Ocd Presentation

Treatment Strategies for Children with Obsessive-

Compulsive Disorder.

By: Chrissy Snead

What is Obsessive-Compulsive Disorder?

• Obsessions such as1. Persistent and recurrent thoughts, images, or

impulses, that are experienced, at some time during the disturbance, as inappropriate and intrusive and that cause marked distress or anxiety.

2. Impulses, images or thoughts are not simply excessive worries about real-life problems.

3. The person attempts to suppress or ignore such thoughts, images, or impulses, or to neutralize them with some other thought or action.

4. The thoughts, images, or impulses are a product of his or her own mind and are not imposed.

• Compulsions such as:1. Repetitive behaviors that the person feels

driven to perform in response to an obsession.2. The behaviors are aimed at preventing or

reducing a situation or dreaded event.* The person recognizes that the obsessions or

compulsions are excessive or unreasonable.• The obsessions or compulsions are time

consuming, cause marked distress, or significantly interfere with the person’s routine.

• It is not due to the physiological effects of a substance problem or general medical condition.

• The obsessions or compulsions are not restricted to another Axis I disorder such as an Eating Disorder.

Common Obsessions

Contamination-fear of germsHarm to self or othersSymmetry-needing things to be

even or lined upDoubting-being sure you’ve

completed common task such as locking the door

Numbers-having to do something a certain number of times

Religiosity-fear that you have sinned or a need to pray continuously

Hoarding-fear of throwing out objects

Sexual themes-doubts about sexual orientation or fears of being perverted.

Common Compulsions

Washing and CleaningChecking-rechecking locksSymmetry-if you bump the left

hand then bumping the rightCounting-making sure the t.v. is

on a certain number, having to count while doing task such as putting on clothes

Repeating/Redoing-opening and closing doors or turning lights on and off, rereading till perfect.

Hoarding-Unable to throw items away

Praying-confessing every bad thought or continuous praying.

How common is it?

• Over 1 million children have OCD

• 1 in every 100 young people

• Boys tend to develop OCD earlier than girls. More boys are diagnosed 3:2.

• The average age of diagnosis is between 7-10 years old.

• It is unknown why some children become checkers and others become washers.

Where does it come from?

• During the middle ages it was thought to be “of the devil.” as a result of the religious movement.

• Next it was thought to come from illness or fevers.

• Psychoanalysis (Freud) thought that overly rigorous toilet training and intrusive parenting practices during the anal stage of development lead to OCD about cleanliness.

• It is now known to be biologically driven. Having a parent with anxiety or OCD increases the possibility of a child being diagnosed.

• It has been found that some children with lots of strep infections increase the prevalence of OCD. This is because the strep virus

can cause damage to the basal ganglia in the brain. The body’s own immune system attacks the basal ganglia instead of the strep infection.

Thus there is a connection to Serotonin- the neurotransmitters that are information from one cell to the next. In OCD it is thought that these message circuits do not function properly. Thus the use of SSRI medications to increase serotonin levels.

To Medicate or Not Medicate?

• Selective Serotonin Reuptake Inhibitor or SSRI’s are most commonly used with OCD. Examples of these are Zoloft, Prozac, and Paxil.

• FDA approved medications for treatment in children with OCD is Fluoxetine or Prozac and Zoloft.

• Studies have shown that SSRI’s are effective in the treatment of anxiety, OCD, and major depressive disorders in children.

• Studies also show a low risk for suicide with the use of SSRI medication.

• Research has shown that cognitive-behavioral therapy is as effective as SSRI treatment of OCD.

Treatment Strategies

Cognitive Behavioral Therapy* CBT is a psychotherapeutic approach that aims to

influence dysfunctional behaviors, emotions, and cognitions through a goal-oriented, systemic procedure.

* It shares a base in behavioral learning-Pavlov and Mary Cover Jones (work on unlearning of fears in children) 1920’s

* Cognitive Psychology-Albert Ellis and Aaron T. Beck* The approaches were combined in the 1980s and 1990’s.* Therapy is often brief and time limited* Can be used in individual or group settings

Cognitive Behavioral Therapy

• Includes a variety of approaches such as..-Keeping a diary of significant events and associated behaviors, feelings, and

thoughts.-Testing and questioning assumptions,

thoughts, evaluations and beliefs that might be unrealistic or unhelpful.

-Gradually facing things previously avoided-Relaxation strategies-Distraction techniques-Trying new ways of reacting or behaving.

Introducing CBT to Children with OCD.

Up and Down the Worry Hill.

This book introduces common OCD behaviors and thoughts, going to see a therapist, introduction to CBT concepts.

Blink, Blink, Clop, Clop: Why do we do things we can’t stop?

This book uses farm animals to describe common thoughts and behaviors. It introduces CBT concepts such as saying no to the thought.

Using CBT with OCD

• What to do when you worry too much book.– This book is a helpful

resource for therapist and parents. It has many CBT strategies such as logical thinking, thought stoppers, distraction, and relaxation strategies. The book is suggested for kids ages 6-12.

Resource for Parents

Freeing your child from Obsessive Compulsive Disorder.

This book is good for parent’s, teachers, or therapist wanting to learn more about OCD. It talks about what OCD is and where it comes from. The book also helps parent’s to gain insight into how their behavior is impacting their child’s OCD. It introduces CBT concepts and behavior modifications.

Family Therapy is also beneficial for helping parents to discontinue their participation in the child’s rituals and also gives the parents support.

Behavioral Strategies

• Have been shown to be effective in treatment with OCD

• Require compliance and a high level of effort on the part of the parent and patient.

• Examples of this are…• Brave Behavior Chart• The Hand Wash Count

Play Therapy and OCD

Play therapy techniques are useful in addressing…

Resistance-Many children have a fear of changing their behaviorFeelings of Shame-Kids often feel that they are weird or are ashamed of their OCD symptoms.

This can also been seen as lower self esteem.Social Adjustment-They may not be doing typical activities such as going over to a friends house or spending the night away from home due to their fears. They may withdraw from social activities so that others will not notice their OCD symptoms.

Play Therapy

• Allows the child to express feelings and gives insight into the child’s world.

• Displacement-this is a technique in which a therapist describes the experiences of a hypothetical problem rather than speaking directly to the experiences of the client.

Examples of displacement are dramatic play, sand tray play, art work, puppet play, books or stories, and movies.

Storytelling

Once Upon A Time…Therapeutic Stories that Teach and Heal. By Nancy Davis, Ph.D.

These are a collection of stories that can be used for a wide range of ages and diagnosis. There are over 21 stories related to anxiety or obsessive-compulsive disorder.

Stories to help with nightmares.

Case StudyA is a four year old female who was referred to

treatment by her PCP. Her parents’ primary concern was her compulsively pulling out and chewing on her hair. No stressful or traumatic events were reported. She had a sister age 6 months. She had occasional aggressive behaviors such as hitting with peers at school.

Therapy focus on implementing a behavior modification plan, and utilizing play therapy. During play therapy she was inconsistent about acknowledging her symptoms. Her behavior modification was that she could have a small squishy toy to squeeze when she had the urge to pull her hair. She was awarded points for telling her parents about her urges to pull her hair.

Play therapy focused on her resistance to the behavior modification. On the first session of play therapy, patient found the skunk puppet in the play room. She picked up the skunk and reported “this guy stinks” and threw it out the door of the play room. The therapist used this as an opportunity to talk about how the skunk must feel. About halfway through treatment the patient decided that the skunk was not as stinky and allowed it to remain in the room, but placed it in the trash can. A also used the dollhouse to depict a story of a family and their pet cat. The family would reject the cat for different reasons and would get other pets that were “better.” Through this story she was able to express her fears of being replaced by her younger sibling. Through her play the family began to accept the cat and have love for the cat as well as others.

Play therapy also focused on allowing patient to express her feelings. Her parents’ were educated on allowing patient to “use her words” to express feelings at home and being able to reflect these to patient.

She did test limits in the play session as was evident when she wanted to pour water on the play-doh. The therapist gave her some choices and used this as an opportunity to show unconditional positive regard.

During her course of treatment her hair pulling improved to the point were normal hair growth was seen and parents did not observe any pulling behavior. Her aggressive behavior at school improved also. Towards the end of therapy she announced that the skunk had taken a bath and smelled okay and was allowed to join her in the play room.