Fear of being embarrassed or behaving in a socially unacceptable manner. Fear of thinking evil or sinful thoughts. Need for order, symmetry, or exactness. Excessive doubt and the need for constant reassurance. Common compulsions include:

     

Repeatedly bathing, showering, or washing hands. Refusing to shake hands or touch doorknobs. Repeatedly checking things, such as locks or stoves. Constant counting, mentally or aloud, while performing routine tasks. Constantly arranging things in a certain way. Eating foods in a specific order.

   

Being stuck on words, images or thoughts, usually disturbing, that won't go away and can interfere with sleep. Repeating specific words, phrases, or prayers. Needing to perform tasks a certain number of times. Collecting or hoarding items with no apparent value. (Katz, 2012) Sometimes obsessions and compulsions appear related. For example, a child with an obsessive fear of intruders may check door locks repeatedly. A child with an obsessive fear of disease may wash excessively. Other obsessions and compulsions are linked only in the child’s mind. A child with OCD may fear that harm will come to her family unless she taps in a particular pattern or avoids using certain numbers (OCF Chicago, 2006, pg. 9). A common fear among children with OCD is that of losing a loved one unless certain rituals are carried out. In an article about how to cope when your child has OCD, Jacquelyn Waller-Vintar says of her daughter: …if a parting routine of a kiss, followed by a certain spoken phrase, then three waves and a turn to the right, is not followed exactly, the whole scenario has to be repeated, correctly. If it isn't, Tessa is convinced that I will die (Waller-Vintar, 2013, p.1). OCD can look very different from child to child. A child may exhibit one of the symptoms of OCD or they may exhibit several. There also degrees of OCD including mild, moderate, and severe. Symptoms of OCD can change over time, seasonally, at certain developmental milestones and with hormonal changes. Symptoms can also fluctuate in content and intensity based on schedule changes, nutrition, exercise, sleep quality and quantity, and solitude in home life and school life (Martin, 2011).

I’m Concerned that my Child might have OCD

If you are noticing that your child is exhibiting any of the symptoms you may be concerned of the possibility of your child having OCD. It is important to keep in mind that it is developmentally normal for young children to have superstitions such as avoiding cracks in the sidewalk. Children may prefer to eat the food on their plate in a certain order, or want to save the scraps of paper left over from an art project. Something to make note of is when a child seems to be preoccupied by both obsessions and compulsions, and seems to have a lot on his/her mind. It is important for children to feel that they are safe to express their feelings to the important adults in their life. Children who are struggling to understand the upsetting thoughts

they are experiencing, and the rituals they feel compelled to perform, may feel comfortable enough in a safe and caring relationship, to share their concerns. Beth Boyle Machlan, a senior lecturer at NYU recalls of her 8-year old daughter: Then one night, just before her bedtime back rub, she whispered that she had something to tell me. “What is it, bunny?” “You know how Ella Enchanted had to do things even if she didn’t want to? Sometimes I feel like I have to do things, too.” I tried not to panic. “What kind of things?” “I have to count things. Or line them up. I feel like if I don’t do that, something bad will happen.” “What will happen, sweetie?” “Something bad,” she repeated firmly. “To you or Daddy.” I knew immediately that Lucy was describing obsessive-compulsive disorder, or O.C.D., a condition that often arises alongside Tourette’s. Her allusion to Ella Enchanted, a character in a contemporary fairy tale who must do anything she is told, suggested that she knew her fears weren’t “real.” At the same time, they were obviously bothering her to the point where she needed to ask for help — something Lucy usually hated to do (Machlan, 2012, para.3).

On the other hand, even in a relationship in which children do feel safe and secure, fear and shame may prevent them from disclosing to an adult. Sometimes children are humiliated and scared about the intrusive thoughts they have and the rituals they feel inclined to carry out. It is not uncommon for children to become secretive and to try and hide symptoms. If a parent feels that symptoms of OCD are being expressed, it is important to seek help. While OCD can be debilitating and frustrating for both parents and children, the good news is that this disorder is highly treatable. With support from their family as well as professional(s) children can learn strategies to overcome OCD. In the next section we will discuss treatment options that are available for children with OCD.

Treatment

When discussing the treatment options for OCD it is first important to be aware that: The symptoms of other disorders such as ADD, Autism, and Tourette’s syndrome, can also look like Obsessive Compulsive Disorder, so a thorough medical and psychological exam is essential before any diagnosis is made (Robinson, Segal, Smith, 2013, para.11). If you think your child may have OCD the first step is to make an appointment with your pediatrician. Your pediatrician can make a referral to a mental health centre where your child can be evaluated by mental health professionals such as a psychologist or a psychiatrist. It is important to find a CBT therapist or clinic that is experienced in treating children with OCD (Wagner, 2009). When seeking treatment for your child it is extremely likely that you will learn about Cognitive Behavioural Therapy. Research indicates that Cognitive Behavioural Therapy (CBT) is very effective in helping children and families overcome OCD (Godderis, McEwan, Schwartz, Waddell, 2005). In fact, CBT “ is recommended by leading national authorities such as the Mayo Clinic, the National Institutes of Health, Harvard Medical School and the American Academy of Child and Adolescent Psychiatry” (OCD Education Station, 2013, para. 2). CBT is a type of ‘talk therapy’ that can take place in a group format or individually. The family is encouraged to be involved in the therapy sessions. CBT helps children to confront their OCD fears and respond in ways that are constructive, rather than performing rituals. CBT uses Exposure and Response Prevention Therapy (ERPT). An example of ERPT would be a child who is fearful of germs would be asked to touch a feared object little by little until they realize that the object is not dangerous (OCD Resource Centre of Florida, 2013) Antidepressants called SSRI’s (Selective Serotonin Reuptake Inhibitors) can be used to help children with OCD, but should only be prescribed for OCD that is moderate or severe. Your child’s doctor will determine which medicine to try. Since medicines take some time to act, it may take several weeks before a noticeable change in your child’s behaviour occurs. While medicine can help reduce the symptoms of OCD, symptoms often return when the medicine is no longer taken (Wagner, 2009). For this reason it is recommended that the use of medication be accompanied with therapy.

How Can I Help my Child at Home?
Learning all that you can about OCD can help you to further understand this disorder and why your child has been acting in certain ways. Gaining more understanding and knowledge can also help you feel more confident in supporting your

child. Management of OCD is not to be restricted to only parents and the child. The whole family should be involved and should have an understanding of what OCD is and what strategies the child is working on to overcome OCD. In supporting you child to change his/her thoughts and behaviours it is helpful for you as the parent to remember that as frustrating as the symptoms of OCD can be, it is not your child that is the problem, it is OCD (March, Mulle, 2010). Since OCD often causes feelings of shame, it can be reassuring for children to hear that it is not their fault and that it is OCD that is the problem, not them. Talking about OCD in ‘third person’ can help reaffirm to your child that it is OCD that is the problem and that you are there to help. An example of this would be “You know this thing about needing to wash your hands over and over? That’s not you, that’s OCD” (March, Mulle, 2010). To help distinguish OCD from themselves, children may call OCD by a name like ‘Mr.Bossy’ or ‘the brain bully’ (March, Mulle, 2010). While making it clear that OCD is not your child’s fault, children still need to know that they are still responsible for practicing strategies and for taking the medication (if given), but they are not alone and you are there to help(March, Mulle, 2010). Earlier we discussed briefly how the whole family should be involved in the treatment process. OCD truly takes a toll on every member of the family. Children with OCD may ask their siblings or parents to engage in their rituals. For example, a sibling may be asked to the check cleanliness of objects or the locks on doors more often than necessary. This can be very frustrating for family members who feel obliged to participate in the vicious cycle of OCD (Yip, 2012). Rather than participating in the ritual, the family member can respond calmly and courteously, “It’s the OCD asking.” This response helps family members detach themselves from the rituals, and can help the child recognize that OCD is something separate from who he/she is (Yip, 2012). OCD can bring forth other significant challenges for families. For instance, if a child is interrupted mid-ritual by another member of the family, this can result in anger manifested by screaming, kicking, name-calling, etc. While knowing that there is real fear associated with the interruption of this ritual, parents still need to act promptly and offer guidance to all of the children involved. Validating fear and frustration associated with OCD does not mean that consequences aren’t needed. Treatment at home is an extensive topic that this section has only touched on. For more information about how to help your child at home some online resources are:

Children’s Hospital of Eastern Ontario: http://www.cheo.on.ca/uploads/OCD/OCD%20ENG.pdf Anxiety BC: http://www.ocdottawa.com/documents/AnxietyBC-Strategies.pdf

Taking Care of You
Helping someone to manage OCD can be taxing, to say the least. It is natural and healthy for parents to comfort their children and to do what they can to help their children to not be afraid or worried. When a child has OCD this kind of comforting is not always possible, and if comforting is in the form of assisting children in rituals it can actually reinforce the OCD. This is one of the reasons why OCD can be so difficult to face. Even in the midst of treatment it is completely normal for parents and other family members to feel frustrated and discouraged. Self care is crucial for any parent but especially for parents of children who are dealing with an illness. In attempt to help their child, parents may become isolate. They may give up activities and not spend as much time with friends and other important people in their life. Recognizing your own limits and making time for yourself are keys to self care” (CAMH, 2012, para. 16). Enough can’t be said for the importance of having a network of support. Confiding in people who are understanding, empathetic and supportive can help ease some of the burden you are feeling. A self-help organization or support group can provide additional support. One may be offered by a community mental health organization, clinic or local hospital (CAMH, 2012). Also resuming activities you have enjoyed and trying out new ones (eg. pottery, running, volunteering) can help you to stay connected with others and serve as outlets for having fun and staying healthy.

Additional Resources

Prince Edward Island Richmond Centre- Children's Centralized Intake 1 Rochford Street Charlottetown, PE C1A 7N8 T: 1-866-833-5443 (toll free) F: (902) 368-4427

McGill Community Mental Health Centre 55 McGill Avenue PO Box 2000 Charlottetown, PE, C1A 7N8 902-368-4911 Online

How to Help your Child: A Parent’s Guide to OCD: http://beyondocd.org/uploads/pdf/parents-guide.pdf

Article: How to Cope when your Child has OCD: http://www.canadianliving.com/moms/family_life/how_to_cope_when_a_family_mem ber_has_obsessive_compulsive_disorder.php

A Child’s Guide to OCD (explains OCD in way that children could easily understand) http://www.ocdkids.org/

Children’s Books Up and Down the Worry Hill: A Children's Book about Obsessive-Compulsive Disorder and its Treatment By Aureen Pinto Wagner, phD What to do When Your Brain Gets Stuck By Dawn Huebner, phD

References
AACAP. (2011). Obsessive-Compulsive Disorder in children and adolescents. Retrieved from http://www.aacap.org/cs/root/facts_for_families/obsessivecompulsive_disorder_in_chi ldren_and_adolescents

Beyond OCD. (2013). Evidence-based treatments for OCD. Retrieved from http://www.ocdeducationstation.org/ocd-facts/evidence-based-treatments-for-ocd/

Godderis, R., McEwan, K., Scwartz, C., & Waddell, C. (2005). Preventing and treating Obsessive-Compulsive Disorders in children and youth. Retrieved from http://www.childhealthpolicy.sfu.ca/research_reports_08/rr_pdf/RR-11-05-full-report.pdf

Katz, M. (2012). Obsessive-Compulsive Disorder. Retrieved from http://www.webmd.com/anxiety-panic/guide/obsessive-compulsive-disorder

Machlan, B.B. (2012). Two-way mirror: Facing a daughter’s OCD. New York Times. Retrieved from http://opinionator.blogs.nytimes.com/2012/07/09/two-waymirror-facing-a-daughters-o-c-d/

March, J.S., & Mulle, K. (2010). What you need to know about…helping children and youth with Obsessive-Compulsive Disorder: Information for parents and caregivers. Retrieved from http://www.cheo.on.ca/uploads/OCD/OCD%20ENG.pdf

Martin, R. (2011). Symptoms of Obsessive Compulsive Disorder in children. Retrieved from http://www.ocdinkids.com/symptoms-of-obsessive-compulsivedisorder-in-children/

NIMH. (2013). Obsessive-Compulsive Disorder: When unwanted thoughts take over. Retrieved from http://www.nimh.nih.gov/health/publications/obsessive-

compulsive-disorder-when-unwanted-thoughts-take-over/what-are-the-signs-andsymptoms-of-ocd.shtml

OCD Resource Center of Florida. (2011). Obsessive Compulsive disorder in kids. Retrieved from http://www.ocdhope.com/ocd-symptoms-kids.php

OCF Chicago. (2006). How to help your child: A parent’s guide to OCD. Retrieved from http://beyondocd.org/uploads/pdf/parents-guide.pdf PubMed Health. (2012). Obsessive-Compulsive Disorder. A.D.A.M. Medical Encyclopedia. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001926/

Robinson, L., Segal, J., & Smith, M. (2013). Obsessive Compulsive Disorder. Retrieved from http://www.helpguide.org/mental/obsessive_compulsive_disorder_ocd.htm

Waller-Vintar, J. (2013). How to cope when your child has OCD. Retrieved from http://www.canadianliving.com/moms/family_life/how_to_cope_when_a_family_mem ber_has_obsessive_compulsive_disorder.php

Wilensky, A. (2006). When your child has Obsessive Compulsive Disorder. Retrieved from http://psychcentral.com/lib/2006/when-your-child-has-obsessivecompulsive-disorder/

Yip, J., (2012). Psychoeducating parents to defeat their child’s OCD Monster! The OCD Monster. Retrieved from http://www.psychologytoday.com/blog/the-ocdmonster/201203/psychoeducating-parents-defeat-their-child-s-ocd-monster?page=2

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