Kids with OCD require a specialist’s care
“Hudson, hurry up! We’ll be late for the bus! You can’t keep holding us up like this every morning.” Ten- year- old Hudson burst into tears. “I have to make sure everything’s in my backpack. I’ll get in trouble with my teacher if anything’s missing.” Margo tried to keep her exasperation in check. Lately, Hudson’s behavior had become very concerning. Hudson would empty and rearrange his backpack over and over each morning, even when Margo had helped him organize his school supplies the evening before. Hudson had become increasingly preoccupied about the way he arranged his belongings in his room, and now refused to touch Fifi, the beloved family poodle, expressing fears about fleas or ticks. Hudson had always enjoyed snuggling with Fifi, and had even enjoyed when Fifi had jumped into his bed at night. But, now, Hudson seemed overly stressed about insects and germs, and would avoid situations where he feared he would be exposed to contagion. He had begun to wash his hands an excessive amount of times. Margo tried her best to reassure and calm Hudson whenever he became agitated, but despite her efforts, her previously sunny, outgoing young son had become increasingly more tentative and prone to worry.
Although the vignette above depicts a fictionalized family, sadly, the stresses they face are not uncommon. Obsessive compulsive disorder (OCD) is a condition that can affect people of any age — including children and adolescents. According to the International OCD Foundation: “Although OCD can occur at any age, there are generally two age ranges when OCD tends to first appear: ¦ Between ages 8 and 12. ¦ Between the late teen years and early adulthood. The average age at which OCD usually appears is 9-10 years old. There are also at least 1 in 200 — or 500,000 — kids and teens that have OCD in the U.S. This is about the same number of kids who have diabetes. OCD is characterized by distressing obsessions and/or compulsions that may compromise a person’s overall functioning and quality of life. Obsessions are persistent, unwanted, intrusive thoughts, images or urges that cause undue anxiety or fear. An obsession might be a fear of contagion or danger, a need to be perfect, or to have everything arranged in a certain manner. Or else a person may have intrusive imagined thoughts of a sexual, violent or religious nature that might seem quite real and frightening (even though there is often no merit to the fear). In many instances, the individual might feel compelled to engage in a
series of mental rituals or behaviors (often repeatedly) in an attempt to suppress these obsessions or to neutralize the stress. These efforts are called compulsions. Some examples of compulsions might be washing and cleaning, setting things in a certain order, or repeatedly reviewing a mental checklist.
Performing these compulsions might offer temporary relief from the worry or frightening thoughts. However, repeating these rituals might become less effective over time, requiring the individual to develop more and more elaborate rituals to obtain the same relief.
It’s important to note that all of us have occasional unwanted and intrusive thoughts or mental images — but most people do not place much importance on them. However, those with OCD have excessive, senseless, ego-dystonic thoughts and behaviors that are often contrary to the person’s beliefs and values — and not based in reality — causing undue anxiety.
Most adults are able to differentiate their OCD thoughts and behaviors from their reasonable, comfortable patterns, which is an important distinction if they wish to identify problem areas and reach out for help.
However, young people with OCD symptoms are often ashamed, or even frightened, by what they are experiencing, and might feel powerless to stop dwelling on these thoughts and behaviors, even though they may want to. They may worry that the upsetting things they’re afraid of will come true. Or else, they may even think that having bad thoughts means they are bad people.
These young people might be reluctant to reach out for help, even when they have a close relationship with their parents. This is why it is so important for astute parents to educate themselves and to keep an eye out for signs that might point to OCD: Does the young person seem preoccupied with worrisome thoughts or behaviors (especially if the preoccupation lasts an excessive amount of time?) Has there been a change in the child’s socialization, or ability to function in schoolwork and/or everyday tasks? Children with OCD often spend one to several hours per day, preoccupied with the symptoms of OCD.
There is a related condition worth highlighting. While most OCD diagnoses do not fall into this category, it’s important for parents and medical personnel to be aware that, for a small group of children, a strep infection can actually trigger a sudden onset of OCD symptoms. Infectious disease and mental health experts call this pediatric autoimmune neuropsychiatric disorder, or PANDAS.
Dr. Kyle Williams, MD, PhD and director of the Pediatric Neuropsychiatry and Immunology Program at Massachusetts General Hospital, recently spoke at the MGH Leadership Council for Psychiatry in Palm Beach. He asserts that the lack of knowledge about PANDAS can lead clinicians to overlook the possibility of post-strep reactions in children exhibiting OCD symptoms. Dr. Williams works alongside a multi-disciplinary team evaluating and treating young patients with sudden onset OCD symptoms, and has initiated research to understand the biologic basis of the disease. Proactive parents can keep this phenomena in mind should they notice a sudden onset of OCD behaviors following a strep infection— especially because there are specified medical interventions that can be effective in offering relief.
Mental health professionals have established very effective treatment interventions that have proven to be very successful with young people struggling with OCD symptoms. Parents can be essential allies in helping their youngsters gain mastery over their anxieties and symptoms. Therapists with an expertise in treating OCD take steps to provide a safe, controlled setting, offering cognitive behavioral therapy techniques, including a means of gradually exposing the youngsters to the very things that trigger their anxieties, while supporting them in learning how to push through and tolerate the anxiety. As the young people become more confident in facing their worries, they often discover that there is less pull to perform the compulsive rituals. In some instances, medication will be prescribed to assist in the process. Although the process may require some frustration and perseverance, in the end, many young people and their families are gratified to note significant progress.
The symptoms of OCD can be very distressing to young people — and their families. Unfortunately, it’s not uncommon for well-intended family members to aggravate or intensify the symptoms in their efforts to be helpful. Sometimes when parents seek to offer reassurance and to ease the anxieties, they unintentionally reinforce the negative thoughts and worries. Seeking help from a specialist who is knowledgeable in the treatment of OCD can offer tremendous education and support. ¦
— Linda Lipshutz, M. S., LCSW, can be reached at (561) 630- 2827, online at www.palmbeachfamilytherapy.com or on Twitter @LindaLipshutz.