Transcript OCD Tourettes and Trichotillomania information and treatment

Contact information
• University of Houston – Clear Lake Psychological Services Clinic
• Offers Psychological, Marriage and Family, and School services
• Specialty services include Anxiety/OC-spectrum treatment
• 281-283-3330
• http://www.uhcl.edu/portal/page/portal/HSH/HOME/CENTERS_I
NSTITUTES/PSYC_SC
• Sliding Fee scale clinic (no insurance)
• Fees range $15-$50 per session (can be reduced if needed)
• Intake is free
• Hours M-Th: 9-9, Fri: 9-5
• All ages welcome
• Chad Wetterneck
• 281-283-3364
• E-mail – [email protected]
OC-spectrum in
Children and
Adolescents
Chad T. Wetterneck, Ph.D.
University of Houston – Clear Lake
Objectives
• Provide a brief overview of OCD and related
spectrum conditions
• Discuss presentation and difficulties in school
• Review Treatment and provide options
• Questions?
Obsessive Compulsive
Disorder
Diagnostic criteria includes:
• Presence of obsessions AND/OR compulsions
• Obsessions or Compulsions are present for one or more
hours per day
• Significant interference in daily life functioning
• Symptoms not related to medications or another medical
condition
Epidemiology
• Prevalence
• 1% to 2% of the general population meet diagnostic criteria at
any given time
• 2% to 3% lifetime prevalence
• 4th most common psychiatric disorder
• 50% to 65% have at least one other mental disorder
• Affects males and females equally
• Male onset (6-15 years of age)
• Females (20-29 years of age)
• Pediatric autoimmune neuropsychiatric disorder associated with
streptococcal infection (PANDAS)
Symptom Dimensions
• Contamination
• Symmetry / “Just Right”
• Sometimes appears as perfectionist tendencies
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Harming
Blasphemous
Sexual
Violent
Superstitious
Hoarding
What Might You See in School…
• Contamination
• Opening doors, lockers, desks, or books with elbows or with
tissue in hand, holding hands in the air to avoid physical contact,
refusal to shake hands or share pencils or other supplies
• Frequent trips to the bathroom, either to use the toilet or wash
hands
• Getting upset if others touch his or her belongings, wanting to
clean or wipe them off
• Sore, chapped or bleeding hands
Symptoms in school
• Symmetry/Just Right
• Over-focus on neatness. Lining up, ordering or arranging items on
desks, in backpacks or lockers repeatedly
• Wanting to complete assignments “perfectly,” checking and redoing it
• Sloppiness or carelessness in completing assignments, which is
not typical for the child
• Erasing repeatedly until the paper has holes in it, the ink is
smudged and the writing or drawing is illegible
• Reading letters, words or sentences repeatedly, repeating
syllables until they sound right
• Filling in scantron sheets very carefully; getting upset if they are
not perfectly filled in
Symptoms in school
• Symmetry (Cont.)
• Very slow and deliberate work, resulting in incomplete
assignments.
• Incomplete assignments or homework, although the child is
capable of doing them
• Checking homework, backpack, lockers, pockets, or under the
desk and chair repeatedly, ensuring that locks and zippers are
fastened.
• Frustration or anger when things are disorganized, when
interrupted, or when routines change unexpectedly.
• Asking the teacher or other students the same questions
repeatedly, even though the child knows the answer
Symptoms in school
• Superstitious
• Counting or focus on lucky and unlucky numbers
• Sudden avoidance of familiar things or reluctance to try new
things
• Odd behaviors such as walking in specific patterns through
doorways, counting tiles or syllables, touching or tapping in
symmetry or sitting and standing repeatedly
• Secretive or unusual behaviors for which there is no obvious
explanation
Symptoms in school
• Harming thoughts may be associated with things that look like
symmetry concerns
• Depends on the function
• Feeling Just Right or Belief that an action can prevent harm
• Taboo thoughts (i.e., sexual, scrupulous, violent) are often
harder to spot and less likely to be shared due to stigma and
shame
Tourette’s Syndrome
Diagnostic criteria includes:
• Presence of multiple motor AND one or more vocal tics
• Symptoms occur nearly every day or intermittently for a
period of one year
• Impairs functioning
• Childhood onset
• Symptoms not related to medications or another medical
condition
Prevalence
• Occurs 3 to 4 more times in boys than girls
• Affects 1 in 1,000 or .10% of the population of the United
States
• Symptoms first noticed in childhood
• Occurs in all populations and all ethnic groups
Examples of Simple Tics
Motor
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Eye blinking
Sticking tongue out
Head-turning
Muscle-tensing
Flexing fingers
Kicking
Twitching
Vocal
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Throat-clearing
Sniffing
Barking
Coughing
Yelling
Hiccupping
Belching
Animal sounds
Examples of Complex Tics
Motor
• Adjusting/picking at
clothing
• Flapping arms
• Facial grimacing
• Jumping
• Shaking feet
• Pinching
• Poking
• Kissing
• Spitting
Vocal
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Talking to self
Different intonations
Echolalia
Coprolalia
Repeating parts of words
or phrases
Trichotillomania/Chronic SkinPicking
Diagnostic criteria includes:
• Recurrent pulling of one’s hair resulting in noticeable hair
loss
• An increasing sense of tension immediately before
pulling out the hair or when attempting to resist pulling
• Pleasure, gratification, or relief when pulling out the hair
• Pulling causes significant impairment in an important
area of functioning
Phenomenology
• .06-1% of population
• Typical onset between ages 9-13
• More common in females (TTM – more equal in CSP)
• Results in a variety of physical and psychological effects
--avoidance of social/pleasurable activities, intimate relationships,
shame, etc.
Detecting TTM/CSP at school
• Most obvious are missing entire sections of hair (or bleeding
areas/scabs in CSP)
• Students may cover areas of pulling/picking
• Often twirl hair or touch areas affected
• May be very embarrassing to point out even individually
How we identify/diagnose OC-spectrum
issues?
• Diagnosis is made through observations and
interviews with the patient and caregiver(s),
examination of family history, and ruling out
other secondary causes of disorders
• Comorbid conditions are also examined
• Comorbidity may be the norm
Factors influencing OC-spectrum
conditions
• Parenting style will impact symptoms
• Reassuring, punishment, attention, etc.
• Family support tremendously important
• Families must also be their child’s advocate
• Are there school factors that may cause behaviors to
intensify?
• YES!
• Anxiety, Stress, and Fatigue
Treatment
• Behaviorally-based treatments
• Exposure and Response Prevention (ERP) for OCD
• Habit Reversal/Comprehensive Behavior Intervention for
Tourette’s Syndrome for TS & TTM
• Key components
• Exposure
• Family Support
• Additional interventions
• Mindfulness and acceptance strategies
• Behavioral rewards/incentives
• Success of treatment
Where you can get more help
http://www.ocfoundation.org - International Obsessive
Compulsive Disorder Foundation. Resources for those who
have OCD, caretakers/parents, and educational and mental
health professionals
http://www.tsa-usa.org – Tourette Syndrome Association,
Inc. offers many resources (publications, videos, training
sessions, etc. that are aimed at helping students, parents,
families, and especially educators understand Tourette’s as
well as tips to properly handle the symptoms – EXCELLENT
resource
http://www.trich.org – Trichotillomania Learning Center:
Website for TTM and CSP for the whole age range and
treatment providers