Ask Doctor K: Therapy first step in OCD treatment
DEAR DOCTOR K: I think my 9-year-old son may have OCD. How is this condition treated in children?
DEAR READER: Before discussing treatment for OCD, it’s important to describe what it is. You know, of course, but other readers may not.
Children (and adults) with obsessive compulsive disorder are troubled by repeated, intrusive, distressing thoughts. These obsessions cause great anxiety. As a result, people with OCD often have a strong urge to repeat certain behaviors in order to reduce the anxiety. OCD usually starts in childhood or adolescence; symptoms may appear as early as age 3. A young child with OCD may insist on bedtime routines done without variation, night after night. He or she may insist that toys be arranged in exactly the same way every day.
Many children like a sense of order and routine. But with OCD, these beliefs or behaviors become all-consuming. They interfere with school, home life and recreational activities.
Treatment may help improve a child’s ability to function. Many experts recommend trying a type of talk therapy called cognitive behavioral therapy. If you decide to try CBT, look for a clinician experienced at working with children and teens.
A version of CBT known as exposure and response prevention is typically used in treating OCD in patients of all ages. During therapy, a clinician exposes patients to the things, places and circumstances that provoke their obsessions. Patients are then prevented from performing the usual compulsive ritual.
For example, if your child is obsessed with germs, he may be asked to touch a “dirty” shoe. Then he will be told to wait before washing his hands. The waiting time will increase over time. Eventually, he will learn to tolerate the anxiety, making the compulsive behaviors unnecessary.
Medication can also help children better manage OCD. Selective serotonin reuptake inhibitors are the drugs most often prescribed.
A combination of CBT and medication often gives a child the best chance of relief.