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OBSESSIVE-COMPULSIVE DISORDER IN CHILDREN AND ADOLESCENTS: FAMILY BASED STRATEGIES AND INTERVENTIONS
James A. Gall, Ph.D., PLLC
1
Overview2
Family dysfunction does not cause OCD, however family members affect and are affected by a child with OCD
OCD disrupts the psychosocial and academic performance of roughly 1 in 200 children/adolescents (Academy of Child and
Adolescent Psychiatry) Treatment tailored to a child’s
developmental needs and family context may reduce chronic nature of OCD
Objectives
Understand the epidemiology of OCD, diagnostic criteria, symptoms, developmental factors, and comorbidity
Understand the importance of parental involvement in all phases of treatment for children experiencing OCD
Understand the importance of treatment tailored to a child’s developmental characteristics
3
Objectives
Understand the family/parental role as co-therapists in helping a child learn to manage their symptoms
Understand how the family context and parental reactions affect a child with OCD
Learn strategies for working with the school as well as strategies for improving the overall family functioning
4
Definition (DSM-IV)5
Obsessions as defined by: Recurrent and persistent thoughts,
impulses, or images which are intrusive and cause marked anxiety or distress
Thoughts, images, or impulses are not simply excessive worries about real problems
The person attempts to suppress the thoughts, images, or impulses, with some other thought or action
Definition 6
The person recognizes that he obsessions are a product of his/her own mind
Compulsions as defined by: Repetitive behaviors that the person is
driven to perform in response to an obsession
The behaviors of mental acts are aimed at reducing or preventing distress or some dreaded event
Definition7
The person recognizes that the obsessions or compulsions are excessive and unreasonable
Note: This does not apply to children
The obsessions or compulsions cause marked distress or significantly interfere with normal routine (school, social activities, relationships)
Children at Risk8
OCD affects as many as 1% of children (as common as childhood asthma; 3-5 youngsters with OCD per average-sized elementary school)
50% of adult cases of OCD are diagnosed before age 15
2% of children are diagnosed between ages of 7-12
OCD is more prevalent in boys (2:1 ratio) 20% of children with OCD have a family
member with OCD
Children and Rituals9
Some compulsive and ritualistic behaviors in childhood are part of normal development – most common between the ages of 4-8; an attempt to master fears and anxieties
Many children collect objects, engage in ritualized play, avoid imaginary contaminants
Children and Rituals10
Many childhood rituals advance development, enhance socialization, assist with separation anxiety, and help define their environment
Childhood rituals disappear on their own – rituals of a child with OCD persist well into adulthood
Symptoms at Home11
May be worse at home than at school Repeated thoughts they find unpleasant –
not realistic Repeated actions to prevent a feared
consequence Consuming obsessions and compulsions Distress if ritual is interrupted Difficulty explaining unusual behavior Attempts to hide obsessions or compulsions
Symptoms at Home12
Resistance to stopping the obsessions of compulsions
Concern that they are “crazy” because of their thoughts
Symptoms at School13
Families often seek treatment once symptoms affect school performance
Difficulty concentrating – problem finishing or initiating school work
Social Isolation
Low self-esteem
Symptoms at School14
Other conditions – ADHD
Learning disorders/cognitive problems which are often overlooked
Daydreaming – the child may be obsessing
Repetitive need for reassurance
Symptoms at School15
Rereading and re-writing, repetitively erasing – look for neatness, holes in paper
Repetitive behaviors – touching, checking, tracing letters
Fear of doing wrong or having done wrong
Symptoms at School16
Avoid touching certain “unclean” things
Withdrawal from activities or friends
Treatment17
“There is nothing that is wrong with
me that what's right with me can’t
fix”
Treatment: Psychological Interventions
18
Family-based cognitive behavioral therapy is uniquely tailored to the child’s developmental needs and family context (Bradley Hasbro Children’s research Center, 2008).
Family based CBT provides the child and parents with a set of tools to help manage and reduce the OCD symptoms
Young children require parental guidance and have less emotional awareness
Treatment: Psychological Interventions
19
The need for education – not their fault Differentiate between the child and OCD Explain OCD in understandable language Listen to and observe your child Personifying the obsessions – give it a name Stop blaming yourself – bad parenting does
not cause OCD Instill hope, learn to fight back, engage in
exposure therapy – parents are co-therapists
Interventions at Home20
Therapist must work with the school- NO EXCEPTIONS!
Provide a sympathetic and tolerant environment
Understand the disorder
Listen to your child’s feelings
Plan for transitions
Interventions at Home21
Adjust expectations until the symptoms improve
Praise your child’s efforts to resist symptoms
Plan for what to say to people outside the family
Understand parental limits
“It’s the OCD talking.”
Interventions at Home22
Celebrate accomplishments
Foster hope and normalized developmental behavior
Understand parental role in supporting therapy interventions at home – help child commit to exposure therapy and boss back OCD
Interventions at School: Modifications, Accommodations, and Strategies
23
Develop a collaborative relationship with the school, especially the teacher and counselor.
Most school officials want to help the child and work with the therapist – they want help too!
Allow more time to complete certain type of assignments
Interventions at School: Modifications, Accommodations, and Strategies
24
Accommodate late arrival due to symptoms at home
Give the child a choice of projects
Adjust the homework load
Anticipate issues such as school avoidance
Assist with peer interactions
Interventions at School: Modifications, Accommodations, and Strategies
25
Monitor transition periods
Support and reinforce behavioral strategies developed by the clinician
Encourage the child to problem-solve
Allow alternative ways to complete work or take tests – be creative!
Interventions at School: Modifications, Accommodations, and Strategies
26
Eliminate undesirable options, e.g., use a pencil without an eraser
Have the student identify and substitute less disruptive compulsive behaviors
Find solutions for restroom problems
Interventions at School: Modifications, Accommodations, and Strategies
27
Do not punish the child for behavior they have no control over
Never tolerate teasing directed towards a child with OCD
Monitor for special educational services/resources
Interventions at School: Modifications, Accommodations, and Strategies
28
Flexibility and a supportive environment are essential for a student to achieve success in school
“There is nothing that is wrong with me that what's
right with me can’t fix”
We are Done!29
Questions &
Answers
References and Resources30
The OCD Foundation of Michigan – 313.438.3293
www.ocdmich.org The International OCD Foundation: www.ocfoundation.org Anxiety Disorders Association of
America www.adaa.org
James A. Gall, Ph.D., PLLC31
Office phone: 810. 543. 1050