obsessive-compulsive disorder in children and adolescents: family based strategies and interventions...

OBSESSIVE-COMPULSIVE DISORDER IN CHILDREN AND ADOLESCENTS: FAMILY BASED STRATEGIES AND INTERVENTIONS

James A. Gall, Ph.D., PLLC

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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

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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)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

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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

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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

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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

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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

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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

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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

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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

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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