Unstuck: Escaping OCD's Grip

Terri Akman,

For children with obsessive-compulsive disorder, early diagnosis and treatment are essential. Strategies to get their minds “unstuck” on the things they obsess about can help kids with OCD lead å positive, productive lives. Although most often a psychological disorder, some forms of OCD can be caused by viruses, including streptococcal, and can be treated with antibiotics.

The Diagnosis

OCD can be diagnosed as young as age 7 or 8, but unfortunately, children with the disorder sometimes receive a different, incorrect diagnosis.

For example, “they are misdiagnosed as having an autism spectrum disorder because of their rigid, inflex-­ible behavior, and when you are obsessing in your thoughts, you are not socially relating to people,” says Douglas Tynan, PhD,  program director at Nemours Health and Prevention Services in Newark, DE.

Hair-Pulling: A Very Different Form of OCD

Children who have the urge to pull out their hair, a disorder called trichotillomania, falls under the broad spectrum of OCD, but is very different. “When people go to the sink to wash their hands, they’re usually anxious and afraid of something specific,” explains Martin Franklin, PhD, associate professor of clinical psychology and psychiatry at the University of Pennsylvania School of Medicine. “When you talk to people who are pulling, they might hate the pulling after the fact, but it’s a behavior kids engage in because they like the way it feels.”

Cognitive behavioral therapy has proven to be effective. “Somewhere around the age of 10 to 12, when these kids are more conscious of the social world, they start to get stressed about it, worry that other people will notice, and avoid social situations," says Dr. Franklin.

When diagnosed at an early age — 7 to 9 — therapy improves kids’ awareness of when they’re pulling and what their pulling triggers might be. The next step is to provide substitution behaviors and to change the environment where the pulling occurs. For example, for a child who says she pulls her hair when she enters the bathroom, turns on the light, and notices an eyelash pointing in the wrong direction, simply dimming the light can be effective.

Research is still ongoing, but results so far indicate that the younger the kids are when treated, the better their results. “What we don’t know yet is in five years, do those kids go back to pulling, but we do have some encouraging evidence that if you treat kids with behavioral therapy, it looks like they get really good outcomes and maintain those outcomes,” Dr. Franklin explains.

The diagnosis of OCD can be tricky, adds Katherine Dahlsgaard, PhD, lead psychologist for the Anxiety Behaviors Clinic (ABC) at The Children’s Hospital of Philadelphia. “Parents should seek out a specialist in anxiety disorders because if it is OCD, a good diagnosis guides treatment. The good news is that Philadelphia is  a mecca for specialists in anxiety.”

OCD behaviors such as hand washing or hoarding are more easily treated than internalized obsessions such as counting or needing to repeat specific phrases. Without treatment, an obsession can completely overtake the child. A child with a fear of germs or dirt might panic and be unable to use a restroom in school, for instance.

Treatment

“The most effective treatment is a combination of anti-depressant medication and cognitive therapies to teach children to challenge irrational beliefs and cope with them,” says Dr. Tynan. ERP (exposure and response prevention) therapy teaches children how to neutralize the stress and anxiety caused by thoughts that lead to compulsive rituals. “The classic example is the child who has a fear of contamination,” explains Dr. Dahlsgaard. “If I touch that door handle I will get germs all over me and then I’ll get really sick and I’m going to die.”

A therapist works with the child to gradually touch the doorknob, recognize that his anxiety will temporarily increase, but understand that in the long term he will overcome that anxiety.

Causes of OCD

Most often, OCD is genetic. Family members often have the same obsessions or compulsions. For example, if you have a relative who is a compulsive hand washer, look for signs of that behavior in your child.

New research has found that otherwise healthy children can develop OCD due to strep or other types of infection. “Your kid goes to bed, normal kid, no problem, and the next morning wakes up with severe OCD — with ticks or separation anxiety,” explains Dr. Dahlsgaard. Once treated with an antibiotic, the OCD symptoms usually disappear if they are caused by a virus.

Once they learn how to manage their behaviors, kids with OCD can lead normal lives. “It’s pretty common in high achievers and I think people with OCD tend to go into careers that require a high degree of precision,” says Dr. Tynan. “They can be very successful and satisfied.”

Terri Akman is a contributing writer to MetroKids.

Parent OCD Resources

Martin Franklin, PhD of the University of Pennsylvania School of Medicine recommends these parent OCD resources.

1. International OCD Foundation. A great source for solid info on OCD and related disorders, information on empirically supported treatments, resources and links. The site includes a treatment provider database.

2. Philadelphia Behavior Therapy Association. A great organization with an extensive local referral directory of behavioral therapists.

3. OCD: What to Do When Your Brain Gets Stuck: A Kid's Guide to Overcoming OCD by Dawn Huebner, PhD. It's a fun, well-written, and accurate book intended for  ages 6-12, but great for parents, too. Available at online bookstores.

This article appears in the July 2012 issue of MetroKids.
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