Weighing the pros and cons

July 21, 2010 12:52 PM

What might be the implications of getting my 6-year-old daughter assessed by a mental health clinic?

My almost 6-year-old daughter is a happy and well-adjusted child. She also shows some signs of OCD. NO, I am not a doctor and I am not diagnosing her. But from the reading I’ve done and the behaviours she exhibits, I do believe she has at least a mild form of it (there is also a family history). This would not concern me if it didn’t seem to negatively impact her life, but it does. At times it causes her a fair amount of stress. She is embarrassed about some of the things she does (compulsions) and she avoids certain activities which she would otherwise enjoy due to the “OCD”.

I spoke to our family doctor about my concerns and he referred my daughter to a child and adolescent mental health clinic for an assessment. The assessment is a 1-2 hour interview conducted with both of us (my daughter and me) together, and also with us separately (i.e. they will interview her alone at some point).

I have a couple of concerns:

1 – my daughter’s “symptoms” ebb and flow. At the time that I made the appt with the family doctor (4 months ago), she was in a phase where she was obsessing a LOT over a certain thing and it was greatly impacting her life. I spoke to her about her intrusive thoughts and read her a book called “Up and Down the Worry Hill” which she liked a lot. She was relieved to see that other kids have the same issues and was looking forward to meeting the “special doctor” who would help her control the worrying thoughts. However, since that time she has basically dropped that obsession and is in a “lull” period. This is pretty normal for her. She still exhibits small OCD behaviours, but it’s no big deal – very easy for her to deal with. I’m a bit concerned that taking her to the doctor to talk about things now might make her uncomfortable – I think she feels normal right now and reminding her of the obsessions might make her upset. (As I said, she’s already embarrassed about it.) On the one hand, I want to help her get help if she needs it. On the other hand, I don’t want her to get a complex if it is something she can deal with on her own.

2 – what other implications might the assessment have? My father (a practicing physician) said that once a person gets into the system, it’s hard to get out of it. She will get diagnosed and treated and labeled and it will shape her for the rest of her life. Right now she’s a very happy, bubbly child – she’s really a joy to anyone who knows her. My parents (who know her extremely well) are afraid we might pull that happiness out of her by subjecting her to assessments and treatments that may ultimately be unnecessary (the signs she exhibits are relatively mild – right now). Also, is this something that could affect her ability to get insured (for example)? Can insurance companies even ask the question “have you ever been assessed for/diagnosed with a mental illness”? I am confident that her school will not know about this unless we tell them – the social worker at the clinic assured me of that. But I worry that it might affect other areas of her life.

Should we go through with this assessment? Any guidance would be appreciated. I would especially appreciate hearing stories from people who have been assessed for similar issues and how that impacted them down the line. We are in Ontario, Canada, if it helps.

posted by yawper to health & fitness (38 answers total)

If your daughter's symptoms are indeed very mild, perhaps you should wait and see if they progress or intensify before subjecting her to an assessment, though I really don't think that it will be a horrible experience that will plague her for the rest of her life.

I do wonder about your daughter's embarrassment re: her compulsions. How has she learned that her behavior and actions are not normal, wrong, etc? Meaning, how has she learned to associate her behavior as something "embarrassing"? I'm not trying to put any blame or anything, but at six years old, embarrassment is the kind of thing that is projected onto them, rather than coming from their own awareness.
posted by litnerd at 1:03 PM on July 21, 2010

I guess my only suggestion is to consider whether this is negatively impacting her life or negatively impacting yours, as it's entirely possible the crux of her problem is that she's six years old.

First graders are weird, and they're far from being who they're going to be. Fortunately, the thing about being six is that it only lasts twelve months. This may be something she grows out of next year, next month, or next week.

Unless she's having major trouble adjusting to school, getting along with other children, or progressing within the bounds of "normal," and this goes on for quite some time (i.e. more than a few months) I would be quite reluctant to get my six year old worked up for mental illness.
posted by valkyryn at 1:08 PM on July 21, 2010

Litnerd, she knows her behaviours are not normal because her older sister would point them out (this was before I read that book to both of them and talked to the older one separately about it). She's also a bright child; she can see that other family members/classmates etc do not worry about putting the towel back on the rack perfectly straight, etc.
posted by yawper at 1:09 PM on July 21, 2010

My father (a practicing physician) said that once a person gets into the system, it’s hard to get out of it.
This may be the case for an adult with no family or support system, but for children I find this hard to believe.

I am confident that her school will not know about this unless we tell them – the social worker at the clinic assured me of that.
From what I understand, privacy laws prevent the clinic from telling the school.

My parents...are afraid we might pull that happiness out of her by subjecting her to assessments and treatments that may ultimately be unnecessary.
She has problematic behaviors which can cause her stress. These behaviors already make her unhappy. Not attempting to solve the problem is not fair to her, and the behaviors may not get better on their own. A few hours worth of assessments, to start, are not a bad trade-off. The way you describe it, your parents almost think you are going to be hospitalizing her and turning her into a depressed shell. On the contrary, don't you think it's more likely that getting this behavior under control will make her happier?

It sounds like your daughter wants to at least have this problem addressed by a professional, which is more than enough reason to go ahead with the initial assessments.
posted by puritycontrol at 1:09 PM on July 21, 2010 [4 favorites]

Speaking as someone whose OCD problems started to manifest at around that age and have never gone away, I think it is really great that you are thinking of getting her assessed. I wish that had been done for me as a kid!
posted by phoenixy at 1:16 PM on July 21, 2010 [3 favorites]

I do wonder about your daughter's embarrassment re: her compulsions. How has she learned that her behavior and actions are not normal, wrong, etc?

Anecdotally, I didn't tell anyone about one of my intrusive thoughts-- which happened like clockwork for most of my childhood and adolescence, and still pops up now-- and I still knew it was embarrassing as hell and not normal to be having. Being perfectly aware that your thoughts are not normal is a big part of the overall "oh, god, this is awful" OCD experience.
posted by fairytale of los angeles at 1:18 PM on July 21, 2010 [2 favorites]

The problems are currently less severe, but they are not gone.

From someone who should have had more interaction with 'the system' during childhood, please have your daughter assessed.

More to the point: OCD is not just treated with medication, but also by forming habits and practicing 'challenge statements' to combat the obsessions.

The earlier we form habits, the easier they are to learn and maintain.

The habits your daughter is developing now will be harder to change as she ages.
posted by bilabial at 1:21 PM on July 21, 2010 [2 favorites]

I think assessment is a good idea generally. She's not going to find it especially traumatic or anything. It is unlikely that she will be labeled by the "system" unless you want her to be later (unless you decide to sign her up for special therapies, etc.).

BUT, and this is a big "but", there are insurance implications occasionally. For instance, certain companies won't cover people with autism, for instance.

In general, though, it is better to have some idea of what you're dealing with.
posted by Mr. Justice at 1:22 PM on July 21, 2010

I'm not sure how the assessment alone would hurt her. At the very least, you'll find that she's going though a phase and is fine. The most you'll find is whatever problem she may have, and then you can start her on the track for a healthy life.

I spent time in a hospital and was incorrectly diagnosed with depression (I actually have anxiety) when I was 16, and I feel like I could have benefited with some proper therapy as a kid. Unfortunately, my parents never thought that my odd behavior was anything to be worried about, and they couldn't really afford therapy anyway.

Our health systems are vastly different (US here), but as far as getting "stuck in the system" is concerned, I'll always have that blemish on my medical records. It's not the only blemish, of course, and I could never donate eggs or anything of that sort despite what's going on in my head. But, I always fear that my mental health will get questioned some day if I were ever to be successful/important in any public way. That's probably just my anxiety talking.

I think you should have her assessed. Her life, medical history included, would probably be better if she's helped as a kid rather than as an adult. I may not have progressed to the state I am now had I been helped as a kid.
posted by two lights above the sea at 1:23 PM on July 21, 2010

Mr. Justice: She's in Canada. She doesn't have to worry about insurance companies not covering her. Luckily.
posted by two lights above the sea at 1:24 PM on July 21, 2010

I think it is worth seeing a specialist for. The thing with assessment is that they will be able to figure out how much support your daughter needs. I cared for a boy who was assessed when his behavior was obviously not typical. He was not strictly diagnosed with anything, but given support (early intervention) for the areas he needed. We worked with him and as he aged he learned to control his behavior and is now in school without support. Once every few months he goes to see his specialist and they touch on the tricks he has developed and touch base. The whole process was so beneficial. I think the earlier you get your daughter in the better! And maybe going when she isn't having too much trouble will keep a strict diagnosis unneccessary.
posted by Swisstine at 1:31 PM on July 21, 2010

She was relieved to see that other kids have the same issues and was looking forward to meeting the “special doctor” who would help her control the worrying thoughts.

Can you talk to her more about this? Even though she's in a lull right now, she might like the idea of going to a special doctor anyway. (I'm not saying that if she refuses to go that you should abandon the idea of having her assessed, but she's already able to engage somewhat in her own treatment, and she might have thoughts on the subject that will help you figure out when/how best to help her.)
posted by rtha at 1:39 PM on July 21, 2010

yawper: My father (a practicing physician) said that once a person gets into the system, it’s hard to get out of it.

puritycontrol: This may be the case for an adult with no family or support system, but for children I find this hard to believe.

puritycontrol, it's quite the contrary. A single adult without family support who suspects that they have mild OCD, goes for treatment, gets diagnosed (correctly or incorrectly) but then later has reservations about their diagnosis or the treatments outlined by their doctor can simply walk. Unless there's a threat of harm to themselves or others, all they have to do to get out of the system if there's been a mistake, overdiagnosis or concern over methods of treatment is stop going to treatment or walk out the door.

A small child who is diagnosed with a disease and enters treatment for that disease, correctly or incorrectly, has little or no say in the matter. The decisions are made by doctors or parents, who, despite good intentions, can make slightly or highly incorrect decisions that have lifelong impact on the child that the child can't easily out of. If the child shows signs of OCD and is diagnosed as such by a doctor -- even if they just turn out to be picky, uptight, neurotic, or even completely normal -- that child is likely to be subjected to years of therapy and medications. That can have a tremendously negative result on the child's physical health, belief structure, development and self-esteem -- and there's nothing the child can do to stop it, or at such a young age, even evaluate whether or not what's going on is the right thing. That isn't to say that yawper's daughter doesn't have OCD -- we don't know -- but many people throughout history, including myself, were pushed into the mental health system as children despite having only minor problems and coming out worse for wear.

yawper, wait until there's a serious problem that's substantially interfering with her or your life. If your child isn't functioning in school or at basic tasks, then it's completely legitimate to take her to a psych, but if she just has worrying thoughts, or stumbles figuring out what is expected but generally gets by as part of various phases, you might want to see if it's just a minor development issue.

Taking a moment to make sure the towel is on a towel rack straight isn't a problem with functioning that justifies a visit to the psych -- and in fact, if she's making effort to do something minor well and she's derided for it, she's naturally going to be confused and worried. On the other hand, if she's taking 10 minutes to put the towel on the rack every time she goes to the bathroom, or regularly won't come to dinner or leave the house because of it, or won't stop talking about it hours after, or if her teachers have come to you because it's been disruptive to her learning, an evaluation may well be in order.
posted by I EAT TAPAS at 1:42 PM on July 21, 2010

I think some people are being overly-dismissive of the potential insurance issues. Would it be possible to have her assessed out-of-pocket, and not involve the insurance companies at all until you know what you are dealing with?
posted by thegreatfleecircus at 1:46 PM on July 21, 2010

thegreatfleacircus: You mean outside of the gov't health system or just not letting them pay? The OP states that she's in Canada.
posted by two lights above the sea at 1:51 PM on July 21, 2010

Thanks so much for the replies so far.

To clarify re insurance: I'm concerned about both life and health insurance. She doesn't have to worry about health insurance right now -- the assessment is covered under our national healthcare. But she is a dual US-Cdn citizen and might choose to move to the US eventually. Also, life insurance. I know when I bought my policy I was asked a ton of health questions (but can't remember if any of them specifically mentioned mental illness).

Also, a big part of the problem is the ebb and flow I mentioned: I took her to the doctor when she was in a highly obsessive phase, but by the time we got an appt for the assessment, it was 4 months later and things have changed. I'm pretty sure, based on history, that another phase will come...I just don't know when. And perhaps the fact that it isn't intrusive all the time is a sign that it isn't that serious? That's the confusing part.
posted by yawper at 1:57 PM on July 21, 2010

Just want to chime in that I was diagnosed as clinically depressed with suicidal tendencies around your daughter's age. While the experiences of the depression and the suicidal tendencies have impacted my life a lot, the diagnosis itself or "being in the system" have not. I've not been labelled, marginalized, or otherwise treated differently, but I do have a history to point to when I need help, and I get taken seriously because of that.

If your daughter's compulsions make her unhappy AND she's interested in meeting with a doctor to make them stop, go for it.
posted by peanut_mcgillicuty at 1:57 PM on July 21, 2010 [4 favorites]

And perhaps the fact that it isn't intrusive all the time is a sign that it isn't that serious? That's the confusing part.

That's why an assessment would be handy-- when all you know is your daughter's experience, you don't have a strong body of evidence to say one way or the other. The clinicians should have enough experience of other pediatric anxiety/OCD patients to give you a reasonable idea of her prognosis, if they've seen similar variability in other cases, etc.
posted by fairytale of los angeles at 2:02 PM on July 21, 2010

Whatever you do, I would strongly encourage you to make sure you don't let your fears about negative social consequences influence your child unduly.
When I was at a similar age, and going through some issues that were noticeably affecting my life in negative ways, my folks made a big production about how getting mental health treatment was a negative thing. I was subjected to physical tests of limited value, and significant pain, that put me at risk of life long incontinence and impotence. When I did finally get to talk to someone, I was too traumatized to trust any medical professional.
posted by No1UKnow at 2:05 PM on July 21, 2010

"She will get diagnosed and treated and labeled and it will shape her for the rest of her life."

Well, if she doesn't get diagnosed and treated, it'll still shape her for the rest of her life, she just won't have professional help if, in fact, she does have a mental illness.

This is a common concern for people of older generations. I can tell you, I was diagnosed with depression as a teen. I went to college. I went to law school. I was admitted to the bar. I bought health insurance on the individual market in the US. For all of these things I was honest about my depression and it never barred me from anything I wanted to do. I'm married, I have a kid, I have two cats. I'm a happy person ... who knows she suffers from depression and is therefore able to manage it. Which is much better than being an unhappy person suffering from depression who doesn't know if her thoughts are normal or why she's in such a funk all the time and why she can't just "snap out of it."

I mean, yeah, the diagnosis shaped me, but in a better way than just suffering untreated depression would have shaped me. It's not like it used to be, where mental illness was scary and "rare" and landed you in an asylum. The medical model in the West is that it's just another illness and shouldn't have a big stigma attached to it.

@two lights: "But, I always fear that my mental health will get questioned some day if I were ever to be successful/important in any public way. That's probably just my anxiety talking."

I hold minor elected office. Nobody cares. It wasn't, like, on my campaign literature, but a lot of people know about it and I don't keep it a secret. It is what it is, and it's so common these days, everyone has someone close to them who's dealt with mental illness. The attitude I get seems to be that I'm a functional member of society; therefore, my illness is obviously not a big deal. (And the attitude I've observed with others who've had more public issues -- a friend in a position of community trust who checked himself into the psych ward for a couple weeks, for example -- is similar to the attitude people have when someone's parent dies and they're grief-stricken and not fully functional for a while. People were kind about it, gave him some space and time, and as long as he returned to fully publicly functional within, oh, six months or so, nobody gave it a second thought. If he did it every YEAR I think people would start to question his role in the community, but every five years, or every decade? Just one of those things. (Although let us of course hope that my friend will not struggle so much in the future that he needs a repeat visit.) There was also a sense of admiration that he got the help he needed, even though it was rather embarrassing for him, and approval that he's managing the mental illness rather than ignoring it, similar to the approval a sober alcoholic gets, I think. Like, "hey, he's got this bad thing, but he's really stepped up to deal with it.")
posted by Eyebrows McGee at 2:06 PM on July 21, 2010 [6 favorites]

thegreatfleecircus: "I think some people are being overly-dismissive of the potential insurance issues. Would it be possible to have her assessed out-of-pocket, and not involve the insurance companies at all until you know what you are dealing with?"

I would consider paying cash. Keeps this visit out of the insurance system. Can always add it later. Cannot take it out.
posted by JohnnyGunn at 2:13 PM on July 21, 2010

My son has been examined by mental health professionals, and I'm glad. One therapist he saw was no good. One was fine, but not what he needed. And his current one is wonderful, and has helped him greatly, and he loves her, and she has made his life better. He's learning skills that help him with peer interactions and at home. In my son's case, withholding therapy would be the wrong thing to do. Early intervention is often a good thing.

About life insurance: when I got a new policy they asked questions about receiving treatment for mental health in the last [some number] years. It's going to be, what, 20 or 30 years until she's considering life insurance? You definitely shouldn't keep her out of therapy now if she needs it because of a potential problem that's decades away.

There are issues regarding schools, but it sounds like you're not interested in that and we're in different countries, anyway.
posted by The corpse in the library at 2:17 PM on July 21, 2010

I do not work with children and I do not have an opinion about your child but the concerns about diagnostic labeling as I most often hear them voiced are that some psychiatrists are too quick to diagnose symtpoms as serious mental health disorders based on minimal interaction with a patient, especially young patients having their first contact with the mental health treatment system. For instance, I have had numerous clients who at some point were diagnosed with a psychotic disorder which either later turned out to have been an acute psychotic episode (drug induced, for instance) and not a chronic disorder or an acute episode of some other mental health crisis that during a brief interaction with a clinician appeared to be psychosis. This is problematic for this type of client because someone misdiagnosed with a psychotic disorder and prescribed medication appropriate for that disorder may find themselves having seriously adverse effects from the medication if they are not actually psychotic, and advocating for themselves to be taken off that medication or reassessed to be place on the appropriate medication can be difficult, especially if the client is young and the clinician is focused on the diagnosis only and not what the client is telling them. These clients of mine were very poor, had no advocates or support within their family, and some of them came into contact with mental health professionals for the first time as young adults in prison, which is basically the worst possible way to come in contact with a mental health professional for the first time.

So, to summarize, in mental health practice itself the question is whether or not young clients are being unecessarily hit with heavy diagnosis too soon in a clinical relationship and how this impacts the prescribing decision that may result in an inappropriate med combination. It's a really important issue because being prescribed and instructed to continue taking the wrong meds can be truly hellish. I've heard the testimonials from my clients about what it's like to be on Thorazine in prison when you're not psychotic and it's really terrifying.
posted by The Straightener at 2:18 PM on July 21, 2010

She was relieved to see that other kids have the same issues and was looking forward to meeting the “special doctor” who would help her control the worrying thoughts.

Considering that she was looking forward to talking to the doctor, I think you would do her a disservice if you didn't take her to some caring professional. Even if you decide that taking her for a full mental health assessment is not necessary, I would suggest that you take her to a child-focused therapist who can talk with her about her anxiety.

[I speak from experience - my mom suggested that I should visit a doctor about what she thought was depression when I was a little older than your daughter, but didn't followed through. I felt really relieved initially to have her validating my own concerns about how I felt, only to feel let down a little marginalised when the appointment never materialised]
posted by brambory at 2:22 PM on July 21, 2010

puritycontrol: This may be the case for an adult with no family or support system, but for children I find this hard to believe.

puritycontrol, it's quite the contrary.

A small child who is diagnosed with a disease and enters treatment for that disease, correctly or incorrectly, has little or no say in the matter. The decisions are made by doctors or parents, who, despite good intentions, can make slightly or highly incorrect decisions that have lifelong impact on the child that the child can't easily out of.

Interesting how we interpreted the "stuck in the system" warning differently -- I took it to mean the child is institutionalized and the power is taken away from the parents (that's my perspective from my work with people with severe disabilites). I understand your argument that the child often doesn't get to make major decisions about treatment, but the OP is enlightened enough to get advice on the side from a community she trusts. Given that the parent has come to us to ask whether she's making the right decision, I gave her the benefit of the doubt and based my answer on the notion that she would let her daughter have a say in any treatments that may be used. The OP's already asked her daughter if she wanted to see a doctor in the first place.

I'm pretty sure, based on history, that another phase will come...I just don't know when. And perhaps the fact that it isn't intrusive all the time is a sign that it isn't that serious?
The frequency of the behavior shouldn't be the guiding criteria of severity. Your older child recognized the problem, your daughter realizes that she does something other people don't, and as you said, the behavior causes her stress. These are all good reasons for an assessment. The assessment may very well yield results that say that the lack of frequency is a sign that it isn't a serious problem, but you won't know until you get an assessment. Think about it this way -- if you had stabbing pain in your body, but it only happened every once in awhile, you'd still get it checked out, right?
posted by puritycontrol at 2:23 PM on July 21, 2010

If it were me, I would try to find a child psychologist who specialized in OCD and anxiety based behaviors, and just focus as you have been -- on intrusive thoughts, and on dealing with them.

In the system or out of it, that's what you'd be doing, and if you could keep it off the record (off insurance, etc.) it might be helpful in the long run if you want to be cautious. You don't have to treat it as much as diagnosing as finding coping skills.

You actually sound like you're doing a really good job.
posted by A Terrible Llama at 2:23 PM on July 21, 2010

We found getting an assessment for our son at a little past that age (for anxiety, primarily) extremely helpful. The therapist helped us sort out what was within the realm of normal and what was problematic; it was reassuring both in that we were able to rule out some bad stuff and that the therapist confirmed for us that there were some things worth intervening with, and that early intervention could make a big difference--his judgment was that problems that stem from anxiety can be intractable and much harder to deal with if they're left untreated until later. We didn't end up doing therapy for very long, but I was very glad we did it.

Part of my perspective on this is that I had an untreated anxiety disorder (and some associated "obsessive-compulsive tendencies," as my shrink put it) until I was almost 30. I am very glad to have done what I could to help my son learn to cope at a much younger age (he's 9 now and doing very well).

We found that the therapist we worked with, who was referred by our kids' doctor, was very sensitive to issues of diagnoses following kids through life, and he was slow to apply a diagnosis, choosing instead to focus on the specific behaviors and thoughts that were problematic.

Anecdotally, as a person who has in fact been diagnosed with and treated for mood disorders, the only time I've ever been asked about it was during our home study for adoption. I've never bought private insurance, though, only had group insurance through employers, so that may make a difference.
posted by not that girl at 2:36 PM on July 21, 2010

You say OCD runs in your family (mine too), but given your daughter's young age of onset, have you looked into the possibility that her caae was triggered by PANDAS? That's Pediatric Autoimmune Neuropsychiatric Disorders Associated with Strep. The current thinking is that up to 25% of sudden-onset OCD in children is actually caused by strep infection (as in strep throat) that attacks the brain. Strep infection is now being looked at as a trigger for other neurological problems in children, such as Tourette's Syndrome.

The good news is that it's treatable with antibiotics! So maybe it's worth getting your daughter checked out at your regular pediatrician for the antibodies or other blood markers before heading over to a mental health assessment.
posted by Asparagirl at 2:41 PM on July 21, 2010 [1 favorite]

Never mind the private insurance thing, and kindly forgive my US-centrism.
posted by not that girl at 2:45 PM on July 21, 2010

"We found that the therapist we worked with, who was referred by our kids' doctor, was very sensitive to issues of diagnoses following kids through life, and he was slow to apply a diagnosis, choosing instead to focus on the specific behaviors and thoughts that were problematic."

I wanted to second this -- my neighbor's child, who is six, has some problematic behaviors that have caused him trouble at school. There's a lot going on there, socially and emotionally as well as developmentally, but the therapist they finally, finally, finally went and saw has refused to "label" him and is also focusing on specific behaviors and interventions to cope with problem behaviors and developmental delays. The therapist said that the boy does display some "autism-spectrum behaviors" but that it would be impossible to give a diagnosis until he'd known the kid at least a year and had sorted out some of the badness that had grown around the problems. (Since the parents were overwhelmed, they didn't cope well, and small things grew into big things.) He also told the family that if their son makes good progress and can manage his issues, he didn't think there would necessity of giving him a diagnosis, rather than continuing with specific interventions for specific behaviors, if the boy didn't need one for, say, Special Ed services. (In the U.S.)
posted by Eyebrows McGee at 2:50 PM on July 21, 2010

Hi. I'm a doctor in the USA so just wanted to let you know I'm coming from that perspective (not a psychiatrist and NYD). If you are interested here is my take since she is a dual citizen.

I think you've gotten a lot of good comments about the actual issue of taking her for the assessment. I just wanted to add that assuming you do take her for the assessment, at least here in the United States the tendency seems to be to put people, even kids, on medications right away, for any problem (not just psychiatric). I would suggest making a strong push for trying cognitive/behavioral therapies first, at least for a couple of months, before going the medication route. Given that her symptoms are relatively mild I think this would be prudent.

Also, and I assume this is the same in Canada, paying for the visit in cash does not "keep it off the record" as people are saying or implying. The insurance companies can look directly at your medical record, you have given them permission to do this when you apply. I haven't applied for life insurance myself, but I know it's the same for disability insurance (and they definitely do ask about mental health issues, plus, a lot of them deny or limit coverage for mental health disabilities).

Insurance companies in the United States will also take any opportunity to dodge their responsibility to pay for your care. Thus, if you don't tell them about mental health problems, but later on, you have a suicide attempt and are hospitalized (or whatever, incur medical costs because of the problem), and they look and find out that depression was a pre-existing condition that you didn't tell them about, you're in trouble.
posted by treehorn+bunny at 3:30 PM on July 21, 2010

I experienced fairly mild OCD during my childhood and based on my experience I think that getting your daughter assessed now is probably going to be a good thing. My mom was aware of my condition, having similar tendencies herself, but she always felt that my symptoms did not interfere with my life and therefore I did not need treatment. The problem is, she did not know what was going on inside my head. Intrusive thoughts were a much bigger problem for me than outward compulsions, but she couldn't see these.

When I was 11 or 12, I read about OCD in the newspaper and I ran to her with the article and said, "Mom, I think I have this!" I was so excited that I had a name for all these crazy things that were constantly running through my head. I was rather disappointed when she looked totally unsurprised and said, "Yeah, I think you do too." She told me that if I ever felt like I wanted help dealing with it I should let her know and we could find a therapist. I ended up starting therapy about two years later and while this worked okay for me, I do wonder if I might have been better off if I had help developing coping strategies for my anxiety at a younger age.

By dealing with this myself I learned to be very good at controlling any compulsions or anything that anyone else might see, such that now I would say OCD is no longer an accurate diagnosis for me. However, this also just meant that I internalized a lot of anxiety and when I finally did seek therapy it was never quite as helpful with that as I wanted it to be. Earlier intervention might have helped me change my thought patterns before they were so deeply ingrained.

I do not regret that my mom did not take me to a therapist sooner since I think I developed a lot of self-awareness in the process of deciding when I actually needed help. However, if she had told me she was going to take me to the doctor at a younger age and then never did because I seemed to get better, I would be pretty upset since she really had no idea what was going on with me internally. Given that your daughter seemed interested in talking to a doctor, I really, really think you should give her the opportunity to do so.
posted by horses, of courses at 3:41 PM on July 21, 2010 [2 favorites]

My son was diagnosed with OCD when he was 7, so yes, it could be OCD. It could also well be worthwhile to rule out PANDAS.

It could also be nothing, but yeah, if it is OCD, it's easily dealt with, but it does need to be dealt with.

memail me if you want to know more about how it played out with my kid (who is 99% of the time "normal," but does occasionally have flareups that require some rejiggering our lives).

Please don't get sucked into the mindset of "once the system knows a person has an illness, it's all over."

Substitute the word diabetes for OCD and see how little sense it makes.
posted by dzaz at 4:54 PM on July 21, 2010

My answer depends a lot on the type of mental health professional who would be assessing your child. If it's a clinical mental health counselor, social worker, or other non-MD clinician, the chance of your child being put on meds is much lower. (Actually, the chance of a child being medicated for OCD without some time passing between assessment and prescription is quite low, at least in my area.)

I don't know enough about the Canadian medical system to say whether going to this particular clinic will result in a diagnosis. If you're leery of getting the official 300.3 DSM code in her record, consider looking for a mental health professional who accepts private clients and doesn't bill insurance; many counselors, for example, wish they didn't have to render diagnoses immediately to satisfy insurance requirements. Also, the assessment process for a young child often doesn't seem like a psychiatric assessment, since it may involve storytelling, play therapy, or other approaches that a diagnostician can use to identify key behavioral elements, but that look very casual to the outside viewer. (The clinician will work with you and your spouse to get the significant background info since your daughter's so young.)

FWIW, the DSM has this to say: "[t]he majority of individuals have a chronic waxing and waning course". While I am certainly NOT diagnosing your daughter, compulsive and obsessional behaviors come and go or grow/lessen in intensity. I developed these behaviors in grade school and I wish I'd seen someone to tell me I was normal and give me some cognitive skills to defuse them and mitigate some of the perfectionism that grew out of my compulsions.
posted by catlet at 5:56 PM on July 21, 2010

I don't have much to add, except that this book, Mr. Worry, helped our daughter to understand more about a friend who has OCD tendencies, and a family member's anxieties.
posted by peagood at 6:01 PM on July 21, 2010

Thank you for all your wonderful answers. They have ALL been helpful and I appreciate them very much. My husband and I talked it over and we've decided to go ahead with the assessment. I also asked my daughter if she was still interested in seeing the "special doctor" and she gave me a hearty yes! So that about sealed it :)
posted by yawper at 8:21 PM on July 21, 2010

I know this is resolved but just wanted to throw in my hearty agreement with some of the "best answers"...

You sound like a really caring parent, which is awesome.

I definitely think that assessing kids early is a good thing. So many of the habits you learn and maintain growing up will last into adulthood, and if she can start trying to form new habits and handle her anxiety in a healthy way now, it could prevent a lot of problems when she's older.

Similar to brambury, my parents kind of blew off some blatant cries for help. One of my moms is actually a psychologist, and I think she really wanted to think I was fine... they sent me to one therapy session when they found out I was cutting, and then when the therapist said I was "perfectly fine" (AFTER ONE SESSION) they said it was clearly just a phase because cutting was "trendy". As far as they knew, I never cut again. In reality, I got better at hiding things. The point is, nothing was solved and they didn't ever ask me "do you think you need more therapy?"

Kudos to you for deciding to assess her, and best wishes!
posted by SputnikSweetheart at 12:18 AM on July 22, 2010

Just in case anyone reads this in the future, I wanted to give a brief update. We got our daughter evaluated, and she was diagnosed with OCD. Since the initial assessment we have had 3 sessions with a social worker at the clinic, who has offered her a listening ear and taught her some coping skills. It has made a world of a difference! Not only does she worry much less, she also talks openly about it now. It seems like addressing the issue has lifted a weight off her shoulders, and that in turn has drastically reduced the obsessions and compulsions. It's been win-win. Thanks Mefi!
posted by yawper at 5:46 PM on April 19, 2011 [2 favorites]