Obsessive-Compulsive Disorder in Children and Adolescents: Family Based Strategies and Interventions

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Obsessive-Compulsive Disorder in Children and
Adolescents Family Based Strategies and
Interventions

• James A. Gall, Ph.D., PLLC

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Overview

• 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 childs developmental
  needs and family context may reduce chronic
  nature of OCD

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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 childs developmental characteristics

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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

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Definition (DSM-IV)

• 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

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Definition

• 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

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Definition

• 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)

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Children at Risk

• 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 (21 ratio)
• 20 of children with OCD have a family member
  with OCD

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Children and Rituals

• 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

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Children and Rituals

• 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

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Symptoms at Home

• 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

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Symptoms at Home

• Resistance to stopping the obsessions of
  compulsions
• Concern that they are crazy because of their
  thoughts

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Symptoms at School

• Families often seek treatment once symptoms
  affect school performance
• Difficulty concentrating problem finishing or
  initiating school work
• Social Isolation
• Low self-esteem

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Symptoms at School

• Other conditions ADHD
• Learning disorders/cognitive problems which are
  often overlooked
• Daydreaming the child may be obsessing
• Repetitive need for reassurance

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Symptoms at School

• 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

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Symptoms at School

• Avoid touching certain unclean things
• Withdrawal from activities or friends

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Treatment

• There is nothing that is wrong with me that
  what's right with me cant fix

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Treatment Psychological Interventions

• Family-based cognitive behavioral therapy is
  uniquely tailored to the childs developmental
  needs and family context (Bradley Hasbro
  Childrens 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

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Treatment Psychological Interventions

• 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

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Interventions at Home

• Therapist must work with the school-
• NO EXCEPTIONS!
• Provide a sympathetic and tolerant environment
• Understand the disorder
• Listen to your childs feelings
• Plan for transitions

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Interventions at Home

• Adjust expectations until the symptoms improve
• Praise your childs efforts to resist symptoms
• Plan for what to say to people outside the family
• Understand parental limits
• Its the OCD talking.

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Interventions at Home

• 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

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Interventions at School Modifications,
Accommodations, and Strategies

• 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

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Interventions at School Modifications,
Accommodations, and Strategies

• 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

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Interventions at School Modifications,
Accommodations, and Strategies

• 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!

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Interventions at School Modifications,
Accommodations, and Strategies

• 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

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Interventions at School Modifications,
Accommodations, and Strategies

• 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

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Interventions at School Modifications,
Accommodations, and Strategies

• 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 cant fix

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We are Done!

• Questions
• Answers

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References and Resources

• 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

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James A. Gall, Ph.D., PLLC

• Office phone [phone]