Obsessive compulsive disorder or OCD, is an anxiety disorder that traps children in cycles of repetitive thoughts (obsessions) and behaviors (compulsions).
These obsessions are not your ordinary worries. They consume your child’s daily schedule and can cause distress.
Compulsions are rituals children do to get rid of the obsessions. For example, a young child may have thoughts that someone will break into his house and be consumed with rituals of checking the doors, whereas an older child may fear that he will be contaminated with germs and constantly wash his hands.
OCD may vary with age and usually has a genetic component to it. If parents have OCD, they are more likely to pass it on to their child. Also, stress can worsen the symptoms of OCD. The more stressed children are with school or if a traumatic event happened, the more likely their obsessions will increase.
I once had a child (age 10) who had the obsessive thought that something bad would happen to himself and his family. He feared and kept obsessing that someone would break into his house and kidnap him and kill his family while they were sleeping.
The child lived on the second floor and his parents had a home security system in place. The child would have the compulsion to constantly check the door and windows to make sure they were locked and lost many hours of sleep obsessing that someone would find a way to break into his house.
Techniques to Try
As I worked with the child and his parents, I used the following techniques to help ease his OCD symptoms:
1. Explain what OCD is: It is important to explain to the child what OCD is and how it grows. You can tell the child that OCD is anxiety or worry that grows just like any fruit or vegetable. They grow because you pay attention to the fruit or vegetable. You plant a seed, you water it and a green shoot appears. If you keep watering it the shoot will turn into a stalk and many fruits or vegetables will appear. Many children pay attention to their obsessions and eventually their obsessions and compulsions will grow just like the small seed.
2. Tell the child to put their worries into words: Tell the child to think about what is really true as opposed to what they are afraid might happen. Reminding the child that if a bad thing happens they can get through it or they can make a plan to help them feel calmer and less worried. For example, the child may be afraid of someone breaking into his house. You can help by asking the child to challenge his thoughts. For example, you can ask the child: “What makes you think that someone will break into the house?” Did someone break into the house last night or the night before? they think that the alarm will not go off? You can also have him test the alarm so he can see and hear that it works and that if someone breaks into the house, the alarm will go off.
3. Create a Worry Time: It is a good idea to spend less time on obsessions. If you do not spend time on them, they will eventually go away. Create a Worry Time with the child. During this time, you will sit with the child for about 15-20 minutes talking about whatever he or she is worried or obsessing about. This time should not be interrupted; instead it is a time where you will offer help and just listen. You can tell the child that if he has a worry to lock it up in their imaginary worry box, walk away and get distracted with something else. The worry that he’s locked up will only be opened during worry time. If he distracts himself, the worry will lessen. The point for a worry box is to help children learn not to pay attention to their worries all the time because the worries will grow. By the time they reach “Worry Time,” their worries won’t be big problems anymore.
4. Talk Back (to obsessions) and expose (the compulsions): Teach the child to talk back to their obsessions and then to distract themselves by playing. Tell the child that if the obsession continues to talk to him, to do something else and not pay attention to the obsession. Expose the child to some relaxation techniques (listed below) so they can have a toolbox of skills ready. If the child is obsessing over germs and constantly cleans his hands, gradually expose the child to situations without having him wash his hands. For example, have the child touch a doorknob without cleaning his hands. The more times he does this act, the less compelled he will feel to wash his hands and the obsessions will also subside. Continue to gradually expose him to situations that he obsesses over. Cognitive behavior therapy is usually the best form of treatment, however some severe cases of OCD may also require medication.
5. Teach him to challenge the obsessions by talking back and looking for the reality behind the obsessions. Tell him to imagine that the obsessions are like bullies. The child can tell the obsession bully “Leave me alone,” “Go away,” “You are not real,” “You are bugging me,” “I’m not going to listen to you,” or “I don’t believe you.”
6. Relaxation: Teach the child relaxation techniques. Have the child get involved with an activity that is fun, teach him to breathe slowly in through the nose and out through the mouth and try some progressive relaxation techniques. Of course, you need to make the techniques child appropriate. Also, you can him them to use visualization or to think of a memory that he likes and that makes him feel good. I like using this visualization: Imagine that you are a baseball player and every ball that is thrown represents a worry. Each worry that is pitched to you, you hit the ball out of the ballpark.
These are some of the techniques I used with this particular client, however all children and situations are different. It is important for parents to also seek help from a professional who will implement the best form of treatment to a child with OCD.