I recently attended a fantastic conference presented by Dr. Martin Franklin of the University of Pennsylvania on the topic of children and teens with Obsessive Compulsive Disorder (OCD). At the heart of Dr. Franklin's treatment approach is that children and teens must learn to tolerate and overcome their own emotional distress.
Obsessive-compulsive disorder in children and teens has two components. The first is obsessions, which consist of recurent thoughts, impulses, or mental images. The second component is compulsions, which are repetitive behaviors that the child feels driven to perform in response to the obsessions. Obsessive thoughts are different from worries about such real-life problems as bad grades in school. In addition, obsessive thoughts are not usually related to any real-life problems.The compulsion may represent a strict rule that the child must apply rigidly in every situation (tapping with fingers or tying one's shoes a certain number of times, for example) in order to feel "right." In childhood OCD, a family history of OCD is more frequent than in adult onset OCD, leading to the belief that genetic factors may play more of a role in childhood OCD.
I have summarized Dr. Franklin's key points and am passing them along below:
• OCD is best presented to children and parents as a neurobehavioral problem.
• Therapy is further conceptualized as a fight waged against the OCD by the child, the therapist, and the family.
• Children are supported by learning that OCD is not their fault.
• A mindset of embracing versus avoiding anxiety is encouraged. In treatment this means action steps are better than excessive thinking.
• Cognitive Behavioral Treatment (CBT) and Selective Serotonin Inhibitors (SSRI's) as medications are effective for OCD and combined treatment may be superior to monotherapy.
• CBT is more effective than teaching only relaxation therapies.
• Exposure to feared thoughts through corrective behaviors is crucial. The goal is to show that the perceived consequences of obsessive thoughts are highly unlikely.
• Exposure to the fear while preventing the rituals is crucial in treatment.
• Though they may mean well, it does not usually help when parents offer advice, reassurance, punishment, distraction, and avoidance for OCD.
• Trying to directly neutralize or squash obsessive thoughts just leads to a rebound of negative thoughts and an over importance of the thoughts.
• Cognitive therapy for OCD for children and teens means learning constructive self-talk, identifying negative thoughts, and mindfulness strategies.
• Kids are taught ways to talk back to OCD, make positive self-statements, and to learn to tolerate emotional distress.
For further information:
Talking Back to OCD: The Program That Helps Kids and Teens Say "No Way" -- and Parents Say "Way to Go" (John March, 2006)
Treatment of Obsessive Compulsive Disorder, Annual Review of Clinical Psychology, Vol. 7, pp. 229-243, 2011 (Martin Franklin, Paper, 2011)
Dr. Jeffrey Bernstein is a child and family psychologist in the greater Philadelphia area and the author of four self-help books, including 10 Days to a Less Defiant Child.