Transcript Obsessive-Compulsive Disorder in Children and Adolescents

1
OBSESSIVE-COMPULSIVE
DISORDER IN CHILDREN AND
ADOLESCENTS: FAMILY BASED
STRATEGIES AND
INTERVENTIONS
James A. Gall, Ph.D., PLLC
Overview
2



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
3



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
Objectives
4



Understand the family/parental role as cotherapists 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
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
Definition
7

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 Risk
8





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 712
OCD is more prevalent in boys (2:1 ratio)
20% of children with OCD have a family member
with OCD
Children and Rituals
9


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 Rituals
10


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 Home
11







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 Home
12


Resistance to stopping the obsessions of compulsions
Concern that they are “crazy” because of their
thoughts
Symptoms at School
13


Families often seek treatment once symptoms affect
school performance
Difficulty concentrating – problem finishing or
initiating school work

Social Isolation

Low self-esteem
Symptoms at School
14


Other conditions – ADHD
Learning disorders/cognitive problems which are
often overlooked

Daydreaming – the child may be obsessing

Repetitive need for reassurance
Symptoms at School
15



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 School
16

Avoid touching certain “unclean” things

Withdrawal from activities or friends
Treatment
17
“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 Home
20

Therapist must work with the schoolNO EXCEPTIONS!

Provide a sympathetic and tolerant environment

Understand the disorder

Listen to your child’s feelings

Plan for transitions
Interventions at Home
21

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 Home
22



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 Resources
30



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., PLLC
31

Office phone: 810. 543. 1050