Helping Kids with OCD
Twelve-year-old Caleb comes to school dragging. Being up at 4 a.m. to prep his homework still doesn't give him enough time to make each letter perfect. Having to erase completely is exhausting and makes the paper rip apart so he has to keep starting over on a new sheet.
During class he makes every possible effort to stay awake. Then at the end of the day he has to scramble to pick up his homework assignments. By the time he gets home Caleb is typically too tired to even look at his schoolwork.
Caleb suffers from obsessive-compulsive disorder (OCD), an anxiety disorder characterized by recurring obsessions and/or compulsions. These urges are so powerful, they create severe discomfort and interfere with a child's regular schedule, family relationships, school work or social involvements.
For OCD sufferers, obsessions are urges and mental images that are stubbornly repetitious and generally unpleasant. These might include fears of illness or contamination, needing objects placed in the right order and relentless doubt or worry.
Compulsions involve repeating thoughts or actions that temporarily seem to alleviate anxiety. Instead of relief, compulsions trigger even more intense urges later. Examples are rereading paragraphs a certain number of times, checking then rechecking answers on homework and picking a scab until it "feels right."
Most experts believe that OCD has a biological basis. Dr. Jeffrey M. Schwartz, psychiatrist and author of the popular book on OCD, Brain Lock (HarperCollins, 1996), writes, "It's as if the brain gets stuck in gear." But not stuck as in "can't move" – stuck as in "doing a behavior over and over again." Schwartz compares the OCD brain to a car without automatic transmission. It can't shift from one behavior to another. The individual has to manually force thoughts to go to the next thing.
The back cover of Brain Lock shows actual PET scans of energy use in the typical brain and that of a brain with OCD. Experts speculate that the repetition of the same behavior causes certain areas of the brain to heat up. This might be creating or contributing to Caleb's exhaustion.
Mitzi Waltz, a researcher in the field of childhood developmental disabilities and senior lecturer of journalism at the University of Sunderland in England, says the tiredness is also the constant feeling of being on edge. "It takes over your thoughts and just won't go away," she says. She compares this to the discomfort and disruption of being continually nauseous.
Some researchers are finding a link with the auto-immune system. Dr. Hugh F. Johnston, clinical associate professor at the University of Wisconsin Medical School, says OCD has a number of causative factors coupled with some complicated genetic ties.
"When children acquire strep throat, for example, the antibodies that attack the bacteria can cross-react with other tissues," Dr. Johnston says. "For example, when they react with heart tissue, rheumatic fever can result. If brain tissue is affected it can lead to OCD."
What Should You Do?
If you suspect your child might be suffering from OCD, you need to take action. As a first step, learn about OCD symptoms and be aware of early warning signs (mentioned below).
"One thing parents can watch for is a symptom seen in all children with OCD – asking reassurance questions," says Dr. Johnston. These include things like: Do you love me? Am I going to get sick and die? What if the car won't start? After you answer you'll receive even more questions like these: Did you really mean that? Were you just saying that?
To begin the process of assessment and recovery, Dr. Johnston suggests contacting one or more of these professionals:
- Your pediatrician. "Most pediatricians are generalists who specialize in perhaps cardiology or neurology, and they may be very good in their specialties," Dr. Johnston says. "But you need a pediatrician who has some additional training in human behavior."
- Your child's school psychologist. They often receive training in childhood disorders. If nothing else, perhaps the school psychologist can refer you to additional resources.
- A clinical psychologist. Many are knowledgeable about OCD and its treatment.
- A child psychiatrist. According to Dr. Johnston, more than any other of the professions, child psychiatrists receive the most training in childhood OCD.
"The 'gold standard' in behavior treatment is cognitive behavior therapy," Waltz says. This involves learning new ways to cope with the anxious, fearful feelings that trigger obsessive-compulsive behaviors as well as reducing those feelings, usually through exposure – a gradual, careful introduction of the individual to the feared situation. During exposure the individual practices new responses to it.
In order to reduce anxiety and more easily regain behavioral control, many clinicians include medication. "We as a culture view giving mind-altering substances to children as bad," says Dr. Johnston. "Caution is good, but to make the decision to put a child on medication, you need to balance the risks versus the benefits. You can't know the benefits of drug-therapy without a trial on medication."
Dr. Johnston recommends a two-month trial. "About 5 to 10 percent have symptoms that vanish when that child begins medication," he says.
"You don't want to miss that. If symptoms are managed as a result of treatment, your child can have all the opportunities in life that other kids do."
Early Warning Signs
In addition to continuous questioning for reassurance, what are other early indicators of possible OCD?
Waltz maintains that one discernible warning sign is separation anxiety or a fear of being away from the child's primary caregiver. The following symptoms do not absolutely indicate OCD, but they are often seen in the histories of those who have the disorder:
- Ear infections
- Strep throat
- Rheumatic fever
- Picky eaters
- Agitated when interrupted
- Uncomfortable with the feeling of their clothes
- Slightly late to crawl, walk, talk
- Slower to develop bladder or bowel control