In some cases, children with OCD exhibit symptoms that may not immediately be associated with the disorder. Or their behavior may mimic symptoms of other disorders.
Here are examples of some of these behaviors:
Some children with OCD may need to eat foods in a certain order; chew a certain number of times; refuse to eat certain foods (that they may have eaten in the past) because they are afraid; cut food into a specific number of pieces; or tap their fork or spoon a certain number of times before eating. If they are unable to complete these rituals, they may refuse to eat. It’s important to differentiate these OCD symptoms from symptoms of anorexia nervosa, bulimia, other eating disorders; these may occur at the same time as OCD.
Inability to Make Decisions
In some cases, young people experience serious concerns in making a selection. The result may be an inability or serious reservations about making any decisions at all.
Extreme Separation Anxiety
Some children, especially younger ones, may have overwhelming fears of being left alone or that their parents or caregivers will never return. While this behavior is reminiscent of separation anxiety disorder, it may also signal OCD in a child fearing that his or her parents will be harmed or even die.
Children with OCD sometimes hide their activities or make their rooms or possessions off limits to siblings and parents. Frequently embarrassed by their rituals, young people want to keep them hidden so they carry them out in secret. Also, children who have contamination fears may not want anyone to touch anything in their rooms or their possessions.
When a normal routine or a seemingly regular activity is disrupted, some children may have a temper tantrum; for example, inflexibility to the point of a tantrum if a small part of a bedtime ritual or other household routines are changed. For some children, rituals must be repeated a certain or “magic” number of times. If a child’s magic number happens to be 11, and he is interrupted at repeating number 10, he will have to start over from the beginning while experiencing a great deal of frustration. Also, children who experience fears of harm to themselves or loved ones may become panicked if their rituals that are intended to prevent harm are interrupted.
It’s important that great care be taken when observing and documenting a child’s behavior to make an accurate diagnosis.
Finding Therapist: What to Ask
A cognitive-behavior therapist should be agreeable to speaking with you about your child’s OCD and answering all your questions. You need to be comfortable with the therapist, because he or she will be guiding you through every step of your child’s treatment. He or she will also be giving you advice, ideas and directions to help you manage your child’s progress between sessions. It’s also extremely important that your child and the therapist are a good match, or “click.”
State-of-the-art treatment for OCD is cognitive-behavior therapy (CBT), which involves exposure and response prevention (ERP) and cognitive therapy (CT), sometimes in combination with medication. It cannot be stressed strongly enough that your child’s therapist actually be trained in CBT.
There is no evidence to support the use of talk therapy, however, to treat OCD. If the therapist tells you that he or she treats OCD using talk therapy or role playing, walk away. Keep in mind that supportive therapy (e.g., counseling) may help children manage conflicts due to OCD, including difficulties with school, peers and family members. Family members may also benefit from supportive therapy; most CBT approaches involve families in treatment. You should also walk away if you’re told that your parenting actions have caused your child’s OCD. In addition, the therapist should be able to assess all of your child’s symptoms to determine if your child has OCD and any other coexisting disorders that require treatment.
Here are some questions to ask a prospective therapist:
- Do you have a background in child and family therapy?
- What techniques do you use to treat this specific form of OCD? (You’re looking for responses that include CBT and cognitive therapy.)
- Are you trained to use CBT, including ERP, to treat OCD?
- Where did you obtain your training? (You’re looking for them to tell you about an established training program in CBT.)
- Are you licensed to practice in this state? (Beware of unlicensed therapists.)
- How many children (or teens) with OCD have you successfully treated?
- Will you conduct therapy sessions (if necessary) by telephone, online or via Skype; are you willing to evaluate and treat OCD in the setting in which it usually occurs (e.g., home, school)?
- Are you willing to work with other professionals such as the primary care physician, school counselor or social worker to ensure a coordinated approach to treatment?
- How do you involve the family in the treatment of OCD? (You want a therapist who will teach parents how to monitor and support the homework assignments given to the child or teen.)
Avoid a treatment provider who…
- Believes that OCD is caused by childhood trauma, toilet training, self-esteem issues or family dynamics;
- Claims that the main technique for managing OCD is relaxation, talk therapy or play therapy;
- Blames parents or one’s upbringing for OCD;
- Seems guarded or angry at questions about treatment techniques;
- Claims that medication alone is a treatment for OCD; or
- Suggests your child will need years of therapy: CBT is not intended to go on indefinitely.