Therapy, Meds Can Help OCD Kids

If you suspect your child may have signs of obsessive-compulsive disorder, what do you do? In the final installment of a series on obsessive-compulsive disorder, learn how your child can get help. Fifth in a series.

Parents may face an uphill battle in getting the right treatment for their child with obsessive-compulsive disorder (OCD).

Even if a parent recognizes what the problem is, other issues exist - a lack of therapists trained in pediatric mental health, problems with access through HMOs and primary care providers who don't recognize the seriousness of the problem, says Susan E. Swedo, M.D., chief of the pediatric and developmental neuropsychiatry branch of the National Institute of Mental Health.

However, that shouldn't discourage you from seeking an opinion from a doctor and getting help for your child.

OCD is a chronic, often debilitating mental disorder, causing intensely recurrent, unwanted thoughts, or obsessions, usually coupled with uncontrollable, repetitive behaviors, or compulsions. Typical behaviors include repetitive hand washing, counting, checking, hoarding or cleaning.

First, medication

With the rise of antidepressants known as selective serotonin reuptake inhibitors (SSRIs) in the 1990s, more people with mental disorders have been able to get better pharmacological help. SSRIs have fewer side effects than older antidepressants and usually work well in children. Some medications used to treat OCD include Anafranil® (clomipramine), fluvoxamine (Luvox ®), and sertraline (Zoloft®). "First and foremost, there must be medication to help calm them. If you don't, you are tying their hands behind their backs. They can't get the behavior under control. You have to quell the anxiety first," says Mark Wellek, M.D., past president of the American Society for Adolescent Psychiatry.

Children, teens and adults being treated with antidepressants, particularly anyone being treated for depression, should be watched closely for worsening of depression and for increased suicidal thinking or behavior. Close watching may be especially important early in treatment or when the dose is changed - either increased or decreased. Bring up your concerns immediately with a doctor.

Second step, therapy

"But you can't just give them the drug. You have to watch them closely. You want to teach them how to stop the thoughts. But you won't be able to wipe it out completely. I've never seen anyone do that."

It takes a team of professionals along with the family to offer behavioral and cognitive therapy to not just the child but also to the family members.

"The family physician is in a unique position to help the family and patient address the condition in the context of that family and that particular community," Martin says. "When special expertise is required, the family doctor can coordinate that care. Most family doctors are going to be very comfortable with SSRIs. Although I may be able to manage the medication, I really want that child in psychotherapy, too."

David Fassler, M.D., a child and adolescent psychiatrist and clinical associate professor of psychiatry at the University of Vermont College of Medicine and a spokesman for the American Psychiatric Association, adds, "The kids starts to think over and over. 'I have to focus on that car' and can't think of anything else. You can distract them from that thought of a car to something else so you can interrupt that obsession. Sometimes parents try hitting the kids' hand. But that doesn't work. If I got a kid doing a routine and when you call attention to it, then boom! They stop. We teach parents to be benign, helpful observers."

The struggle to help your child cope with this disorder is a tough one and will always be. Keep the complete picture in mind when helping your child.

"The obsessions and compulsions are symptoms, and not a disease, just as the high blood sugar in diabetes is a symptom, and not the real disease," Swedo says. "But both sets of symptoms are thought of as diseases, because that helps doctors understand where to start with treatment.

"For high blood sugar, the goal is to return it to normal levels by diet, exercise, medications and/or insulin. For obsessions and compulsions, the goal is to eliminate the symptoms through medication and behavior therapy. In both cases, elimination of the symptom is the goal of treatment, even though the cause of the symptoms (i.e., the real disease) isn't being addressed. Thus, there is the potential for good symptom management, but not a cure," she says.

Sources:

Centers for Disease Control and Prevention

The American Society for Adolescent Psychiatry

Anxiety Disorders Association of America

The National Institute of Mental Health

The National Alliance for the Mentally Ill

The American Academy of Child and Adolescent Psychiatry

The American Academy of Pediatrics

The American Academy of Family Physicians

The Obsessive Compulsive Foundation

The Madison Institute of Medicine

This article was reviewed and updated June 2007.