Presenter: Allen H. Weg, Ed.D.
Download this webinar’s corresponding slides here.
View this webinar by clicking here
Dr. Weg discussed the assessment and differential diagnosis of OCD in children and adolescents, then he reviewed cognitive behaviors treatment methods of the disorder including the use of storytelling. Dr. Weg reviewed the tools to use and roles of parents, teachers and counselors in the life a child or adolescent with OCD.
Comments(33)
wefivehodges says:
February 29, 2012 at 9:28 pmMy 9 year old daughter has been diagnosed with severe ocd and has been getting CBT. One thing that always confused us is that she could never explain her obsessions. After hearing your presentation, it sounds like her symptoms are more like tourettic ocd than ocd. Can you explain the differences in treatment?
Thank you,
Greg
Dr. Weg says:
August 29, 2018 at 3:06 pmGreg-
The short answer to your question is that there is not a lot of difference in treatment. In typical OCD, there is often a fear associated with not doing the ritual. So, for instance, the child might feel the need to tap things 3 times or “something bad” will happen- sometimes this is general and vague, but sometimes specific (“My mom will get hurt.”) In therapy we would have the child do response prevention (for instance, tap the “wrong number of times,”) but then also do the difficult cognitive exposure of imagining, on purpose, that his mom will now get hurt. In touretic OCD, there are no specific fears, except maybe that they child feels that they “just won’t be able to handle it,” and there while behaviorally we would challenge the tapping ritual, there would be no specific cognitive exposure- Dr. Weg
KelleyT says:
March 1, 2012 at 8:03 amWhat could parents do when they stop accommodating the OCD demands and the adolescent has a tantrum and begins to have a meltdown (yelling, screaming, crying, pleading etc.)?
Dr. Weg says:
August 29, 2018 at 3:07 pmKelley-
Think how you would respond to an adolescent having a tantrum who did not have OCD, and respond the same way. Do not reinforce or give undo attention. Give them space and time to cry it out, after the first few times when they see you do not respond, that alone might lower the intensity and allow them to regain control more quickly. Other interventions: as mentioned in the webinar, empathize, but stick by your guns that your giving in would only make their disorder worse in the long run. In bad acting out cases (where there may be threats of, or actual acting out of violent behavior), you want to make sure you offer them healthy methods for dealing with the intensity of their emotions, perhaps event provide therapy dealing specifically with anger and high emotional management (Dialectical Behavior Therapy is an option), and, if things really escalate and someone’s safety is being compromised, be prepared to phone the police, but things rarely get to that point.
KelleyT says:
March 2, 2012 at 5:22 pmDo you have referrals for anyone in the San Jose, CA area that does similar therapy? Your techniques seem suited to elementary-age children. What about for a 16-year-old?
Dr. Weg says:
August 29, 2018 at 2:43 pmIf you go to http://www.ocfoundation.org, you will see a link for finding a therapist. These are divided by state- just look for your state. Regarding 16 year olds, while the drawings we reviewed might not be appropriate for older children, labelling it the OCD, storytelling, and most everything else I discussed would be fine with adolescents. Dr. Weg
KelleyT says:
March 2, 2012 at 5:23 pmIs it common for someone with OCD to involve others in their rituals? My 9 year old has my wife repeating phrases all day long. Usually in inrements of 15 times and always with 9 different word endings like s, ing, ness, less, eb, ebi, etc.
Dr. Weg says:
August 29, 2018 at 2:44 pmAs discussed in the webinar, OCD in children often snare the rest of the family, and everyone gets caught up in the rituals. The first step of treatment is to slowly and carefully unravel this web, and extract the parents’ role in these rituals.
KelleyT says:
March 2, 2012 at 5:25 pmHow do you deal with mental compulsions that the child has – can you ask them? I don’t want to suggest this problem, but uncover what is happening. The child is 6.
Dr. Weg says:
August 29, 2018 at 2:46 pmMental compulsions with a 6 year old would be a challenging situation, and most probably require a qualifed professoinal. the therapist would move in the direction of helping the child express what the obsession and compulsion were, and then having the child actually describe and repeat the feared obsession that he or she was trying to neutralize with the mental compulsion.
KelleyT says:
March 2, 2012 at 5:29 pmWhat do you suggest when parents do not tell their child about their OCD? I work with a 9 year old that is unaware of the name
Dr. Weg says:
August 29, 2018 at 2:47 pmIt sounds like you are saying that the parents do not want to teach their child about the child’s OCD. Clearly, if the child is suffering, it would be important for the parents to discuss this directly with the child, and then move torwards treatment. The parents should be worked with directly and alone, challenging their concerns about speaking onpenly with their child about this disorder.
KelleyT says:
March 2, 2012 at 5:29 pmHow does the hair pulling begin? Does it start with eyelash pulling?
Dr. Weg says:
August 29, 2018 at 2:48 pmTrichotillomania, or compulsive hair pulling, is related to, but in some ways very different from OCD. The resource for this disorder is http://www.trich.org. Trich, as it is called for short, can begin anywhere on the body, eyelashes, eyebrows, the top of the head, pubic hair, or general body hair- and can progress to any other body part or stay focused in only one area. Dr. Weg
KelleyT says:
March 2, 2012 at 5:30 pmMy daughter’s odc seems to go in waves is that typical?
Dr. Weg says:
August 29, 2018 at 2:49 pmYes,”OCD typically waxes and wanes,”is an expression you will see a lot in the literature. Often major life changes or stressors of different kinds will trigger an increase in symptoms. Dr. Weg
KelleyT says:
March 2, 2012 at 5:33 pmIs there a significant difference in the tx of OCD in adolescents with developmental disabilities like autism, pdd?
Dr. Weg says:
August 29, 2018 at 2:50 pmAutistic Spectrum disorders and other developmental disorders present difficult challenges when it comes to the assessment and treatment of OCD. First, you have to be sure that what looks like compulsive rituals are, in fact, OCD rituals, and not Autistic Spectrum disorder symptoms, such as the facinaiton with the repetitive movement of inanimate objects. Next, in general, the more impaired the child is, the more one involves the parents, and the more concrete and simple the interventios. Dr. Weg
KelleyT says:
March 2, 2012 at 5:34 pmIs OCD related to Copralalia in that my son, 8, now uses inappropriate words (not curse words) and it feels more OCD than TS.
KelleyT says:
March 2, 2012 at 5:34 pmIs it common to have trich or hair pulling and then also exhibit ocd symptoms in addition. Could the OCD therapy assit with Trich also?
Dr. Weg says:
August 29, 2018 at 2:52 pmRegarding OCD and Trich:
While Trich is considered “an OCD spectrum disorder,” which means the two are related, this concept is controversial. For instance, one of the big important differences is that, while persons with OCD typically derive no pleaseure from their compulsions, only a temporary relief from anxiety, most persons with Trich report actual pleasure from the feeling of pulling their hair out. This difference has profound importance regarding treatment- Trich is typcally NOT treated with ERP. Dr Weg
KelleyT says:
March 2, 2012 at 5:35 pmIs exposure therapy suitable for anxiety? Like fear of being alone in the house? or using bathroom at night?
Dr. Weg says:
August 29, 2018 at 2:54 pmExposure and Anxiety: Exposure therapy, with the addition of cognitive therapy and, if needed, medication, is the treatment approach favored by CBT therapists, and is strongly supported by research. This is true for most anxieties, including the ones you mentioned, like separaton anxiety or being alone. Keep in mind, however, that this should be done within the context of a hierarchy, that is, one small step at a time (“Mom is walking to the mailbox and leaving you in the house alone for 2 minutes- you can watch through the window” and move up from there), which should be repeated as often as it takes for the child’s anxiety goes down before proceeding with the next step, and with the input and consent of the child as much as possible. Dr. Weg
KelleyT says:
March 2, 2012 at 5:36 pmI am a job coach working with students with developmental disabilities. I have a student that is also diagnosed with OCD. He asks tons of useless questions that totally out of context. What is a method or strategy you would use to stop these off topic questions?
Dr. Weg says:
August 29, 2018 at 2:53 pmFor the job coach working with the DD student who compulsively asks questions- 1)Label the question as an OCD symptom- {“Johnny, I think your question is really just an OCD symptom”), 2)Empathize (“I know it is very hard for you and you feel like you need to know the answer to that questoin from me right now”), 3)Direct towards treatment intervention (“but you know I cannot answer the question because that would only make your OCD worse, so you need to challenge your OCD and work on accepting that you do not need to answer that question right now,”) and 4)Redirect to the task at hand (“so let us focus on what we were working on…”) If the student finds it too difficult to do this, always ask “what can you do to fight back?” this might involve delaying your answer by x number of minutes (or even seconds), or limiting how many questions he can ask over a period of time, or how long he has to wait before asking another question, or contracting for you to answer the “wrong” answer when he asks compulsive questions. Trial and error are the key, and watching that the student is challenged, in the sense that he subjects himself to some anxiety, but is not overwhelmed, is also key. In addition, the more he can be a part of the intervention development, the better. Dr. Weg
KelleyT says:
March 2, 2012 at 5:37 pmHow do you know when it’s time to seek out a therapist to help your child deal with OCD? How do you find a therapist who knows how to do the therapy you talked about here?
Dr. Weg says:
August 29, 2018 at 2:55 pmWhen is it time to find a therapist? When your child asks for help, when his or her symptoms are getting worse and nothing you do seems to help, when the symptoms are beginning to interfere with daily functioning (school attendance or performance, social activities and friendships, eating, sleeping, showering, washing, and dressing habits- when any of these are negatively affected, time to get help). How to find a good one? First, look in the right places (web sites for OCD New Jersey and International OCD Foundation were given at webinar) and ask the right questions- Have you worked with OCD before? How long? How often? With children? How do you treate it? If you do not hear Cognitive Behavior Therapy AND Exposure and Response Prevention inhj the answer, go someplace else. Dr. Weg
KelleyT says:
March 2, 2012 at 5:38 pmHave you seen children who have severe aversion to weather- storms- related to OCD and control?
Dr. Weg says:
August 29, 2018 at 2:56 pmRegarding OCD and weather: First, OCD can “attach” itself to just about anything imaginable, no topic or content area is immune. I had a client who compulsively watched the weather channel because she was anxious that we would get a devestating drought in Centeral New Jersey. Rain and storms comforted her- while more than 3 sunny days in a row triggered her anxiety. But it sounds like you might be dealing with a straightforward phobia of storms. It is impossible to tell from the question. It should be evaluated by a professional. Dr. Weg
KelleyT says:
March 2, 2012 at 5:39 pmDo you have any suggestions for a student that obsesses about time?
Dr. Weg says:
August 29, 2018 at 2:58 pmRegarding obsessing about time: Please remember first, that just because someone is obsessing about something and engaging in compulsive rituals, this alone does not mean that he or she has OCD. It is important that the Os and Cs create significant stress and interfere a great deal with functioning.
Regarding the issue of time, it is hard to know the treatment without more details, but the rule of thumb is, ask, “what does the OCD want me to do/not do?” and then work hard to do the opposite. So if the person is concerned about being late, but in reality never is, the therapy would be that when they find themselves obsessing about what time it is and how much time they have left, that they do NOT check their watch, continue at their regular pace, label their fear an OCD fear, and challenge the OCD by purposely thinking “I am very, very late, and the consequences will be desasterous!!!”- Yes, exactly opposite of the kind of thing one would normally tell oneself to calm down! Dr. Weg
KelleyT says:
March 2, 2012 at 5:40 pmCan OCD and anxiety create thoughts in a teenage girls brain of starving themself?
Dr. Weg says:
August 29, 2018 at 3:03 pmRegarding the question of OCD and starvation in teenage girls: There are many ways OCD can interfere with eating behaviors, even to the point of starvation. However, when a teenage girl (and sometimes boy) presents with self-starvation, it is more typically a case of anorexia nervosa, and an expert should be consulted immediatley to have her assessed. Dr. Weg