Obsessive Compulsive Disorder in Children - Symptoms and Treatment

"1,2,3,4,5. Now the door is locked"
~Jack Nickelson playing a person with Obsessive-Compulsive Disorder in the film, "As Good As It Gets"

I. What is Obsessive-Compulsive Disorder?

We have all, as children, wished upon a star or skipped over cracks in a sidewalk. A person suffering with Obsessive-Compulsive Disorder will do and think these kinds of things to the point where these thoughts and rituals rule their lives. They feel helpless and at the mercy of these persistent thoughts and rituals.

Obsessive-Compulsive Disorder (OCD) is characterized by thoughts (obsessions) and/or actions (compulsions) that affect the ability of the sufferer to cope successfully in society. OCD has a significant impact on its sufferers' ability to go to school, work and socialize without stress.

It is estimated that one in 200 children or adolescents in the United States has varying degrees of Obsessive-Compulsive Disorder (OCD). Research shows that OCD tends to run in families, but it does not necessarily follow that a child will develop OCD even though another member of their family has the disorder.

II. What are the symptoms of OCD?

For children, rituals are a very important part of life. Children like to be tucked into bed around the same time every night, after a bedtime story, after brushing their teeth, etc. Children like to be able to depend on the consistency of everyday living. It is only when the patterns become ritualistic: for instance, the brushing of teeth many times over, the over concern with worries, that do these thoughts and rituals become problematic.

Obsessions: Obsessions are thoughts that occur over and over again. The person feels out of control with their thoughts. Some common obsession symptoms are: losing control of urges, over concern with contamination and germs, imagining harming others or self or worry about harm coming to others or self.

Compulsions: Compulsions are the acting out of obsessive thoughts. They bring a small bit of relief to the obsessions. For instance, a child who is afraid of an intruder breaking in to harm his or her family may compulsively keep checking the doors at night to make sure they are locked securely. They will check the doors over and over again, fearful that they've missed something. Some common compulsive symptoms are: washing, checking, counting, arranging things, hoarding, touching, and repeating.

III. How is OCD Diagnosed?

A teacher or guidance counselor may suspect a child may have OCD may refer the parents to a psychiatrist who will review the behavior with the child and the family. Family physicians, mental health centers can make referrals to mental health professionals who may provide treatment. There are doctors and specialists who specialize in the treatment of OCD.

Diagnosticians use a series of checklists in order to help them diagnose OCD. These are measurement scales. Among the different measurement scales are the Yale-Brown Obsessive-Compulsive Scale: this is a 1- item scale that measure how severe the symptoms are in OCD patients. The Patient Self-Rating Scale is a seven item scale that compares the patient's current status with that before treatment. The National of Institute's of Mental Health's Global Scale measure and rates obsessive and compulsive symptoms against how well the patient functions.

IV. How is OCD Treated?

Medications have been shown to be very effective in treating OCD. The SSRI group of medications are now used to control the symptoms of OCD. These medications are not curatives but do help the patient reduce the symptoms by 50-80% or more. Some of these medications include Prozac, Luvox and Zoloft.

Psychotherapy combined with medication and cognitive-behavioral therapy has been shown to be the most effective way of treating OCD.

Medications

Cognitive Behavior Therapy

V. I suspect my child has OCD. What do I do now?

Professionals to Seek Out

1. See your physician or pediatrician
2. Consult with your clergy to assist in spiritual and
   practical guidance
3. Consult with an educational consultant to help you
   find the right program for your child.
4. Consult with a therapist or counselor.
5. Consult with an Educational Advocate to help
   you with your current school situation
6. Consult with an Educational Consultant to find the
   right program for your child.

Find out more about Educational Consultants

Programs

1. Inpatient: hospitalization
   
2. Outpatient Facilities
   Outpatient facilities have therapeutic staff on-hand to offer therapy and support to patients on a part-time basis.
   
3. Day Treatment
   
4. Residential Programs
   

a. Emotional Growth School
Emotional Growth schools are highly structured environments that stress academics and teach coping skills through the use of conflict resolution. Children learn they can make choices and learn to accept responsibility through the use of modeling behavior and outdoor therapy. The length of stay is between 9 and 18 months, at which time they either return to the mainstream or attend a boarding school, if possible. Parents are involved with the school staff and the children throughout the child's attendance at the school.
Find out more about Outdoor Therapy

b. Therapeutic Residential Boarding School
These schools are usually fully accredited schools with emotional growth programs. They stress holistic education: growth of the person through holding children responsible for their actions. There is no rehabilitation or physicians on staff.

c. Therapeutic Wilderness Program
A Therapeutic Wilderness program does not necessarily have academics; their goal can be to introduce the children to a different role. These programs use Outdoor Therapy to help build low self-esteem. They make obtainable goals for them to reach. The programs vary but they are about 6 to 8 weeks long. It is a very structured program with a goal of teaching the children coping skills and raising their self-esteem. Children go from this program to mainstream back into their public school or attend a small structured boarding school.
Find out more about Therapeutic Wilderness Programs

d. Residential Treatment School
A Residential Treatment Program or School provides a full professional staff that includes therapists, psychologists, and psychiatrists. They also have a small academic program. Many of the children in the program have been recommended there by mental health agencies that make the placements. It is a highly structured environment whose emphasis is on treatment and learning coping skills and independent living. Chemical dependence education and rehabilitation is also provided. Outdoor therapy is sometimes used to facilitate building social skills and self-esteem. Recovery programs are also available. Residential Treatment schools are secure schools.
Find out more about Residential Treatment Schools

Which program is right for my child?