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Title: Does Your Child Have Obsessive-Compulsive Disorder?
Author: Anthony Kane, MD
Website: http://addadhdadvances.com
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Does Your Child Have Obsessive-Compulsive Disorder?
by Anthony Kane, MD
Introduction
Worries and doubts are part of normal everyday life. However,
when these concerns affect normal functioning, it is a sign that
there might be a greater problem.
Modern psychiatry classifies Obsessive-Compulsive Disorder (OCD)
as one of the Anxiety disorders. Currently, 1 in 200 children and
adolescents in the United States has Obsessive-Compulsive Disorder.
Fortunately, there is a lot that you as a parent can do to help
your child.
Symptoms
Obsessions are persistent and recurrent impulses, thoughts, or
images that are unwanted and cause distress. These are usually
irrational and are not the normal products of daily living.
Compulsions are repetitive actions, like washing hands or hoarding
things, or mental actions, like counting or repeating words
silently. As the name implies Obsessive-Compulsive Disorder
is characterized by both.
Typically, the person is plagued by repetitive thoughts, images,
or impulses that are disturbing, illogical, and out of the
person’s control. In an attempt to make these obsessions go
away the person develops and performs compulsively a set of
actions to relieve the discomfort caused by the obsessions.
For example, a person who is obsessed with sickness may develop
compulsive hand washing. A person who is obsessed with fear
of fire might continually check to make sure that the stove is
off. The person gets no pleasure from doing these actions.
Rather they provide temporary relieve from his unpleasant
thoughts. The person may spend hours over the course of the day
doing compulsive actions to relieve his obsessive thoughts.
At some point, most people realize that the anxieties are only a
product of their own minds and have nothing to do with reality.
However, they are unable to control the thoughts or the behaviors.
Description
Obsessive-Compulsive Disorder can start as early as preschool
age. The way OCD shows itself in a child will vary with the
child’s age. A younger child may have anxiety that harm will
come to him or a family member. He may repeatedly check to see
if the doors of his house are locked.
An older child may be afraid of germs and that his food is
poisoned or that he will get AIDS. He may constantly wash his
hands or food. The child may even know and can verbalize that
it doesn’t make sense. However, the compulsive behavior is
beyond his control.
Children with OCD frequently don't feel well physically. This
may be because of the stress their anxieties cause or it may be
due to lack of sleep or poor nutrition. These children often
have stress related disorders such as headaches or stomach
upset.
Frequently, children are angry with their parents. This usually
occurs when the parents are unable to comply with their
child’s behavioral quirks. These children usually have trouble
keeping friends because of their behaviors make them stand
out. These children often suffer from poor self-esteem.
Diagnosis
To receive the classic the diagnosis of OCD a person must have
obsession and/or compulsions that cause the person anxiety or
distress and cannot be attributed to another cause, such as
substance abuse. The obsessions or compulsions cause a lot of
distress and interfere with normal living.
The diagnosis usually goes unrecognized for a very long time.
Studies show that most people don’t receive the diagnosis of
OCD until 9 years after the symptoms first appear. It may take
an addition 8 years before they receive adequate treatment.
The reason for this is two fold. Most patients are embarrassed
by their condition, so they avoid telling anybody. Secondly,
many doctors are not familiar with the condition, so that they
are not quick to recognize it nor do they know how to treat it.
Causes
The current research indicates that OCD is a neurologically
based brain disorder. Studies show that there seems to be a
communication problem between the frontal lobes of the brain
and the brain’s deeper structures. These areas of the brain use
the neurotransmitter, serotonin to communicate. People with OCD
have lower levels of serotonin in these areas of the brain.
Drugs that increase the brain serotonin levels also improve OCD.
Obsessive-Compulsive Disorder has also been linked to strep
infections. Recently, a study was done giving OCD patients anti-
strep antibodies. Patients showed a significant improvement in
their OCD symptoms.
Related Disorders
Children with OCD commonly have other psychiatric problems.
Below is a list of psychiatric conditions that frequently occur
along with OCD:
· Other anxiety disorders
· Depression
· ADHD
· ODD
· Learning disorders
· Hair pulling
Treatment
Most children with OCD can be treated effectively with a
combination of psychotherapy and certain medications,
particularly serotonin reuptake inhibitors. Family support and
education are also central to the success of treatment.
Antibiotic therapy may be useful in cases where OCD is linked
to streptococcal infection.
Psychotherapy
Cognitive behavioral psychotherapy is the psychotherapeutic
treatment of choice for children, adolescents, and adults with
OCD. This method helps the patient internalize a strategy for
resisting OCD and has lifelong benefit. This therapy focuses on
changing the persons thoughts and feelings by first changing his
behavior.
This form of therapy has only moderate success. 25% of patients
are unable to finish the course of the program. Of those that
do finish, between half and three quarters report some degree of
benefit after three to five months. These benefits last
after the therapy has stopped.
Therapy usually is administered on a weekly basis for at least
two months. There is an intensive form of therapy in which the
person works with the therapist in 2-3 hour periods three times
a week. If the person chooses the faster approach, he can
complete treatment in three weeks.
Medication
The serotonin reuptake inhibitors (SRIs) are uniquely effective
treatments for OCD. These medications increase the concentration
of serotonin, a chemical messenger in the brain. Five SRIs are
currently available by prescription in the United States:
· Clomipramine (Anafranil)
· Fluoxetine (Prozac)
· Fluvoxamine (Luvox)
· Paroxetine (Paxil)
· Sertraline (Zoloft)
· Citalopram (Celexa)
Most people notice some benefit after 3 to 4 weeks. It takes 8-10
weeks before these medications take full effect, but most
people say they are significantly better. 20% of people don’t do
well on their first medication and are forced to try a different SRI.
SRI Side Effects
The most common side effects are:
· Nervousness
· Insomnia
· Restlessness
· Nausea
· Diarrhea
Clomipramine has a broader action than the other drugs and carries
with it additional side effects including:
· Dry mouth
· Sedation
· Dizziness
· Weight gain
· Blood pressure problems
· Irregular heart beats
Medications control symptoms, but they do not cure the disorder.
When a child stops taking medication, the symptoms usually
return. For this reason, the current recommendation is to use
cognitive behavioral therapy in conjunction with medication.
No two children respond to anti-OCD medication in exactly the
same way. Some children don’t respond to any medication. Side
effects
also vary from person to person. For this reason, your child may need
to try more than one medication. Although we still don’t know for
certain, no one has identified any long-term problems from taking
these medications.
Newer Treatments
Recent studies have linked certain cases of OCD with the presence of
anti-strep antibodies. In a study performed at the National Institute
of Mental Health, a number of children with OCD and who tested
positive for strep were given a treatment to remove circulating
anti-strep antibodies. Within a few weeks some of the children’s
symptoms lessen and in a few cases they disappeared completely.
Treating for circulating strep anti-bodies is still considered
experimental. However, this new treatment might soon be changing the
way we treat some people with OCD.
Conclusion: What You as a Parent Can Do
1. If your child has Obsessive-Compulsive Disorder, the most
important thing you can do to help your child is to learn
as much as you can about the condition.
2. Children and adolescents often feel shame and embarrassment
about their OCD. Many fear it means they're crazy. Good
communication between parents and children can increase
understanding of the problem and help the parents
appropriately support their child.
3. Family problems do not cause OCD, but the way the family
deals with the symptoms can affect the child. If your family
is having difficulty dealing with a member who has OCD, you
should try to consult a Family Therapist for direction.
4. Try to be as kind your child as possible. This is the best
way to reduce the symptoms of OCD. It will not work to
command your child to stop the behavior. Your child is unable
to stop and he will only feel even greater distress if he is
reprimanded or forced to stop his rituals. Remember, as much
as your child’s behavior bothers you, he is suffering even
more.
5. You have to be your child’s advocate in school. You must
make sure that the child’s teacher and the school
administrators understand the disorder.
6. Use support groups. Sharing common problems with other
parents is an excellent way to help you feel that you are
not alone and is great support. You also might gain some
insights on how to deal with the daily problems that come up.
7. Make time for yourself and your own life. You must not let
yourself be trapped by your child’s rituals. Your child
does not need a martyr as a parent.
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Anthony Kane, MD
ADD ADHD Advances
http://addadhdadvances.com
================================================================
Anthony Kane, MD is a physician, an international lecturer, and
director of special education. He is the author of a book,
numerous articles, and a number of online programs dealing with
ADHD treatment (http://addadhdadvances.com/childyoulove.html),
child behavior and discipline
(http://addadhdadvances.com/child-behavior.html), ODD, and
education. You may visit his website at http://addadhdadvances.com.
To sign up for the free ADD ADHD Advances online journal send
an email to: subscribe@addadhdadvances.com?subject=subsart
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