0:00:10.949,0:00:13.069 So, I was hoping that you could tell 0:00:13.079,0:00:17.030 me and tell other parents what obsessive compulsive disorder 0:00:17.739,0:00:20.180 looks like in children and adolescents. 0:00:20.940,0:00:21.860 So, 0:00:21.979,0:00:26.420 obsessive compulsive disorder in children and adolescents, not surprisingly, 0:00:26.430,0:00:30.750 is characterized by obsessions or intrusive thoughts 0:00:30.760,0:00:33.409 or images or feelings that are unwanted. 0:00:33.580,0:00:35.599 So, children may have 0:00:36.169,0:00:38.549 like worries or fears or 0:00:38.560,0:00:40.979 thoughts that just pop into their head for no reason 0:00:40.990,0:00:42.229 that are very upsetting to them. 0:00:42.240,0:00:43.990 So, things like they're afraid of germs or 0:00:44.000,0:00:46.709 something bad happening to somebody or that they're gonna 0:00:47.319,0:00:50.720 do poorly in school or that or that something they left 0:00:50.729,0:00:53.540 the door unlocked and a burglar might come. 0:00:53.880,0:00:55.669 And compulsions 0:00:56.000,0:00:59.459 which are the behaviors that are designed to make these bad feelings go away. 0:00:59.470,0:01:02.659 So, a child that worries about germs or contamination 0:01:03.069,0:01:06.290 will wash their hands or clean things in order to make 0:01:06.300,0:01:08.660 this worry about germs are getting sick go away. 0:01:08.919,0:01:12.599 A child that's afraid of something bad happening like a robber coming or 0:01:12.610,0:01:16.180 a burglar coming to the house will make sure all the doors are locked 0:01:16.519,0:01:19.779 and that everybody is safe to make this bad concern go away. 0:01:20.730,0:01:23.050 So, some of the things you describe like worries and 0:01:23.059,0:01:25.860 fears sound like things that all kids deal with. 0:01:26.019,0:01:29.680 So, how does a parent know if their child or their adolescent 0:01:29.800,0:01:31.540 has a disorder,o[br]s[br]27[br]00:01:32,059 --> 00:01:35,629[br]the obsessions and the compulsions are a problem in their life? 0:01:36.260,0:01:40.260 So, parents can tell if the obsessions or compulsions are problems 0:01:40.489,0:01:43.230 if they're taken to the extreme. 0:01:43.239,0:01:46.440 So, a child that spends an inordinate amount of time 0:01:46.580,0:01:49.940 worrying about bad things happening or checking the locks 0:01:50.220,0:01:55.440 or washing their hands is a sign that these typical 0:01:55.569,0:01:58.819 kind of fears or normal concerns might be problematic. 0:01:59.080,0:02:03.019 A common symptom is children that feel they need 0:02:03.029,0:02:06.580 to rewrite, erase and rewrite their school work or their school papers 0:02:06.680,0:02:09.710 so that everything is perfect. There can't be any crooked letters 0:02:09.850,0:02:11.720 or any crooked words, and they may spend two or 0:02:11.729,0:02:14.750 three hours on one paragraph or one paper 0:02:15.130,0:02:17.570 erasing and rewriting over and over again to 0:02:17.580,0:02:19.789 the point where the paper is all messy or ripped 0:02:20.000,0:02:22.779 because they might be afraid that if there's something that's not exactly 0:02:22.789,0:02:25.300 perfect with this paper that they're gonna get a bad grade, 0:02:25.309,0:02:26.699 that they're going to flunk. 0:02:26.949,0:02:30.169 Other children with OCD that have contamination fears 0:02:30.179,0:02:32.300 or cleaning rituals or cleaning compulsions 0:02:32.419,0:02:36.419 may spend two hours in the shower—one or two or three hours in the shower. 0:02:36.550,0:02:40.199 They may spend 30 or 40 minutes brushing their teeth or brushing their hair 0:02:40.419,0:02:42.610 to make sure that everything is exactly right. 0:02:42.619,0:02:46.729 Or they may spend hours cleaning their rooms or arranging their rooms 0:02:46.740,0:02:49.970 because they need to have everything just arranged in a certain way. 0:02:50.649,0:02:50.919 So, 0:02:50.929,0:02:53.360 it sounds like, and correct me if I'm wrong, that 0:02:53.369,0:02:56.639 it's not just kids who are doing things frequently, 0:02:56.839,0:03:02.940 but children and adolescents who are really doing these behaviors to an extreme. 0:03:02.949,0:03:06.160 So, it's taking up a large part of their day, impacting their life, 0:03:06.259,0:03:07.610 their family, schooling. 0:03:07.619,0:03:08.419 Is that correct? 0:03:08.529,0:03:13.410 Yes. So, OCD really does. It either can take up a large proportion of time, 0:03:13.649,0:03:15.960 or it's something that's really gonna be interfering. 0:03:16.100,0:03:19.619 You can also have some OCD symptoms that may not take up a lot of time, 0:03:19.630,0:03:21.880 but still can be very upsetting or interfering. 0:03:22.279,0:03:25.759 So, some children with OCD have intrusive images. 0:03:25.770,0:03:28.360 They get pictures or thoughts in their head that are really scary, 0:03:28.369,0:03:32.089 like maybe doing something bad or hurting somebody or hurting themselves. 0:03:32.360,0:03:35.490 And these are thoughts that are unwanted. They don't want to do these things. 0:03:35.500,0:03:38.059 They have no intention of hurting themselves or somebody else. 0:03:38.250,0:03:41.380 But these thoughts keep coming into their head and making them very upset. 0:03:41.479,0:03:43.500 And even though the thoughts can be very brief, 0:03:43.669,0:03:46.339 they still can cause a lot of problems for the child. 0:03:46.789,0:03:49.750 So, if a family is seeing their child or their adolescent 0:03:49.990,0:03:53.000 have obsessions, have compulsions, 0:03:53.440,0:03:56.289 and they're affecting their life in a significant way, 0:03:56.860,0:04:01.089 what should they do? Whom should they speak with about their concerns? 0:04:01.410,0:04:04.929 Well, the important thing is to find 0:04:04.940,0:04:07.470 a therapist or a mental health professional 0:04:07.589,0:04:09.649 that has experience working with children and 0:04:09.660,0:04:12.199 has experience working with obsessive compulsive disorder. 0:04:12.210,0:04:13.600 This would typically be a 0:04:13.729,0:04:15.830 clinical child and adolescent psychologist 0:04:16.170,0:04:18.709 or a child and adolescent psychiatrist 0:04:19.019,0:04:22.108 or another professional that has experience in this area. 0:04:22.920,0:04:24.470 What information about 0:04:25.160,0:04:30.250 treating OCD or obsessive compulsive disorder should parents be aware of? 0:04:30.869,0:04:33.989 Well, the important thing is that there are 0:04:34.100,0:04:39.059 two treatment approaches for OCD that have been been studied and 0:04:39.070,0:04:42.940 researched very carefully and been shown to have some benefit for children, 0:04:42.950,0:04:44.260 adolescent with OCD. 0:04:44.510,0:04:48.070 The first is exposure-based cognitive behavior therapy 0:04:48.260,0:04:50.820 and the second is a specific class of medications 0:04:50.829,0:04:55.220 called the selective serotonin reuptake inhibitors or SSRIs. 0:04:55.959,0:04:57.790 Cognitive behavior therapy 0:04:57.959,0:05:02.010 is really considered the first line treatment approach. 0:05:02.019,0:05:07.119 So, the recommendation is that that in almost all cases, children with OCD 0:05:07.130,0:05:10.540 should try cognitive behavior therapy first because 0:05:10.549,0:05:12.750 it has no side effects, 0:05:13.029,0:05:15.899 and it's really been shown to have very positive effects 0:05:15.910,0:05:18.570 in many cases on children with OCD. 0:05:18.709,0:05:20.540 And importantly, also is that 0:05:20.779,0:05:23.450 once the child has been able to benefit from cognitive 0:05:23.459,0:05:26.640 behavior therapy or completed treatment with cognitive behavior therapy, 0:05:26.730,0:05:28.109 the gains tend to last. 0:05:28.119,0:05:28.869 So, 0:05:29.850,0:05:33.239 in most cases, cognitive behavior therapy would be the 0:05:33.500,0:05:35.570 preferred treatment to start with 0:05:35.869,0:05:37.260 for a number of reasons. 0:05:37.269,0:05:41.690 The first is that cognitive behavior therapy has been shown to be effective 0:05:41.700,0:05:45.649 in a large proportion of cases, probably more so than medication. 0:05:46.059,0:05:49.850 And the symptom reduction or the benefits of cognitive behavior therapy again, 0:05:49.859,0:05:53.230 have been shown to probably be better than that for medication 0:05:53.239,0:05:55.339 to some degree. The CBT, 0:05:55.619,0:05:58.679 that's short for cognitive behavior therapy, 0:05:58.929,0:06:01.869 may tend to lead to slightly better outcomes. 0:06:02.000,0:06:05.989 Also, with CBT, once treatment is finished, 0:06:06.130,0:06:09.299 the kids, children tend to maintain their gains for 0:06:09.309,0:06:12.470 somewhat longer than with medication, oftentimes with medication, 0:06:12.790,0:06:15.230 which can be associated with side effects. 0:06:15.459,0:06:19.049 Once the medication is stopped, the symptoms may come back. 0:06:20.040,0:06:23.010 So, you make reference to cognitive behavioral therapy. 0:06:23.019,0:06:26.089 How would a parent know if the treatment that 0:06:26.100,0:06:28.880 they're getting or if the therapist that they're seeing 0:06:29.540,0:06:31.839 used this cognitive behavioral therapy? 0:06:32.279,0:06:34.320 Well, the important consideration that the 0:06:36.500,0:06:39.559 most active ingredient of cognitive behavior therapy 0:06:39.570,0:06:42.329 is something called exposure plus response prevention. 0:06:42.769,0:06:46.209 So, there are many different forms of cognitive behavior therapy, and 0:06:46.220,0:06:48.290 and there are many forms of cognitive behavior therapy that 0:06:48.299,0:06:52.010 are used for children with obsessive compulsive disorder. 0:06:52.380,0:06:53.440 But only 0:06:53.679,0:06:55.630 cognitive behavior therapy that's 0:06:55.640,0:06:58.890 based on exposure plus response prevention 0:06:59.140,0:07:02.320 has been shown to be effective for OCD. So, parents, 0:07:02.700,0:07:04.880 when interviewing a therapist or trying to 0:07:04.890,0:07:07.799 find a therapist or talking to a therapist about 0:07:07.980,0:07:08.920 whether or not 0:07:09.320,0:07:11.799 that treatment is helpful to the child should really 0:07:11.809,0:07:15.380 ask if the therapist does exposure plus response prevention. 0:07:15.529,0:07:18.059 Ok. Could you give me an example of what 0:07:18.470,0:07:21.279 exposure plus response prevention 0:07:21.559,0:07:23.200 is, or what it looks like? 0:07:23.989,0:07:26.320 Well, first, let me tell you 0:07:27.220,0:07:30.410 the rationale underlying exposure plus response prevention. 0:07:30.750,0:07:34.019 In OCD when children experience unwanted thoughts 0:07:34.029,0:07:36.769 or images like the obsessions, 0:07:37.000,0:07:41.220 that can obviously be distressing or upsetting or troubling to them. 0:07:41.579,0:07:45.399 The compulsions or the ritualistic behavior like the hand washing or 0:07:45.410,0:07:49.040 the checking or the repeating or the touching over and over again 0:07:49.529,0:07:53.130 are then done to make the bad feelings or make the obsessions go away. 0:07:53.140,0:07:54.859 And the obvious example is 0:07:54.980,0:07:57.500 a child that's afraid of germs or contamination 0:07:57.690,0:08:02.109 will repeatedly wash their hands to make these germs or contamination go away. 0:08:02.410,0:08:03.700 So, 0:08:04.239,0:08:07.750 when children with obsessions or who are upset by their obsessions 0:08:07.760,0:08:11.029 engage in the rituals or the compulsions like hand washing, 0:08:11.299,0:08:12.549 what that tends to do, 0:08:12.559,0:08:16.970 it tends to reinforce or strengthen the obsessive thoughts. 0:08:17.049,0:08:22.350 So, everytime the child gives into his or her OCD by checking or washing or repeating, 0:08:22.570,0:08:26.179 that tends to make the thoughts stronger and more believable. 0:08:26.399,0:08:26.950 So, 0:08:27.630,0:08:30.410 what exposure plus response prevention does is try 0:08:30.420,0:08:33.549 to break the connection between the obsessive thoughts 0:08:33.960,0:08:36.010 and the rituals or the compulsions. 0:08:36.260,0:08:39.659 And by demonstrating to children that just because they have an obsessive 0:08:39.669,0:08:42.390 thought doesn't need to mean they need to do their ritual. 0:08:42.659,0:08:44.270 So, for example, in treatment, 0:08:44.280,0:08:46.669 the first thing that we would do is make 0:08:46.679,0:08:49.669 a list of all the child's obsessive compulsive symptoms. 0:08:49.900,0:08:53.710 And then starting with the mildest symptom or the smallest symptom, 0:08:53.950,0:08:56.369 we would trigger the child's symptom. 0:08:56.380,0:08:56.950 For example, 0:08:56.960,0:09:01.260 maybe by putting something contaminated on the child's hand to get him or her 0:09:01.619,0:09:04.000 to become more anxious feeling. 0:09:04.299,0:09:06.640 And at that point, the child would want to do their ritual, 0:09:06.650,0:09:09.400 would want to wash their hands to make the bad feeling go away. 0:09:09.900,0:09:10.799 But in treatment, 0:09:10.809,0:09:13.080 we would work with the child or encourage the child to 0:09:13.090,0:09:16.039 not wash their hands and instead wait and see what happens. 0:09:16.049,0:09:19.840 And what happens is that the bad feelings or the anxiety goes away by itself. 0:09:20.229,0:09:23.909 And by repeatedly doing this, doing the exposure or 0:09:24.239,0:09:28.739 making the child want to do a ritual, but then having them not do the ritual, 0:09:28.880,0:09:30.880 they learn that their anxiety will go away without 0:09:30.890,0:09:33.289 having to do the rituals, and that relationship 0:09:33.299,0:09:36.539 the connection between the obsession and the and the ritual is broken. 0:09:37.159,0:09:38.299 And over repeated 0:09:38.549,0:09:39.140 trials 0:09:39.400,0:09:41.320 of doing the exposure 0:09:41.330,0:09:43.500 plus response prevention, the child learns that the 0:09:43.510,0:09:46.780 thoughts they have the scary thoughts or feelings that they have 0:09:46.789,0:09:50.580 about bad things happening or about germs or contamination 0:09:50.799,0:09:52.260 or other kinds of things 0:09:52.570,0:09:55.179 really aren't that bad and that they'll go away 0:09:55.190,0:09:57.229 on their own without having to do the rituals. 0:09:57.820,0:09:59.080 So, it sounds like 0:09:59.429,0:10:02.729 exposure and response prevention is 0:10:03.150,0:10:05.309 when a child practices 0:10:05.520,0:10:06.789 in a graduated way. 0:10:06.799,0:10:08.609 So, what they're fearful of, 0:10:08.619,0:10:10.650 you don't make them do first, but they build up 0:10:10.659,0:10:13.369 to it by practicing different strategies along the way. 0:10:13.380,0:10:15.010 Do I understand that correct? Yes. Correct. 0:10:15.020,0:10:18.090 The treatment is done in a way that's very sensitive for children. 0:10:18.099,0:10:20.500 So, we always have the children start with a very kind of 0:10:20.510,0:10:24.270 an easy or very mild symptom that's easy for them to resist. 0:10:24.559,0:10:25.650 We don't have them 0:10:25.929,0:10:26.510 work 0:10:26.809,0:10:29.299 on their most difficult or most anxiety 0:10:29.309,0:10:31.780 provoking symptoms until well on into treatment. 0:10:32.429,0:10:33.309 In addition, 0:10:33.520,0:10:35.429 there's a lot of work that we do with the child in 0:10:35.440,0:10:38.559 the family before we even start working on the specific symptoms. 0:10:38.570,0:10:42.479 So, there's a lot of education about anxiety and about OCD so 0:10:42.489,0:10:45.820 that they can learn more about what's causing their problem and 0:10:45.830,0:10:47.780 why they have the symptoms that they have. 0:10:47.950,0:10:53.070 We talk a lot about methods for reducing anxiety and for helping make them stronger 0:10:53.520,0:10:57.520 in terms of their ability to handle their OCD or deal with their OCD. 0:10:57.789,0:10:58.400 In treatment, 0:10:58.409,0:11:00.419 we also work very closely with parents to 0:11:00.429,0:11:03.320 give parents the appropriate tools to help them 0:11:03.429,0:11:06.979 assist their children and help support their children in treatment 0:11:07.219,0:11:09.919 and to set up situations at home that are also going to 0:11:09.929,0:11:13.530 help the children learn how to master or overcome their OCD. 0:11:13.700,0:11:14.280 So, 0:11:14.590,0:11:18.479 parents might be part of the treatment and help their children to practice, 0:11:18.489,0:11:19.799 but they should still be 0:11:20.099,0:11:22.919 doing that in concert with a mental health professional? 0:11:23.049,0:11:26.760 Yeah, it's important that parents work with a mental health professional 0:11:27.020,0:11:29.219 to best learn how to manage or 0:11:29.229,0:11:32.440 interact with their child around his or her OCD symptoms. 0:11:32.650,0:11:36.469 What commonly happens with children with OCD is that 0:11:36.479,0:11:38.330 they will gradually involve their parents or 0:11:38.340,0:11:40.159 other family members and their symptoms. 0:11:40.169,0:11:44.559 For example, making their mother or father wash things for them 0:11:44.849,0:11:48.710 or having them avoid certain kinds of food or things at home 0:11:48.809,0:11:52.200 if the child is afraid that those might be contaminated or covered with germs. 0:11:52.530,0:11:54.549 They may ask parents to check, for example, 0:11:54.559,0:11:57.450 the doors or check the locks or check the stove 0:11:57.460,0:11:59.940 if they're afraid of a burglar or a fire. 0:12:00.239,0:12:03.789 And it really over time can really involve parents and even brothers and 0:12:03.799,0:12:06.750 sisters in ways that can be very difficult for the family to manage. 0:12:07.309,0:12:10.559 So, one of the goals of treatment is to teach parents 0:12:10.739,0:12:13.099 and brothers and sisters and other family members or 0:12:13.109,0:12:15.859 other important people in the child's life how 0:12:15.869,0:12:18.419 to disengage from the child's symptoms, to not 0:12:18.429,0:12:20.549 be so involved in the child's symptoms, 0:12:20.659,0:12:23.309 which will allow the child then to get better with treatment 0:12:23.320,0:12:25.989 and lead to kind of normal family functioning again. 0:12:26.349,0:12:29.169 But this can be a little bit tricky. So, it really should be done 0:12:29.419,0:12:31.309 working closely with the mental health 0:12:31.320,0:12:33.530 professional that is experienced in this area. 0:12:34.770,0:12:35.479 So, 0:12:35.669,0:12:38.440 parents should look for a cognitive behavioral 0:12:38.450,0:12:42.400 therapist who uses exposure and response prevention. 0:12:42.549,0:12:48.599 That sounds to be a very important thing that parents should seek. Are there other 0:12:48.869,0:12:53.260 aspects or things that parents should ask about when looking 0:12:53.270,0:12:56.280 for a therapist for their child for treating OCD? 0:12:56.700,0:12:56.820 Yeah, 0:12:56.830,0:12:58.400 it's very important that parents are 0:12:58.409,0:13:00.979 very careful and very knowledgeable when they're 0:13:01.340,0:13:03.429 looking for a therapist 0:13:03.570,0:13:05.570 to work with their child's OCD. 0:13:05.840,0:13:09.979 The therapist again, must have experience with OCD. 0:13:10.530,0:13:15.390 The therapist must do exposure plus response prevention for the OCD. 0:13:15.789,0:13:17.840 And the child must really be 0:13:17.849,0:13:20.099 knowledgeable in working with children and adolescents. 0:13:20.109,0:13:21.989 These are all important factors. 0:13:22.299,0:13:22.840 So, 0:13:23.760,0:13:27.099 are there other takeaway messages that you would want to give 0:13:27.109,0:13:30.539 to a parent whose child or adolescent has 0:13:30.900,0:13:31.500 OCD 0:13:31.830,0:13:34.700 in terms of what they should be doing as a parent? 0:13:35.280,0:13:37.859 There are a number of things that parents should think about 0:13:37.869,0:13:40.820 when their child has OCD. 0:13:41.039,0:13:43.880 One of the big misconceptions that we run into is that parents 0:13:43.890,0:13:47.659 sometimes think that the children are doing the behaviors on purpose. 0:13:48.039,0:13:50.429 When in reality, in most cases, 0:13:50.440,0:13:54.140 children with OCD are unable to control their symptoms. The anxiety 0:13:54.479,0:13:57.390 is just too strong, and when the child says 0:13:57.400,0:13:59.969 that they need to wash their hands or to check 0:14:00.159,0:14:01.739 or to repeat certain things, 0:14:01.789,0:14:05.130 it really is something that oftentimes is beyond their control. 0:14:05.210,0:14:07.659 So, before parents try to do something to 0:14:07.669,0:14:09.700 stop their children from doing these behaviors, 0:14:09.710,0:14:12.799 they really should talk to a qualified mental health professional. 0:14:13.349,0:14:18.919 Can you tell me how many children and adolescents have OCD or your best guess? 0:14:19.789,0:14:21.419 OCD is pretty common in children and 0:14:21.429,0:14:24.340 adolescents. Anywhere from about 1 to 3% of children 0:14:24.599,0:14:28.150 and adolescents in this country have obsessive compulsive disorder. 0:14:28.450,0:14:31.469 So, if you think about that, if you think of, say a child 0:14:31.479,0:14:34.320 that goes to a school with 1000 children, 0:14:34.330,0:14:38.059 maybe a medium size middle school or small high school, 0:14:38.320,0:14:42.219 there are probably anywhere from 10 to 20 children at that school that have OCD. 0:14:42.229,0:14:43.739 So, it's actually quite common, 0:14:43.880,0:14:46.500 and in milder forms, it may even be more common than that. 0:14:47.770,0:14:50.599 So, how come we don't hear about OCD a lot? 0:14:51.419,0:14:54.390 OCD has oftentimes been called the Secret Disease or 0:14:54.400,0:14:57.570 the Hidden Disease because the symptoms can be quite embarrassing. 0:14:57.750,0:15:00.770 Sometimes they do involve kind of bizarre fears or 0:15:00.780,0:15:04.289 worries that children might not want other people to know about. 0:15:04.539,0:15:05.969 So, in a lot of cases, 0:15:05.979,0:15:09.440 children or adolescents are able to hide their symptoms from friends 0:15:09.450,0:15:12.229 or from classmates or from relatives, and in some cases, 0:15:12.239,0:15:13.520 even from parents. 0:15:13.960,0:15:19.260 So, we don't tend to hear about OCD as often as other disorders, say ADHD 0:15:19.270,0:15:22.299 or some other things that get more attention. 0:15:22.549,0:15:23.780 What should parents look 0:15:24.200,0:15:24.619 for? 0:15:25.469,0:15:25.650 If 0:15:26.059,0:15:27.169 your 0:15:27.179,0:15:30.489 parent thinks, suspects that their child might have a problem with OCD, 0:15:30.500,0:15:32.289 there are a number of things to look for. 0:15:32.400,0:15:34.950 One would be avoiding situations that 0:15:34.960,0:15:36.419 the children may have used to like, 0:15:36.429,0:15:39.919 like not wanting to go to school or avoiding social situations, 0:15:40.190,0:15:42.280 maybe avoiding being away from home. 0:15:42.340,0:15:45.349 Sometimes this occurs because the children are afraid that they're gonna do 0:15:45.359,0:15:47.830 their rituals or their compulsions in public settings. 0:15:48.369,0:15:53.359 Children with OCD, oftentimes, if it's related to perfectionism 0:15:53.369,0:15:54.890 or writing or school work 0:15:55.049,0:15:59.390 may all of a sudden take much longer to do their school work. So, an assignment that may 0:15:59.570,0:16:01.830 take on average 30 minutes to complete, 0:16:02.159,0:16:06.710 may all of a sudden take like an hour or 90 minutes or two hours for a child with OCD. 0:16:07.039,0:16:11.500 Children that tend to erase and rewrite over and over again, 0:16:11.510,0:16:13.299 try to get things perfect 0:16:13.520,0:16:17.580 or really get upset when things aren't exactly right or exactly perfect, 0:16:17.820,0:16:19.750 that may also be a sign of OCD. 0:16:19.880,0:16:23.140 Finally, children that are spend excessive time, 0:16:23.409,0:16:24.719 say washing 0:16:24.909,0:16:29.140 or showering or bathing or engage in other activities, 0:16:29.229,0:16:32.239 that also may be a sign that the child has OCD. 0:16:33.119,0:16:34.979 Do we know what causes OCD? 0:16:35.729,0:16:39.340 OCD is a biological disorder. It's genetic. 0:16:39.349,0:16:41.200 So, it tends to run in families. 0:16:41.729,0:16:45.869 But there's also some kinds of environmental factors associated with OCD. 0:16:45.880,0:16:48.280 So, if a child is stressed 0:16:48.619,0:16:52.469 or tired or sick, that may make the symptoms worse. 0:16:52.729,0:16:53.979 Reactions.... 0:16:53.989,0:16:57.840 If the child is in a situation where others might be reacting to the OCD 0:16:58.219,0:16:59.380 or 0:16:59.710,0:17:02.919 putting pressure on the child, that may also make OCD worse. 0:17:03.669,0:17:07.170 And although some people might say because OCD is a biological disorder, 0:17:07.180,0:17:08.880 shouldn't you treat it with medication? 0:17:09.020,0:17:10.209 That's not the case. 0:17:10.520,0:17:13.229 In fact, the cognitive behavior therapy is 0:17:13.239,0:17:16.729 the most effective treatment that we have for OCD right now. 0:17:17.689,0:17:19.150 So, would you say that 0:17:19.358,0:17:21.989 for children and adolescents who have OCD, 0:17:22.209,0:17:24.050 there's a fair amount of hope that with 0:17:24.060,0:17:26.608 CBT treatment or cognitive behavioral treatment, 0:17:26.618,0:17:27.650 things will get better? 0:17:28.199,0:17:31.660 Yeah, there is a fair amount of hope associated with treatment. 0:17:31.670,0:17:33.290 Cognitive behavior therapy, 0:17:33.300,0:17:34.680 CBT, 0:17:34.949,0:17:37.540 has been shown to be effective in a number of cases. 0:17:37.550,0:17:39.030 Not everybody benefits from it. 0:17:39.040,0:17:41.099 Not every child is able to do it. 0:17:41.109,0:17:43.189 There may be certain situations or factors 0:17:43.439,0:17:47.699 such as coexisting problems that might make it difficult for 0:17:47.709,0:17:51.050 the child to engage in cognitive behavior therapy as the first treatment. 0:17:51.359,0:17:54.650 Or in some situations, the CBT may be so severe 0:17:54.760,0:17:56.939 that the child is unable to engage in the treatment. 0:17:57.150,0:17:58.420 And in these cases, 0:17:58.430,0:18:02.310 other families might want to consider medication and talk to either 0:18:02.319,0:18:04.060 a qualified mental health professional about 0:18:04.069,0:18:06.060 medication or a referral for medication. 0:18:06.560,0:18:09.640 But between these two treatments, 0:18:09.790,0:18:12.060 there's a good chance that most children will be able to 0:18:12.069,0:18:17.400 experience significant benefit and be able to live normal lives. 0:18:17.680,0:18:20.609 Can you tell me a little bit about 0:18:21.079,0:18:23.630 what OCD looks like in the long term, or what 0:18:23.640,0:18:27.380 parents should expect for their children or adolescents who have OCD 0:18:27.660,0:18:29.239 in a longer term sense? 0:18:29.790,0:18:35.209 So, OCD is considered a chronic disorder, which means it tends not to go away by itself. 0:18:35.219,0:18:38.569 It typically starts around age in childhood. 0:18:38.880,0:18:41.170 So, maybe around the ages of 7 to 11. 0:18:42.020,0:18:42.880 And 0:18:43.670,0:18:44.150 it 0:18:44.589,0:18:48.319 in some cases will have a sudden onset. So, it'll just kind of come, 0:18:48.329,0:18:49.530 seems like almost out of the blue. 0:18:49.540,0:18:52.459 In other cases, it tends to have more of a gradual onset. So, the symptoms 0:18:52.609,0:18:57.010 tend to get worse over time and kind of a slower format. 0:18:57.479,0:19:00.729 But without treatment, in most cases for children, 0:19:00.739,0:19:03.790 most kids will just continue to experience the symptoms 0:19:03.959,0:19:07.800 overtime into adolescence and even adulthood. 0:19:08.020,0:19:08.589 In fact, 0:19:08.599,0:19:11.520 most adults with OCD had an initial 0:19:11.530,0:19:14.689 onset of their symptoms during childhood or 0:19:15.140,0:19:15.579 adolescence. 0:19:15.699,0:19:18.119 But the good news is that effective treatment can really 0:19:18.130,0:19:21.260 have a positive impact on children's long-term functioning. 0:19:21.270,0:19:22.239 So, if they're able to 0:19:22.449,0:19:25.199 benefit from cognitive behavior therapy or 0:19:25.209,0:19:27.859 even perhaps medication in addition to the therapy, 0:19:28.140,0:19:30.089 the chances are that they may have a 0:19:30.099,0:19:33.540 very good long term prognosis in the sense that they can go on and to lead, 0:19:33.739,0:19:35.180 you know, normal healthy lives. 0:19:35.319,0:19:37.550 And it sounds like, correct me if I'm wrong, 0:19:37.780,0:19:41.000 a lot of kids or adolescents will learn skills 0:19:41.010,0:19:44.199 for managing their symptoms that they can draw upon 0:19:44.859,0:19:45.880 as they age. 0:19:46.609,0:19:46.800 Yeah. 0:19:46.810,0:19:50.380 One of the benefits of cognitive behavior therapy is that children learn skills; 0:19:50.390,0:19:54.839 they learn strategies for coping with their OCD, for challenging their OCD. 0:19:55.229,0:19:59.280 And just for general problem solving and coping, 0:19:59.349,0:20:01.420 which in the long term can really be beneficial. 0:20:01.430,0:20:03.359 A lot of children that receive treatment 0:20:03.449,0:20:05.150 actually can serve to strengthen them in many 0:20:05.160,0:20:07.079 ways by increasing their confidence and their 0:20:07.089,0:20:09.680 ability to deal with other difficult situations. 0:20:10.630,0:20:16.290 One thing I know about other mental health disorders is that sometimes one mental 0:20:16.300,0:20:20.000 health disorder will co-occur at the same time with another mental health disorder. 0:20:20.010,0:20:24.969 And so kids are dealing with multiple concerns at the same time. 0:20:24.979,0:20:28.665 Does that happen with OCD? Do we see that co-occur with other disorders? 0:20:28.915,0:20:29.244 Yeah. 0:20:29.415,0:20:31.765 OCD quite commonly 0:20:31.935,0:20:33.444 cours with other disorders. 0:20:33.454,0:20:35.385 The most common other disorders are another kind 0:20:35.395,0:20:39.285 of an anxiety disorder such as generalized anxiety 0:20:39.454,0:20:42.685 or social anxiety fears or separation fears. 0:20:42.734,0:20:48.165 We also see it occur quite commonly with Tourette's or Tick Disorders and ADHD. 0:20:48.680,0:20:53.140 In adolescence or in older children or adolescents or adults, 0:20:53.290,0:20:55.469 co-incurring depression is also quite common. 0:20:55.479,0:20:58.680 In fact, most children with OCD or the majority of children 0:20:58.869,0:21:00.160 with OCD 0:21:00.390,0:21:04.449 will present for treatment or come into clinics with one other disorder 0:21:04.459,0:21:07.750 and some kids will even come in with two or more other disorders. 0:21:07.770,0:21:08.270 Ok. 0:21:08.810,0:21:12.630 So, for some parents, it sounds like they report that 0:21:12.920,0:21:17.000 they've noticed this in their children for a long period of time, 0:21:17.280,0:21:20.420 and it might get worse as they get older or stress might make it 0:21:20.739,0:21:22.339 more noticeable. 0:21:22.589,0:21:23.819 For other parents, 0:21:23.829,0:21:27.459 they might just suddenly notice that their child is experiencing 0:21:27.469,0:21:31.500 problems with obsessions or compulsions or it's impacting their life. 0:21:31.510,0:21:31.819 So, 0:21:31.829,0:21:35.500 if a parent is first noticing these problems are really coming to the 0:21:35.510,0:21:40.260 realization that it might be impacting their child or their adolescent life. 0:21:40.270,0:21:41.739 What's the first step for them? 0:21:42.469,0:21:43.329 Well, the first step, 0:21:43.339,0:21:48.489 if you suspect that your child may have OCD or another problem is to not panic 0:21:48.780,0:21:49.810 and not overreact, 0:21:49.819,0:21:53.199 especially not in front of the child because that can be very upsetting to the child. 0:21:53.510,0:21:57.890 But if a parent sees something that doesn't seem right or a change in the 0:21:57.900,0:21:58.160 child, 0:21:58.750,0:22:00.930 I think it would be important for the parent just 0:22:00.939,0:22:03.109 to talk to the child about it. Again, 0:22:03.119,0:22:05.310 not in an alarmist fashion, but maybe, you know, 0:22:05.329,0:22:07.530 I've just noticed that you seem to worry about 0:22:07.810,0:22:11.329 this or that a little bit more than you used to. Do you want to talk about it? 0:22:11.339,0:22:12.880 Can you tell me what's going on? 0:22:13.069,0:22:15.140 And try to get some information from the child. 0:22:15.150,0:22:15.650 Now, 0:22:15.660,0:22:18.614 commonly children and may not want to talk about it or may not want to 0:22:18.625,0:22:20.535 say anything either because they're embarrassed or 0:22:20.545,0:22:22.275 they don't want to upset their parents. 0:22:22.285,0:22:27.295 But if the parent continues to feel that there's something that concerns them, 0:22:27.444,0:22:29.234 it would be important to contact 0:22:29.244,0:22:31.234 again, a qualified mental health professional, 0:22:31.244,0:22:34.074 somebody that is an experienced child and 0:22:34.719,0:22:34.750 adolescent 0:22:34.760,0:22:37.699 psychologist or psychiatrist or social worker that has 0:22:37.709,0:22:39.660 experience working with OCD or 0:22:39.670,0:22:41.020 other kinds of disorders. 0:22:41.189,0:22:45.979 Do kids go through phases where they'll have obsessions or compulsions? 0:22:46.270,0:22:47.079 Meaning, 0:22:47.640,0:22:49.420 when a parent first notices it, 0:22:49.430,0:22:52.199 is that the time to contact a mental health 0:22:52.209,0:22:55.060 professional or should parents wait to see the course? 0:22:55.390,0:23:00.140 If parents see some different kind of a behavior, odd behavior in their child, 0:23:00.510,0:23:02.109 it probably makes sense to watch it for a 0:23:02.119,0:23:05.010 little bit of time and not overreact too soon. 0:23:05.020,0:23:08.530 I mean, unless the behavior is clearly problematic, 0:23:08.839,0:23:10.170 but in 0:23:10.729,0:23:14.229 if there's something that looks a little bit different and maybe 0:23:14.239,0:23:16.640 the parent isn't sure if it's something that serious or not, 0:23:16.650,0:23:18.550 maybe to watch it for a little while because 0:23:18.560,0:23:21.400 most kids go through different stages of something where they 0:23:21.410,0:23:23.589 may be a little more anxious or a little 0:23:23.599,0:23:28.050 less anxious or a little sad sometimes or have 0:23:28.199,0:23:30.630 more active or whatever that might be. And that kind of 0:23:30.734,0:23:33.194 normal in kids, but just to watch 0:23:33.535,0:23:35.994 and continue to monitor and if things don't get 0:23:36.005,0:23:38.135 better or if things look a little bit worse, 0:23:38.204,0:23:40.665 then it might be time to seek out help. 0:23:40.675,0:23:43.645 The recommendation would be that if a parent sees something 0:23:43.655,0:23:46.844 that looks like it is interfering with the child's life 0:23:47.555,0:23:50.635 in terms of school or friends or family functioning, 0:23:50.979,0:23:55.520 is distressing or disturbing to the child, or is upsetting to them, 0:23:55.530,0:23:57.280 that would be the time to 0:23:57.489,0:24:00.599 seek some kind of professional help. 0:24:00.729,0:24:01.119 Ok. 0:24:01.250,0:24:03.619 Well, thank you for your time and for answering questions. 0:24:03.630,0:24:09.239 I'm sure that many parents will be happy to review this information and 0:24:09.250,0:24:11.160 to share their concerns with the qualified 0:24:11.170,0:24:12.839 mental health professional in their area. 0:24:12.849,0:24:15.099 So, thank you again. Oh, it's my pleasure. Thank you.