Seven year old son struggling with obsessive thoughts about cleanliness
November 4, 2024 9:43 PM
My seven year old son has been struggling with spiralling thoughts for the last few days and I'm looking for advice on the best way to help him through this.
My seven-year-old son was recently diagnosed with ADHD and put on medication (Biphentin). Last week, we had an update appointment with his doctor and decided to increase his prescription. While the prescription was being filled, he was off his meds for the weekend. Our house has been sick lately with various degrees of colds and coughing. Over the weekend he began to compulsively ask questions related to his body and being dirty. He's never really done this before. These were things like "If I touch my underwear band, are my hands dirty?", "If I pick my nose and put it in a Kleenex, are my hands dirty?" and "When I do this, then this part of my body hurts". He would say that part of his body hurt and then moments later it was fine. His doctor said there weren't likely to be side effects of the meds besides possibly a change in appetite and a change in sleep that we should watch out for. And we were told that going off the meds for a few days also shouldn't have any side effects. So, my wife and I are trying to make sense of this and also trying to figure out the best way to help our son. It's painful seeing him struggle with what seems to be something like OCD/hypochondria or spiralling thoughts. Does anyone have any experience with this and have any ideas what we could do to help our son? Sorry if this is kind of a naive question, we're just feeling a bit lost here. We've been trying to answer his questions and remind him that he's clean and his body is ok.
My seven-year-old son was recently diagnosed with ADHD and put on medication (Biphentin). Last week, we had an update appointment with his doctor and decided to increase his prescription. While the prescription was being filled, he was off his meds for the weekend. Our house has been sick lately with various degrees of colds and coughing. Over the weekend he began to compulsively ask questions related to his body and being dirty. He's never really done this before. These were things like "If I touch my underwear band, are my hands dirty?", "If I pick my nose and put it in a Kleenex, are my hands dirty?" and "When I do this, then this part of my body hurts". He would say that part of his body hurt and then moments later it was fine. His doctor said there weren't likely to be side effects of the meds besides possibly a change in appetite and a change in sleep that we should watch out for. And we were told that going off the meds for a few days also shouldn't have any side effects. So, my wife and I are trying to make sense of this and also trying to figure out the best way to help our son. It's painful seeing him struggle with what seems to be something like OCD/hypochondria or spiralling thoughts. Does anyone have any experience with this and have any ideas what we could do to help our son? Sorry if this is kind of a naive question, we're just feeling a bit lost here. We've been trying to answer his questions and remind him that he's clean and his body is ok.
How long was he on the meds before stopping them? I'm an adult but I definitely experience some discontinuation side effects from stimulant meds, sometimes manifesting as increased anxiety. Anxiety is a stimulant. I interpret this as my brain casting around for alternate dopamine sources to replace the meds. It settles in a couple of days. This does sound quite noticeable and something to address with a doctor, but I wouldn't assume that it will persist with or without the meds - stopping suddenly can throw a person temporarily off kilter a bit.
posted by lookoutbelow at 10:38 PM on November 4
posted by lookoutbelow at 10:38 PM on November 4
Biphentin can definitely produce anxiety; it's listed as one of the possible side effects of methylphenidate-type drugs. So an increased dose could be causing this, or it could be the temporary discontinuation. As lookoutbelow said, discontinuing (even just for a weekend) affects your brain as it adjusts to the drug leaving your system. I sometimes even get discontinuation effects at the end of the day as the biphentin is wearing off.
Very anecdotal/personal, and not listed in any drug monograph, but along with the general increase in my anxiety and OCD symptoms, I feel irritable and have bodily discomfort when biphentin leaves my system.
The bodily discomfort is hard to describe. It's not pain, per se (though pain sensitivity can also increase for me). Usually it's more like a feeling of itchiness or restlessness that doesn't rise to the surface of consciousness. A little like your skin is crawling all the time. Rough textures or uncomfortable parts of clothing — tags, seams, etc. are more uncomfortable than usual. Any abnormality on my body begins to bother me (e.g. a cut, a mild itch, hair being dirty). The skin-crawling sensation makes it very hard to do any type of housecleaning without feeling "icked out," and I become hyper-aware of dust or dirt on my skin.
I haven't heard many others describe this, but I thought I'd mention it, just in case your son is having a siilar experience. If bodily discomfort is contributing, there are a couple things that might help. What does he usually find physically comforting? Does like baths? Warm drinks — or cold drinks, or fizzy drinks? Have a favourite pair of soft PJs or a blanket? Does exercise usually settle him? Playing with the family pet, or taking a walk?
Anything that helps soothe the body might take the edge off. (And honestly, even his symptoms are wholly psychological, I find that soothing the body helps with that, too.)
In any case, I would definitely take this up again with your doctor!
posted by fire, water, earth, air at 11:10 PM on November 4
Very anecdotal/personal, and not listed in any drug monograph, but along with the general increase in my anxiety and OCD symptoms, I feel irritable and have bodily discomfort when biphentin leaves my system.
The bodily discomfort is hard to describe. It's not pain, per se (though pain sensitivity can also increase for me). Usually it's more like a feeling of itchiness or restlessness that doesn't rise to the surface of consciousness. A little like your skin is crawling all the time. Rough textures or uncomfortable parts of clothing — tags, seams, etc. are more uncomfortable than usual. Any abnormality on my body begins to bother me (e.g. a cut, a mild itch, hair being dirty). The skin-crawling sensation makes it very hard to do any type of housecleaning without feeling "icked out," and I become hyper-aware of dust or dirt on my skin.
I haven't heard many others describe this, but I thought I'd mention it, just in case your son is having a siilar experience. If bodily discomfort is contributing, there are a couple things that might help. What does he usually find physically comforting? Does like baths? Warm drinks — or cold drinks, or fizzy drinks? Have a favourite pair of soft PJs or a blanket? Does exercise usually settle him? Playing with the family pet, or taking a walk?
Anything that helps soothe the body might take the edge off. (And honestly, even his symptoms are wholly psychological, I find that soothing the body helps with that, too.)
In any case, I would definitely take this up again with your doctor!
posted by fire, water, earth, air at 11:10 PM on November 4
Is this a GP or a psychiatrist?
It's not uncommon for GPs not to be aware of the side effects of medication on neurodivergent people. ND people are also notorious for responding differently to meds than most people do.
posted by Zumbador at 12:33 AM on November 5
It's not uncommon for GPs not to be aware of the side effects of medication on neurodivergent people. ND people are also notorious for responding differently to meds than most people do.
posted by Zumbador at 12:33 AM on November 5
You mention that your house has had colds run through it of late. Did your son recently have strep throat? It’s rare, but my understanding is that there’s a subtype of OCD with rapid onset following a strep infection (PANDAS). Not a doctor, don’t know much about it, the rapid onset and proximity to infections just caught my eye.
posted by eirias at 2:20 AM on November 5
posted by eirias at 2:20 AM on November 5
His doctor said there weren't likely to be side effects of the meds besides possibly a change in appetite and a change in sleep that we should watch out for
Seconding Toddles. My sparse personal and extensive vicarious experience with psych meds in general and psych meds in kids specifically has me classing this as borderline actionable malpractice.
There isn't a psych med in the entire history of psych meds that hasn't come with a wide range of side effects, and "not likely" is way too often used to rule out observed and well documented side effects as something else.
Specifics trump statistics. I'm unlikely to smash my little toe into a metal stake at the side of a walking trail too, but that didn't stop it hurting when it happened, and nor can I reasonably spend time wondering about an an explanation that somehow makes it not a side effect of having chosen a barefoot lifestyle.
posted by flabdablet at 3:54 AM on November 5
Seconding Toddles. My sparse personal and extensive vicarious experience with psych meds in general and psych meds in kids specifically has me classing this as borderline actionable malpractice.
There isn't a psych med in the entire history of psych meds that hasn't come with a wide range of side effects, and "not likely" is way too often used to rule out observed and well documented side effects as something else.
Specifics trump statistics. I'm unlikely to smash my little toe into a metal stake at the side of a walking trail too, but that didn't stop it hurting when it happened, and nor can I reasonably spend time wondering about an an explanation that somehow makes it not a side effect of having chosen a barefoot lifestyle.
posted by flabdablet at 3:54 AM on November 5
we were told that going off the meds for a few days also shouldn't have any side effects
That's terrible advice.
Any psych med is going to come with a range of both usage and withdrawal side effects. I am unaware of a single exception to that rule. If a new psych med has recently been started, or a dosage adjusted, before the onset of any new behavioural or perceptual pattern, especially in a kid, experience tells me that a causal link is the single most likely hypothesis.
posted by flabdablet at 4:05 AM on November 5
That's terrible advice.
Any psych med is going to come with a range of both usage and withdrawal side effects. I am unaware of a single exception to that rule. If a new psych med has recently been started, or a dosage adjusted, before the onset of any new behavioural or perceptual pattern, especially in a kid, experience tells me that a causal link is the single most likely hypothesis.
posted by flabdablet at 4:05 AM on November 5
any ideas what we could do to help our son?
He's seven. At that age I'd expect him to have a pretty ready grasp of the idea of desirable effects and side effects, and to get a lot of value from being able to use the idea of side effects to explain to himself why he's currently experiencing some weird thoughts and sensations.
I'd also expect him to be capable of giving you some quite good feedback about whether he's seeing enough benefit from the intended effect of this med to make it worth his while having to learn to cope with the side effects it's actually having on him specifically, as opposed to the imaginary Typical Patient who lives in his doctor's head.
posted by flabdablet at 4:13 AM on November 5
He's seven. At that age I'd expect him to have a pretty ready grasp of the idea of desirable effects and side effects, and to get a lot of value from being able to use the idea of side effects to explain to himself why he's currently experiencing some weird thoughts and sensations.
I'd also expect him to be capable of giving you some quite good feedback about whether he's seeing enough benefit from the intended effect of this med to make it worth his while having to learn to cope with the side effects it's actually having on him specifically, as opposed to the imaginary Typical Patient who lives in his doctor's head.
posted by flabdablet at 4:13 AM on November 5
My young kid (neurodivergent for sure, possible ADHD) struggled with cleanliness related anxiety during the beginning of the pandemic - it seemed very much like the beginnings of OCD. She washed her hands obsessively and asked over and over if things were okay to eat and if her hands or face were dirty.
The single most helpful thing we did was to stop reassuring her - getting the reassurance felt good to her initially, but it actually reinforces the anxiety. So, we started gently pushing back on her questions - when she asked if her hands were clean or if her food was okay to eat, we’d say, something like “what do you think?” or “yeah, you have been worried about that lately.” We also had some big picture conversations with her where we explained why it wasn’t actually helping her to reassure her and explained why we weren’t directly answering the questions.
It worked amazingly well - as she stopped getting reassurances from us, she gradually stopped asking. The anxiety faded and she hasn’t had any similar problems since. Of course, if she actually had OCD or a similar anxiety disorder that wouldn’t have solved it, but it was enough to get her out of the anxiety spiral at the time,
posted by maleficent at 5:45 AM on November 5
The single most helpful thing we did was to stop reassuring her - getting the reassurance felt good to her initially, but it actually reinforces the anxiety. So, we started gently pushing back on her questions - when she asked if her hands were clean or if her food was okay to eat, we’d say, something like “what do you think?” or “yeah, you have been worried about that lately.” We also had some big picture conversations with her where we explained why it wasn’t actually helping her to reassure her and explained why we weren’t directly answering the questions.
It worked amazingly well - as she stopped getting reassurances from us, she gradually stopped asking. The anxiety faded and she hasn’t had any similar problems since. Of course, if she actually had OCD or a similar anxiety disorder that wouldn’t have solved it, but it was enough to get her out of the anxiety spiral at the time,
posted by maleficent at 5:45 AM on November 5
great advice upthread.
re: your actual interactions with him: while hopefully this is a very time limited phenomenon, I recommend you read the "how to help them manage compulsions" here because it has very helpful bulletpoints.
for instance - sometimes, reassuring someone who is experiencing OCD episodes is counter-productive and can reinforce the behavior compulsion cycle.
absolutely no judgment intended btw. I really feel for you as parents - this would be a lot to deal with overnight!
posted by seemoorglass at 5:47 AM on November 5
re: your actual interactions with him: while hopefully this is a very time limited phenomenon, I recommend you read the "how to help them manage compulsions" here because it has very helpful bulletpoints.
for instance - sometimes, reassuring someone who is experiencing OCD episodes is counter-productive and can reinforce the behavior compulsion cycle.
absolutely no judgment intended btw. I really feel for you as parents - this would be a lot to deal with overnight!
posted by seemoorglass at 5:47 AM on November 5
7 years old is when my OCD presented - I remember because I started counting to 7 all the time, or had to swallow 7 times. Etc. And became afraid of germs.
Only commenting to say this because this could be separate from medication concerns.
posted by tiny frying pan at 6:48 AM on November 5
Only commenting to say this because this could be separate from medication concerns.
posted by tiny frying pan at 6:48 AM on November 5
Ask your GP to run a strep test. Overnight onset sounds like pandas (I'm not a doctor, just have a lot of personal experience with my kids and this). If you catch it early and treat with antibiotics, it's much easier long term. Most doctors are skeptical about pans/pandas but if you emphasize abrupt onset and they can confirm with blood work or a strep test, they often come around. Can also be triggered by covid exposure, pneumonia, etc., but strep is the big one. If you can't get an appointment, give children's Motrin. If you see an improvement, it's a good indicator.
posted by luckdragon at 8:39 AM on November 5
posted by luckdragon at 8:39 AM on November 5
Yeah, this could be a med side effect, but definitely keep a weather eye out in case symptoms persist. Do you have a system for keeping track of your son's symptoms? It can be difficult to gauge the severity of symptoms for conditions like ADHD which have a lot of variability. Keeping a symptom journal could help you distinguish between normal childhood development, med side-effects, ADHD hyperfixations, and other long-term issues that require intervention.
Agree that it's better to help him resolve his worries rather than reassure him, in an age appropriate way obviously. If you're giving him quite short answers to his questions, try explaining more and see if that helps him. A lot of neurodivergent people need more context and information in order to feel confident about things. For example, the nose-picking question would be a great opportunity to learn about what boogers are and their purpose in the body! We usually think of hyperactivity as being a physical symptom, but mental hyperactivity is also a thing where the brain needs extra "stuff" to do; puzzles, games, crafts, learning, anything that can burn off some of that mental energy in a constructive way.
Another factor that might be coming into play is that it can be quite hard for ADHD kids to develop and remember habits; so he might know that he should wash his hands after using the bathroom, before meals, etc. but either forget in the moment or not be able to remember later if he did or not, which can lead to anxiety. This is the "did I lock the door/leave the oven on" feeling, super super common for anyone with working memory issues. There's a bunch of strategies to try if this is the case, depending on how his particular brain works. At seven he might be able to explain why he's suddenly so concerned about hygiene, given the time and space to develop his thoughts.
Also, don't be too quick to dismiss his reports of pain even if they seem to disappear later. In kids, self-reported pain is always real in some sense (even if it's standing in for some other need that's not being met), but also, ADHD has a significant co-occurrence with connective tissue disorders which can present as off and on pain with no apparent cause. Post-viral effects (including but not limited to long Covid) can also both worsen ADHD symptoms and lead to mystery pain--that's something this whole generation of kids is gonna be struggling with, unfortunately. And of course no one is at their best while they're sick.
posted by radiogreentea at 9:10 AM on November 5
Agree that it's better to help him resolve his worries rather than reassure him, in an age appropriate way obviously. If you're giving him quite short answers to his questions, try explaining more and see if that helps him. A lot of neurodivergent people need more context and information in order to feel confident about things. For example, the nose-picking question would be a great opportunity to learn about what boogers are and their purpose in the body! We usually think of hyperactivity as being a physical symptom, but mental hyperactivity is also a thing where the brain needs extra "stuff" to do; puzzles, games, crafts, learning, anything that can burn off some of that mental energy in a constructive way.
Another factor that might be coming into play is that it can be quite hard for ADHD kids to develop and remember habits; so he might know that he should wash his hands after using the bathroom, before meals, etc. but either forget in the moment or not be able to remember later if he did or not, which can lead to anxiety. This is the "did I lock the door/leave the oven on" feeling, super super common for anyone with working memory issues. There's a bunch of strategies to try if this is the case, depending on how his particular brain works. At seven he might be able to explain why he's suddenly so concerned about hygiene, given the time and space to develop his thoughts.
Also, don't be too quick to dismiss his reports of pain even if they seem to disappear later. In kids, self-reported pain is always real in some sense (even if it's standing in for some other need that's not being met), but also, ADHD has a significant co-occurrence with connective tissue disorders which can present as off and on pain with no apparent cause. Post-viral effects (including but not limited to long Covid) can also both worsen ADHD symptoms and lead to mystery pain--that's something this whole generation of kids is gonna be struggling with, unfortunately. And of course no one is at their best while they're sick.
posted by radiogreentea at 9:10 AM on November 5
PANDAS can also occur after COVID and some other infections. This sounds like it might be PANDAS.
posted by shadygrove at 9:22 AM on November 5
posted by shadygrove at 9:22 AM on November 5
There is a parenting program specifically to teach parents how to deal with their children’s anxiety. A lot of the treatment for kids with anxiety is treating their parents. Hopefully this is time limited but as mentioned above I think it’s worth checking in with yourself and some outside resources to make sure you feel confident about how to react to this behavior in the way that’s helpful for everyone.
SPACE treatment
posted by knobknosher at 3:08 PM on November 5
SPACE treatment
posted by knobknosher at 3:08 PM on November 5
I don't know if it's a side effect, but if it's not, OCD (the real kind, not "I put my pencils in order by height I'm OCD lol") does occur in kids. There may be a pediatric OCD center in your area that can provide therapy or recommend vetted pediatric therapists.
Also worth keeping in mind is that, while you should actively seek help for this, kids change quickly, and this could very well go away next month.
posted by ignignokt at 7:59 AM on November 6
Also worth keeping in mind is that, while you should actively seek help for this, kids change quickly, and this could very well go away next month.
posted by ignignokt at 7:59 AM on November 6
I know I'm late to the game, but I just got around to listening to the OCD in Children with ADHD webinar from ADDitude magazine and I found it enlightening. They also recommend the SPACE treatment knobknosher mentioned up thread.
posted by skunk pig at 9:14 AM on November 11
posted by skunk pig at 9:14 AM on November 11
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posted by Toddles at 10:11 PM on November 4