Childhood OCD and Family Involvement
Parents with children who have OCD do what good parents do when their child is feeling distressed – they provide comfort and try to ease the anxiety. How many of us parents have left a light on, closed the closet doors, or provided reassurance when our child was feeling afraid of something? I hope all of us have. We love our kids and it’s our job to provide comfort. This gets tricky with OCD though. Providing a sense of safety, comfort, and connection is just as important with them, but the comfort they seek is sometimes in the form of a compulsion.
Compulsions are the actions and rituals a child with OCD does in response to an obsession, which are the fears they get stuck on. Compulsions sometimes seem to help in the short term. The anxiety decreases, and they may get some sense the fear will not materialize. However, with OCD the same fears keep coming back, and sometimes with a vengeance. The urges to engage in compulsions increases because on an emotional level, the child’s brain learned that it worked. It was reinforced by the decrease in anxiety and fear.
It’s normal for family members to get caught up in the compulsions and avoidance when a child has OCD.
Let’s explore some ways parents and family members might get involved.
A child is struggling with having intrusive “bad” thoughts and seeks reassurance over and over again to make sure the thought does not mean they are bad, or that something bad will happen (e.g. perhaps getting sick). The child feels better for the moment, but the fear keeps coming back again and again. A parent may find themselves providing reassurance all day.
A child develops a fear that certain places or items in the house are contaminated and will become cross contaminated by family members who come into contact with those areas or items. The parents and siblings start avoiding those places because they know how distressed the child will be if they are in contact with “contaminated” sources. Sometimes it can seem like most of the house becomes off limits. Or family members experience anxiety wondering if they are going to trigger the OCD by accident.
A child starts to fear certain words due to an obsession that something bad will happen if those words are said. Parents and family members start avoiding these words to prevent the child’s distress. The family now finds themselves “walking on egg shells” when they talk.
A child starts requesting siblings wash their hands frequently due to a fear they have become contaminated. The siblings start doing this to prevent conflict.
The family starts avoiding going places because of certain OCD fears the child has about those places.
These are just some examples. Since the OCD part of the brain is creative, it may look very different on the surface for families.
It’s important to know if you have become involved with your children’s rituals and compulsions and find yourself feeling stuck, it doesn’t mean you have failed. The normal reassurances and accommodations provided to kids without OCD usually works, and kids can go on with their day. Kids with OCD simply don’t respond in the same way when it comes to obsessional fears. A certain part of their brain is responding differently and requires some different parenting techniques when it comes to tending to the fears. They need an approach that is just as loving, kind, relationship building, but more effective than giving into the compulsions. The changes do not happen overnight. It is not an all or none process, where a family suddenly stop giving into all OCD behaviors. It involves educating yourself about OCD, nurturing and transparent communication with your child, and a slow reduction in involvement in compulsions with the child knowing exactly why this is happening. It may be difficult, but the battle is not with the child with OCD, it’s with the OCD itself.
It may be beneficial to seek professional services from someone who has expertise in working with children and families affected by OCD if this is a major challenge.
The therapy used to treat childhood OCD is a type of cognitive behavioral therapy called exposure response prevention. Therapy is usually short term (12-14 sessions), but it can be less or more depending on each case. The response rate is estimated to be up to 80% with children who do respond experiencing up to a 50-60% reduction in symptoms. The therapy doesn’t cure the OCD, but for many it makes it more manageable. It’s the same therapy used with adults, but modifications are made for a child’s developmental level, parental involvement in therapy, and ways to address motivation (kids usually don’t want to be in therapy at first) (Storch, 2019).
You can visit the International OCD Foundation Website for providers in your area. Telehealth can be an effective option too. See https://iocdf.org/find-help/
A book that focuses specifically on reducing accommodations for Childhood OCD and Anxiety that may be helpful is “Breaking Free of Child Anxiety and OCD: A Scientifically Proven Program for Parents” by Eli Lebowitz. I have no affiliation with the author but appreciate the practical strategies provided in the book.
It may be beneficial to find a local support group if this is an option in your area.
Take heart. You are not alone.
Bless you on your journey.
Casey Wagner, MSW, LICSW
Reference
Storch, E. (2019). Cognitive Behavioral Therapy for Pediatric OCD [PowerPointslides].
