Help for a child with compulsions

August 8, 2009 3:42 PM

A child I know and love appears to have behaviors consistent with OCD. I'd love to hear your personal experiences with treating or adapting to this condition/way of being.

I'm not looking for diagnostic advice - this child is in the process of receiving evaluations from an MD and a psychologist (although if you have advice for specific questions that should be asked in these evaluations, that kind of suggestion is welcome). I am interested in hearing from folks who either have this condition, have always suspected they have this condition, or are close to people who do, and hearing your stories. Specifically, what support did you or would you have found helpful.

Thank you!

posted by serazin to health & fitness (13 comments total)

How old is the child? There's a world of difference in behavior modification treatment in 17 year olds vs 5 year olds.
posted by hal_c_on at 4:11 PM on August 8

Young, school age.
posted by serazin at 4:46 PM on August 8

Both 17 year olds and 5 year olds attend school, generally.
posted by telegraph at 5:24 PM on August 8

Serazin, I have a 10yo son who was diagnosed with OCD 4 years ago and it's been mostly under control for years now with the use of medication and cognitive behavioral therapy.

I can tell you that overall if the kid's OCD-like behaviors interfere with their life to the extent that they can't function normally, it's considered genuine OCD. So for example, wanting to line up Legos a certain way is OCD-like but normal (most kids have times where they're really into rituals), but if they have to keep moving the same pieces over and over until they "feel right," that's more of an indicator of OCD.

Also, with this diagnosis, a kid can (and should) be placed in an IEP (or 504) for school to ensure appropriate school support and they should be ready to meet with teachers and administrators yearly to explain the disability (everyone seems to think it's either constant handwashing or cute, like "Monk." Pediatric OCD is NOT cute.

Tell your friends that if it is OCD, there's a lot of great info and support out there, but finding a competent therapist who understands the disability is incredibly hard (I've met a few who told my son to get over it, etc.,).

Lastly, pediatric OCD is VERY cyclical in nature, so kids will be very stable for a while and then for no apparent reason it flares up again.

Your friends are on the right track and you're kind to get info. This can be very painful at times to deal with so they're lucky to have you.

Feel free to email me for specifics.
posted by dzaz at 5:25 PM on August 8 [3 favorites has favorites]

Wanted to add; professional diagnostic input is great, but what helped me the most was getting a full neuropsychiatric workup done (major city children's hospitals do these).

If the kid has OCD, currently part of the treatment will have to be medication (an SSRI...but beware of Luvox b/c kids can become suicidal on it), and the child will be checking in with a pediatric psychiatrist frequently.

So while an MD and psychologist are okay starting points, they will not be integral to treatment.
posted by dzaz at 5:47 PM on August 8

Most parents I deal with are incredibly relieved to see that there are other families out there coping with something similar. A lot of people might say, why can't you just stop them from doing "x" not realizing that its not that simple. So finding a good book that explains OCD in a way you understand and use that to explain to others can be useful, as can a message board online or support group for parents, who are so important for the successful treatment of their children's OCD

Some parents ask why do I need therapy when my kid is the one who is acting this way? True. However, when you think of the amount of control a young child has over their environment versus you, you can see situations in which your choices are influential in their lives in major ways. Also, changing how you react to his symptoms (panic versus calm understanding) can have a lot to do with how he feels about his own symptoms (I'm bad versus I'm different etc). Behavioral treatment will help you guys manage his obsessions and compulsive and work to reduce those in a structured way that gives him tools to cope in anxiety producing situations. The parents are involved in treatment as requested by the treatment provider, the better outcome you're likely to get. Many common treatments include "homework" of practicing during the week. This helps your child practice the skills more than just the one hour a week they have with the psychologist. You as the parent become the homework boss, making sure you practice with them, and everybody gets the benefit of the extra skill boost.

btw, IANAD, I'm a student in my third year of training as a clinical psychologist, with some experience treating clients with OCD, but obviously no expert.
posted by gilsonal at 6:57 PM on August 8

Please note that SSRIs are certainly not the only solution to OCD. In fact there are many medication and non-medication therapies available. 10 years ago Luvox was all the rage for OCD patients, but times have changed.

Be sure that this child's parents find a psychiatrist and/or therapist (depending how it works where you come from) that is open to trying out many therapies to find the right approach.

Cognitive Behavioral Therapy is very popular these days, and I imagine it might be especially effective with young children (though that's just a guess).

Click here for more info.
posted by hiteleven at 8:51 PM on August 8

This is saladin's girlfriend here. As a 4th year clinical psychology doctoral student and someone with early-onset OCD in sustained full remission, I can't say enough how important it is to make sure that the psychologist is providing CBT (NOT psychodynamic therapy), and in particular, is treating the child using exposure and response prevention (ERP). It is a very effective but also a very difficult type of treatment. Basically, you have to 1) talk about your obsessive/intrusive thoughts and the compulsive behaviors you perform in order to make yourself feel okay (this is, in general, the last thing someone with OCD will want to do); 2) monitor when you are having these thoughts/doing these behaviors, often by writing it down; and 3) learn to experience the thought/trigger (exposure) and not do the ritual (response prevention). Essentially it is learning how not to pull your hand away from a hot stove- it feels wrong, unnatural, and is really painful. A high does of an SSRI (OCD tends to require higher doses than depression does in order to be effective) can help during this part of the treatment. The beauty of ERP is that eventually, it won't feel bad at all not to do the compulsions, and even more amazingly, the thoughts that trigger the compulsions will fade away until they are no longer a problem and, in many cases, stop altogether. It's kind of a miracle.

That being said, it can definitely suck to go through; often after my sessions (as a patient) I would need a good long hug from my mom and some time to just be quiet. Other times I wanted to be distracted and talk about other stuff. It is so wonderful that you're thinking about how you can help this kid, outside of his/her treatment sessions. The most important work goes on outside of the treatment room, and my mom and some other really important adults in my life really helped me through a tough but ultimately amazing process.
posted by saladin at 8:45 PM on August 9 [1 favorite has favorites]

Thanks folks. These ideas are helpful.
posted by serazin at 11:00 AM on August 14

While you're still here (if anyone is) -- how about the role of nutrition in OCD? Any thoughts?
posted by msalt at 11:39 PM on October 5

msalt - do you have some links or something about nutrition and OCD? I"d be interested to hear more.
posted by serazin at 8:48 PM on October 6

I've seen a number of passing references in the literature, and some gimmicky/natural food scene books, but nothing particularly solid yet. Meeting with my daughter's psychologist tomorrow, might know more soon.

I've been struck by how much her symptoms flare up when she visits one set of grandparents who are infamous for showering her with candy....
posted by msalt at 10:09 PM on October 6

One thing I've noticed for sure is that almost any type of change from the routine will cause little flare-ups. So it may not be Grandma's candy causing it, but the visit to Grandma.

My kid is a healthy vegetarian; moderate interest in sugar (his favorite food is tofu...really), and I've never seen a correlation between food and OCD. Extra sugar makes him a little bouncy then cranky.

But that's just my kid.
posted by dzaz at 5:59 PM on October 7