1 00:00:10,949 --> 00:00:13,069 So, I was hoping that you could tell 2 00:00:13,079 --> 00:00:17,030 me and tell other parents what obsessive compulsive disorder 3 00:00:17,739 --> 00:00:20,180 looks like in children and adolescents. 4 00:00:20,940 --> 00:00:21,860 So, 5 00:00:21,979 --> 00:00:26,420 obsessive compulsive disorder in children and adolescents, not surprisingly, 6 00:00:26,430 --> 00:00:30,750 is characterized by obsessions or intrusive thoughts 7 00:00:30,760 --> 00:00:33,409 or images or feelings that are unwanted. 8 00:00:33,580 --> 00:00:35,599 So, children may have 9 00:00:36,169 --> 00:00:38,549 like worries or fears or 10 00:00:38,560 --> 00:00:40,979 thoughts that just pop into their head for no reason 11 00:00:40,990 --> 00:00:42,229 that are very upsetting to them. 12 00:00:42,240 --> 00:00:43,990 So, things like they're afraid of germs or 13 00:00:44,000 --> 00:00:46,709 something bad happening to somebody or that they're gonna 14 00:00:47,319 --> 00:00:50,720 do poorly in school or that or that something they left 15 00:00:50,729 --> 00:00:53,540 the door unlocked and a burglar might come. 16 00:00:53,880 --> 00:00:55,669 And compulsions 17 00:00:56,000 --> 00:00:59,459 which are the behaviors that are designed to make these bad feelings go away. 18 00:00:59,470 --> 00:01:02,659 So, a child that worries about germs or contamination 19 00:01:03,069 --> 00:01:06,290 will wash their hands or clean things in order to make 20 00:01:06,300 --> 00:01:08,660 this worry about germs are getting sick go away. 21 00:01:08,919 --> 00:01:12,599 A child that's afraid of something bad happening like a robber coming or 22 00:01:12,610 --> 00:01:16,180 a burglar coming to the house will make sure all the doors are locked 23 00:01:16,519 --> 00:01:19,779 and that everybody is safe to make this bad concern go away. 24 00:01:20,730 --> 00:01:23,050 So, some of the things you describe like worries and 25 00:01:23,059 --> 00:01:25,860 fears sound like things that all kids deal with. 26 00:01:26,019 --> 00:01:29,680 So, how does a parent know if their child or their adolescent 27 00:01:29,800 --> 00:01:31,540 has a disorder,o s 27 00:01:32,059 --> 00:01:35,629 the obsessions and the compulsions are a problem in their life? 28 00:01:36,260 --> 00:01:40,260 So, parents can tell if the obsessions or compulsions are problems 29 00:01:40,489 --> 00:01:43,230 if they're taken to the extreme. 30 00:01:43,239 --> 00:01:46,440 So, a child that spends an inordinate amount of time 31 00:01:46,580 --> 00:01:49,940 worrying about bad things happening or checking the locks 32 00:01:50,220 --> 00:01:55,440 or washing their hands is a sign that these typical 33 00:01:55,569 --> 00:01:58,819 kind of fears or normal concerns might be problematic. 34 00:01:59,080 --> 00:02:03,019 A common symptom is children that feel they need 35 00:02:03,029 --> 00:02:06,580 to rewrite, erase and rewrite their school work or their school papers 36 00:02:06,680 --> 00:02:09,710 so that everything is perfect. There can't be any crooked letters 37 00:02:09,850 --> 00:02:11,720 or any crooked words, and they may spend two or 38 00:02:11,729 --> 00:02:14,750 three hours on one paragraph or one paper 39 00:02:15,130 --> 00:02:17,570 erasing and rewriting over and over again to 40 00:02:17,580 --> 00:02:19,789 the point where the paper is all messy or ripped 41 00:02:20,000 --> 00:02:22,779 because they might be afraid that if there's something that's not exactly 42 00:02:22,789 --> 00:02:25,300 perfect with this paper that they're gonna get a bad grade, 43 00:02:25,309 --> 00:02:26,699 that they're going to flunk. 44 00:02:26,949 --> 00:02:30,169 Other children with OCD that have contamination fears 45 00:02:30,179 --> 00:02:32,300 or cleaning rituals or cleaning compulsions 46 00:02:32,419 --> 00:02:36,419 may spend two hours in the shower—one or two or three hours in the shower. 47 00:02:36,550 --> 00:02:40,199 They may spend 30 or 40 minutes brushing their teeth or brushing their hair 48 00:02:40,419 --> 00:02:42,610 to make sure that everything is exactly right. 49 00:02:42,619 --> 00:02:46,729 Or they may spend hours cleaning their rooms or arranging their rooms 50 00:02:46,740 --> 00:02:49,970 because they need to have everything just arranged in a certain way. 51 00:02:50,649 --> 00:02:50,919 So, 52 00:02:50,929 --> 00:02:53,360 it sounds like, and correct me if I'm wrong, that 53 00:02:53,369 --> 00:02:56,639 it's not just kids who are doing things frequently, 54 00:02:56,839 --> 00:03:02,940 but children and adolescents who are really doing these behaviors to an extreme. 55 00:03:02,949 --> 00:03:06,160 So, it's taking up a large part of their day, impacting their life, 56 00:03:06,259 --> 00:03:07,610 their family, schooling. 57 00:03:07,619 --> 00:03:08,419 Is that correct? 58 00:03:08,529 --> 00:03:13,410 Yes. So, OCD really does. It either can take up a large proportion of time, 59 00:03:13,649 --> 00:03:15,960 or it's something that's really gonna be interfering. 60 00:03:16,100 --> 00:03:19,619 You can also have some OCD symptoms that may not take up a lot of time, 61 00:03:19,630 --> 00:03:21,880 but still can be very upsetting or interfering. 62 00:03:22,279 --> 00:03:25,759 So, some children with OCD have intrusive images. 63 00:03:25,770 --> 00:03:28,360 They get pictures or thoughts in their head that are really scary, 64 00:03:28,369 --> 00:03:32,089 like maybe doing something bad or hurting somebody or hurting themselves. 65 00:03:32,360 --> 00:03:35,490 And these are thoughts that are unwanted. They don't want to do these things. 66 00:03:35,500 --> 00:03:38,059 They have no intention of hurting themselves or somebody else. 67 00:03:38,250 --> 00:03:41,380 But these thoughts keep coming into their head and making them very upset. 68 00:03:41,479 --> 00:03:43,500 And even though the thoughts can be very brief, 69 00:03:43,669 --> 00:03:46,339 they still can cause a lot of problems for the child. 70 00:03:46,789 --> 00:03:49,750 So, if a family is seeing their child or their adolescent 71 00:03:49,990 --> 00:03:53,000 have obsessions, have compulsions, 72 00:03:53,440 --> 00:03:56,289 and they're affecting their life in a significant way, 73 00:03:56,860 --> 00:04:01,089 what should they do? Whom should they speak with about their concerns? 74 00:04:01,410 --> 00:04:04,929 Well, the important thing is to find 75 00:04:04,940 --> 00:04:07,470 a therapist or a mental health professional 76 00:04:07,589 --> 00:04:09,649 that has experience working with children and 77 00:04:09,660 --> 00:04:12,199 has experience working with obsessive compulsive disorder. 78 00:04:12,210 --> 00:04:13,600 This would typically be a 79 00:04:13,729 --> 00:04:15,830 clinical child and adolescent psychologist 80 00:04:16,170 --> 00:04:18,709 or a child and adolescent psychiatrist 81 00:04:19,019 --> 00:04:22,108 or another professional that has experience in this area. 82 00:04:22,920 --> 00:04:24,470 What information about 83 00:04:25,160 --> 00:04:30,250 treating OCD or obsessive compulsive disorder should parents be aware of? 84 00:04:30,869 --> 00:04:33,989 Well, the important thing is that there are 85 00:04:34,100 --> 00:04:39,059 two treatment approaches for OCD that have been been studied and 86 00:04:39,070 --> 00:04:42,940 researched very carefully and been shown to have some benefit for children, 87 00:04:42,950 --> 00:04:44,260 adolescent with OCD. 88 00:04:44,510 --> 00:04:48,070 The first is exposure-based cognitive behavior therapy 89 00:04:48,260 --> 00:04:50,820 and the second is a specific class of medications 90 00:04:50,829 --> 00:04:55,220 called the selective serotonin reuptake inhibitors or SSRIs. 91 00:04:55,959 --> 00:04:57,790 Cognitive behavior therapy 92 00:04:57,959 --> 00:05:02,010 is really considered the first line treatment approach. 93 00:05:02,019 --> 00:05:07,119 So, the recommendation is that that in almost all cases, children with OCD 94 00:05:07,130 --> 00:05:10,540 should try cognitive behavior therapy first because 95 00:05:10,549 --> 00:05:12,750 it has no side effects, 96 00:05:13,029 --> 00:05:15,899 and it's really been shown to have very positive effects 97 00:05:15,910 --> 00:05:18,570 in many cases on children with OCD. 98 00:05:18,709 --> 00:05:20,540 And importantly, also is that 99 00:05:20,779 --> 00:05:23,450 once the child has been able to benefit from cognitive 100 00:05:23,459 --> 00:05:26,640 behavior therapy or completed treatment with cognitive behavior therapy, 101 00:05:26,730 --> 00:05:28,109 the gains tend to last. 102 00:05:28,119 --> 00:05:28,869 So, 103 00:05:29,850 --> 00:05:33,239 in most cases, cognitive behavior therapy would be the 104 00:05:33,500 --> 00:05:35,570 preferred treatment to start with 105 00:05:35,869 --> 00:05:37,260 for a number of reasons. 106 00:05:37,269 --> 00:05:41,690 The first is that cognitive behavior therapy has been shown to be effective 107 00:05:41,700 --> 00:05:45,649 in a large proportion of cases, probably more so than medication. 108 00:05:46,059 --> 00:05:49,850 And the symptom reduction or the benefits of cognitive behavior therapy again, 109 00:05:49,859 --> 00:05:53,230 have been shown to probably be better than that for medication 110 00:05:53,239 --> 00:05:55,339 to some degree. The CBT, 111 00:05:55,619 --> 00:05:58,679 that's short for cognitive behavior therapy, 112 00:05:58,929 --> 00:06:01,869 may tend to lead to slightly better outcomes. 113 00:06:02,000 --> 00:06:05,989 Also, with CBT, once treatment is finished, 114 00:06:06,130 --> 00:06:09,299 the kids, children tend to maintain their gains for 115 00:06:09,309 --> 00:06:12,470 somewhat longer than with medication, oftentimes with medication, 116 00:06:12,790 --> 00:06:15,230 which can be associated with side effects. 117 00:06:15,459 --> 00:06:19,049 Once the medication is stopped, the symptoms may come back. 118 00:06:20,040 --> 00:06:23,010 So, you make reference to cognitive behavioral therapy. 119 00:06:23,019 --> 00:06:26,089 How would a parent know if the treatment that 120 00:06:26,100 --> 00:06:28,880 they're getting or if the therapist that they're seeing 121 00:06:29,540 --> 00:06:31,839 used this cognitive behavioral therapy? 122 00:06:32,279 --> 00:06:34,320 Well, the important consideration that the 123 00:06:36,500 --> 00:06:39,559 most active ingredient of cognitive behavior therapy 124 00:06:39,570 --> 00:06:42,329 is something called exposure plus response prevention. 125 00:06:42,769 --> 00:06:46,209 So, there are many different forms of cognitive behavior therapy, and 126 00:06:46,220 --> 00:06:48,290 and there are many forms of cognitive behavior therapy that 127 00:06:48,299 --> 00:06:52,010 are used for children with obsessive compulsive disorder. 128 00:06:52,380 --> 00:06:53,440 But only 129 00:06:53,679 --> 00:06:55,630 cognitive behavior therapy that's 130 00:06:55,640 --> 00:06:58,890 based on exposure plus response prevention 131 00:06:59,140 --> 00:07:02,320 has been shown to be effective for OCD. So, parents, 132 00:07:02,700 --> 00:07:04,880 when interviewing a therapist or trying to 133 00:07:04,890 --> 00:07:07,799 find a therapist or talking to a therapist about 134 00:07:07,980 --> 00:07:08,920 whether or not 135 00:07:09,320 --> 00:07:11,799 that treatment is helpful to the child should really 136 00:07:11,809 --> 00:07:15,380 ask if the therapist does exposure plus response prevention. 137 00:07:15,529 --> 00:07:18,059 Ok. Could you give me an example of what 138 00:07:18,470 --> 00:07:21,279 exposure plus response prevention 139 00:07:21,559 --> 00:07:23,200 is, or what it looks like? 140 00:07:23,989 --> 00:07:26,320 Well, first, let me tell you 141 00:07:27,220 --> 00:07:30,410 the rationale underlying exposure plus response prevention. 142 00:07:30,750 --> 00:07:34,019 In OCD when children experience unwanted thoughts 143 00:07:34,029 --> 00:07:36,769 or images like the obsessions, 144 00:07:37,000 --> 00:07:41,220 that can obviously be distressing or upsetting or troubling to them. 145 00:07:41,579 --> 00:07:45,399 The compulsions or the ritualistic behavior like the hand washing or 146 00:07:45,410 --> 00:07:49,040 the checking or the repeating or the touching over and over again 147 00:07:49,529 --> 00:07:53,130 are then done to make the bad feelings or make the obsessions go away. 148 00:07:53,140 --> 00:07:54,859 And the obvious example is 149 00:07:54,980 --> 00:07:57,500 a child that's afraid of germs or contamination 150 00:07:57,690 --> 00:08:02,109 will repeatedly wash their hands to make these germs or contamination go away. 151 00:08:02,410 --> 00:08:03,700 So, 152 00:08:04,239 --> 00:08:07,750 when children with obsessions or who are upset by their obsessions 153 00:08:07,760 --> 00:08:11,029 engage in the rituals or the compulsions like hand washing, 154 00:08:11,299 --> 00:08:12,549 what that tends to do, 155 00:08:12,559 --> 00:08:16,970 it tends to reinforce or strengthen the obsessive thoughts. 156 00:08:17,049 --> 00:08:22,350 So, everytime the child gives into his or her OCD by checking or washing or repeating, 157 00:08:22,570 --> 00:08:26,179 that tends to make the thoughts stronger and more believable. 158 00:08:26,399 --> 00:08:26,950 So, 159 00:08:27,630 --> 00:08:30,410 what exposure plus response prevention does is try 160 00:08:30,420 --> 00:08:33,549 to break the connection between the obsessive thoughts 161 00:08:33,960 --> 00:08:36,010 and the rituals or the compulsions. 162 00:08:36,260 --> 00:08:39,659 And by demonstrating to children that just because they have an obsessive 163 00:08:39,669 --> 00:08:42,390 thought doesn't need to mean they need to do their ritual. 164 00:08:42,659 --> 00:08:44,270 So, for example, in treatment, 165 00:08:44,280 --> 00:08:46,669 the first thing that we would do is make 166 00:08:46,679 --> 00:08:49,669 a list of all the child's obsessive compulsive symptoms. 167 00:08:49,900 --> 00:08:53,710 And then starting with the mildest symptom or the smallest symptom, 168 00:08:53,950 --> 00:08:56,369 we would trigger the child's symptom. 169 00:08:56,380 --> 00:08:56,950 For example, 170 00:08:56,960 --> 00:09:01,260 maybe by putting something contaminated on the child's hand to get him or her 171 00:09:01,619 --> 00:09:04,000 to become more anxious feeling. 172 00:09:04,299 --> 00:09:06,640 And at that point, the child would want to do their ritual, 173 00:09:06,650 --> 00:09:09,400 would want to wash their hands to make the bad feeling go away. 174 00:09:09,900 --> 00:09:10,799 But in treatment, 175 00:09:10,809 --> 00:09:13,080 we would work with the child or encourage the child to 176 00:09:13,090 --> 00:09:16,039 not wash their hands and instead wait and see what happens. 177 00:09:16,049 --> 00:09:19,840 And what happens is that the bad feelings or the anxiety goes away by itself. 178 00:09:20,229 --> 00:09:23,909 And by repeatedly doing this, doing the exposure or 179 00:09:24,239 --> 00:09:28,739 making the child want to do a ritual, but then having them not do the ritual, 180 00:09:28,880 --> 00:09:30,880 they learn that their anxiety will go away without 181 00:09:30,890 --> 00:09:33,289 having to do the rituals, and that relationship 182 00:09:33,299 --> 00:09:36,539 the connection between the obsession and the and the ritual is broken. 183 00:09:37,159 --> 00:09:38,299 And over repeated 184 00:09:38,549 --> 00:09:39,140 trials 185 00:09:39,400 --> 00:09:41,320 of doing the exposure 186 00:09:41,330 --> 00:09:43,500 plus response prevention, the child learns that the 187 00:09:43,510 --> 00:09:46,780 thoughts they have the scary thoughts or feelings that they have 188 00:09:46,789 --> 00:09:50,580 about bad things happening or about germs or contamination 189 00:09:50,799 --> 00:09:52,260 or other kinds of things 190 00:09:52,570 --> 00:09:55,179 really aren't that bad and that they'll go away 191 00:09:55,190 --> 00:09:57,229 on their own without having to do the rituals. 192 00:09:57,820 --> 00:09:59,080 So, it sounds like 193 00:09:59,429 --> 00:10:02,729 exposure and response prevention is 194 00:10:03,150 --> 00:10:05,309 when a child practices 195 00:10:05,520 --> 00:10:06,789 in a graduated way. 196 00:10:06,799 --> 00:10:08,609 So, what they're fearful of, 197 00:10:08,619 --> 00:10:10,650 you don't make them do first, but they build up 198 00:10:10,659 --> 00:10:13,369 to it by practicing different strategies along the way. 199 00:10:13,380 --> 00:10:15,010 Do I understand that correct? Yes. Correct. 200 00:10:15,020 --> 00:10:18,090 The treatment is done in a way that's very sensitive for children. 201 00:10:18,099 --> 00:10:20,500 So, we always have the children start with a very kind of 202 00:10:20,510 --> 00:10:24,270 an easy or very mild symptom that's easy for them to resist. 203 00:10:24,559 --> 00:10:25,650 We don't have them 204 00:10:25,929 --> 00:10:26,510 work 205 00:10:26,809 --> 00:10:29,299 on their most difficult or most anxiety 206 00:10:29,309 --> 00:10:31,780 provoking symptoms until well on into treatment. 207 00:10:32,429 --> 00:10:33,309 In addition, 208 00:10:33,520 --> 00:10:35,429 there's a lot of work that we do with the child in 209 00:10:35,440 --> 00:10:38,559 the family before we even start working on the specific symptoms. 210 00:10:38,570 --> 00:10:42,479 So, there's a lot of education about anxiety and about OCD so 211 00:10:42,489 --> 00:10:45,820 that they can learn more about what's causing their problem and 212 00:10:45,830 --> 00:10:47,780 why they have the symptoms that they have. 213 00:10:47,950 --> 00:10:53,070 We talk a lot about methods for reducing anxiety and for helping make them stronger 214 00:10:53,520 --> 00:10:57,520 in terms of their ability to handle their OCD or deal with their OCD. 215 00:10:57,789 --> 00:10:58,400 In treatment, 216 00:10:58,409 --> 00:11:00,419 we also work very closely with parents to 217 00:11:00,429 --> 00:11:03,320 give parents the appropriate tools to help them 218 00:11:03,429 --> 00:11:06,979 assist their children and help support their children in treatment 219 00:11:07,219 --> 00:11:09,919 and to set up situations at home that are also going to 220 00:11:09,929 --> 00:11:13,530 help the children learn how to master or overcome their OCD. 221 00:11:13,700 --> 00:11:14,280 So, 222 00:11:14,590 --> 00:11:18,479 parents might be part of the treatment and help their children to practice, 223 00:11:18,489 --> 00:11:19,799 but they should still be 224 00:11:20,099 --> 00:11:22,919 doing that in concert with a mental health professional? 225 00:11:23,049 --> 00:11:26,760 Yeah, it's important that parents work with a mental health professional 226 00:11:27,020 --> 00:11:29,219 to best learn how to manage or 227 00:11:29,229 --> 00:11:32,440 interact with their child around his or her OCD symptoms. 228 00:11:32,650 --> 00:11:36,469 What commonly happens with children with OCD is that 229 00:11:36,479 --> 00:11:38,330 they will gradually involve their parents or 230 00:11:38,340 --> 00:11:40,159 other family members and their symptoms. 231 00:11:40,169 --> 00:11:44,559 For example, making their mother or father wash things for them 232 00:11:44,849 --> 00:11:48,710 or having them avoid certain kinds of food or things at home 233 00:11:48,809 --> 00:11:52,200 if the child is afraid that those might be contaminated or covered with germs. 234 00:11:52,530 --> 00:11:54,549 They may ask parents to check, for example, 235 00:11:54,559 --> 00:11:57,450 the doors or check the locks or check the stove 236 00:11:57,460 --> 00:11:59,940 if they're afraid of a burglar or a fire. 237 00:12:00,239 --> 00:12:03,789 And it really over time can really involve parents and even brothers and 238 00:12:03,799 --> 00:12:06,750 sisters in ways that can be very difficult for the family to manage. 239 00:12:07,309 --> 00:12:10,559 So, one of the goals of treatment is to teach parents 240 00:12:10,739 --> 00:12:13,099 and brothers and sisters and other family members or 241 00:12:13,109 --> 00:12:15,859 other important people in the child's life how 242 00:12:15,869 --> 00:12:18,419 to disengage from the child's symptoms, to not 243 00:12:18,429 --> 00:12:20,549 be so involved in the child's symptoms, 244 00:12:20,659 --> 00:12:23,309 which will allow the child then to get better with treatment 245 00:12:23,320 --> 00:12:25,989 and lead to kind of normal family functioning again. 246 00:12:26,349 --> 00:12:29,169 But this can be a little bit tricky. So, it really should be done 247 00:12:29,419 --> 00:12:31,309 working closely with the mental health 248 00:12:31,320 --> 00:12:33,530 professional that is experienced in this area. 249 00:12:34,770 --> 00:12:35,479 So, 250 00:12:35,669 --> 00:12:38,440 parents should look for a cognitive behavioral 251 00:12:38,450 --> 00:12:42,400 therapist who uses exposure and response prevention. 252 00:12:42,549 --> 00:12:48,599 That sounds to be a very important thing that parents should seek. Are there other 253 00:12:48,869 --> 00:12:53,260 aspects or things that parents should ask about when looking 254 00:12:53,270 --> 00:12:56,280 for a therapist for their child for treating OCD? 255 00:12:56,700 --> 00:12:56,820 Yeah, 256 00:12:56,830 --> 00:12:58,400 it's very important that parents are 257 00:12:58,409 --> 00:13:00,979 very careful and very knowledgeable when they're 258 00:13:01,340 --> 00:13:03,429 looking for a therapist 259 00:13:03,570 --> 00:13:05,570 to work with their child's OCD. 260 00:13:05,840 --> 00:13:09,979 The therapist again, must have experience with OCD. 261 00:13:10,530 --> 00:13:15,390 The therapist must do exposure plus response prevention for the OCD. 262 00:13:15,789 --> 00:13:17,840 And the child must really be 263 00:13:17,849 --> 00:13:20,099 knowledgeable in working with children and adolescents. 264 00:13:20,109 --> 00:13:21,989 These are all important factors. 265 00:13:22,299 --> 00:13:22,840 So, 266 00:13:23,760 --> 00:13:27,099 are there other takeaway messages that you would want to give 267 00:13:27,109 --> 00:13:30,539 to a parent whose child or adolescent has 268 00:13:30,900 --> 00:13:31,500 OCD 269 00:13:31,830 --> 00:13:34,700 in terms of what they should be doing as a parent? 270 00:13:35,280 --> 00:13:37,859 There are a number of things that parents should think about 271 00:13:37,869 --> 00:13:40,820 when their child has OCD. 272 00:13:41,039 --> 00:13:43,880 One of the big misconceptions that we run into is that parents 273 00:13:43,890 --> 00:13:47,659 sometimes think that the children are doing the behaviors on purpose. 274 00:13:48,039 --> 00:13:50,429 When in reality, in most cases, 275 00:13:50,440 --> 00:13:54,140 children with OCD are unable to control their symptoms. The anxiety 276 00:13:54,479 --> 00:13:57,390 is just too strong, and when the child says 277 00:13:57,400 --> 00:13:59,969 that they need to wash their hands or to check 278 00:14:00,159 --> 00:14:01,739 or to repeat certain things, 279 00:14:01,789 --> 00:14:05,130 it really is something that oftentimes is beyond their control. 280 00:14:05,210 --> 00:14:07,659 So, before parents try to do something to 281 00:14:07,669 --> 00:14:09,700 stop their children from doing these behaviors, 282 00:14:09,710 --> 00:14:12,799 they really should talk to a qualified mental health professional. 283 00:14:13,349 --> 00:14:18,919 Can you tell me how many children and adolescents have OCD or your best guess? 284 00:14:19,789 --> 00:14:21,419 OCD is pretty common in children and 285 00:14:21,429 --> 00:14:24,340 adolescents. Anywhere from about 1 to 3% of children 286 00:14:24,599 --> 00:14:28,150 and adolescents in this country have obsessive compulsive disorder. 287 00:14:28,450 --> 00:14:31,469 So, if you think about that, if you think of, say a child 288 00:14:31,479 --> 00:14:34,320 that goes to a school with 1000 children, 289 00:14:34,330 --> 00:14:38,059 maybe a medium size middle school or small high school, 290 00:14:38,320 --> 00:14:42,219 there are probably anywhere from 10 to 20 children at that school that have OCD. 291 00:14:42,229 --> 00:14:43,739 So, it's actually quite common, 292 00:14:43,880 --> 00:14:46,500 and in milder forms, it may even be more common than that. 293 00:14:47,770 --> 00:14:50,599 So, how come we don't hear about OCD a lot? 294 00:14:51,419 --> 00:14:54,390 OCD has oftentimes been called the Secret Disease or 295 00:14:54,400 --> 00:14:57,570 the Hidden Disease because the symptoms can be quite embarrassing. 296 00:14:57,750 --> 00:15:00,770 Sometimes they do involve kind of bizarre fears or 297 00:15:00,780 --> 00:15:04,289 worries that children might not want other people to know about. 298 00:15:04,539 --> 00:15:05,969 So, in a lot of cases, 299 00:15:05,979 --> 00:15:09,440 children or adolescents are able to hide their symptoms from friends 300 00:15:09,450 --> 00:15:12,229 or from classmates or from relatives, and in some cases, 301 00:15:12,239 --> 00:15:13,520 even from parents. 302 00:15:13,960 --> 00:15:19,260 So, we don't tend to hear about OCD as often as other disorders, say ADHD 303 00:15:19,270 --> 00:15:22,299 or some other things that get more attention. 304 00:15:22,549 --> 00:15:23,780 What should parents look 305 00:15:24,200 --> 00:15:24,619 for? 306 00:15:25,469 --> 00:15:25,650 If 307 00:15:26,059 --> 00:15:27,169 your 308 00:15:27,179 --> 00:15:30,489 parent thinks, suspects that their child might have a problem with OCD, 309 00:15:30,500 --> 00:15:32,289 there are a number of things to look for. 310 00:15:32,400 --> 00:15:34,950 One would be avoiding situations that 311 00:15:34,960 --> 00:15:36,419 the children may have used to like, 312 00:15:36,429 --> 00:15:39,919 like not wanting to go to school or avoiding social situations, 313 00:15:40,190 --> 00:15:42,280 maybe avoiding being away from home. 314 00:15:42,340 --> 00:15:45,349 Sometimes this occurs because the children are afraid that they're gonna do 315 00:15:45,359 --> 00:15:47,830 their rituals or their compulsions in public settings. 316 00:15:48,369 --> 00:15:53,359 Children with OCD, oftentimes, if it's related to perfectionism 317 00:15:53,369 --> 00:15:54,890 or writing or school work 318 00:15:55,049 --> 00:15:59,390 may all of a sudden take much longer to do their school work. So, an assignment that may 319 00:15:59,570 --> 00:16:01,830 take on average 30 minutes to complete, 320 00:16:02,159 --> 00:16:06,710 may all of a sudden take like an hour or 90 minutes or two hours for a child with OCD. 321 00:16:07,039 --> 00:16:11,500 Children that tend to erase and rewrite over and over again, 322 00:16:11,510 --> 00:16:13,299 try to get things perfect 323 00:16:13,520 --> 00:16:17,580 or really get upset when things aren't exactly right or exactly perfect, 324 00:16:17,820 --> 00:16:19,750 that may also be a sign of OCD. 325 00:16:19,880 --> 00:16:23,140 Finally, children that are spend excessive time, 326 00:16:23,409 --> 00:16:24,719 say washing 327 00:16:24,909 --> 00:16:29,140 or showering or bathing or engage in other activities, 328 00:16:29,229 --> 00:16:32,239 that also may be a sign that the child has OCD. 329 00:16:33,119 --> 00:16:34,979 Do we know what causes OCD? 330 00:16:35,729 --> 00:16:39,340 OCD is a biological disorder. It's genetic. 331 00:16:39,349 --> 00:16:41,200 So, it tends to run in families. 332 00:16:41,729 --> 00:16:45,869 But there's also some kinds of environmental factors associated with OCD. 333 00:16:45,880 --> 00:16:48,280 So, if a child is stressed 334 00:16:48,619 --> 00:16:52,469 or tired or sick, that may make the symptoms worse. 335 00:16:52,729 --> 00:16:53,979 Reactions.... 336 00:16:53,989 --> 00:16:57,840 If the child is in a situation where others might be reacting to the OCD 337 00:16:58,219 --> 00:16:59,380 or 338 00:16:59,710 --> 00:17:02,919 putting pressure on the child, that may also make OCD worse. 339 00:17:03,669 --> 00:17:07,170 And although some people might say because OCD is a biological disorder, 340 00:17:07,180 --> 00:17:08,880 shouldn't you treat it with medication? 341 00:17:09,020 --> 00:17:10,209 That's not the case. 342 00:17:10,520 --> 00:17:13,229 In fact, the cognitive behavior therapy is 343 00:17:13,239 --> 00:17:16,729 the most effective treatment that we have for OCD right now. 344 00:17:17,689 --> 00:17:19,150 So, would you say that 345 00:17:19,358 --> 00:17:21,989 for children and adolescents who have OCD, 346 00:17:22,209 --> 00:17:24,050 there's a fair amount of hope that with 347 00:17:24,060 --> 00:17:26,608 CBT treatment or cognitive behavioral treatment, 348 00:17:26,618 --> 00:17:27,650 things will get better? 349 00:17:28,199 --> 00:17:31,660 Yeah, there is a fair amount of hope associated with treatment. 350 00:17:31,670 --> 00:17:33,290 Cognitive behavior therapy, 351 00:17:33,300 --> 00:17:34,680 CBT, 352 00:17:34,949 --> 00:17:37,540 has been shown to be effective in a number of cases. 353 00:17:37,550 --> 00:17:39,030 Not everybody benefits from it. 354 00:17:39,040 --> 00:17:41,099 Not every child is able to do it. 355 00:17:41,109 --> 00:17:43,189 There may be certain situations or factors 356 00:17:43,439 --> 00:17:47,699 such as coexisting problems that might make it difficult for 357 00:17:47,709 --> 00:17:51,050 the child to engage in cognitive behavior therapy as the first treatment. 358 00:17:51,359 --> 00:17:54,650 Or in some situations, the CBT may be so severe 359 00:17:54,760 --> 00:17:56,939 that the child is unable to engage in the treatment. 360 00:17:57,150 --> 00:17:58,420 And in these cases, 361 00:17:58,430 --> 00:18:02,310 other families might want to consider medication and talk to either 362 00:18:02,319 --> 00:18:04,060 a qualified mental health professional about 363 00:18:04,069 --> 00:18:06,060 medication or a referral for medication. 364 00:18:06,560 --> 00:18:09,640 But between these two treatments, 365 00:18:09,790 --> 00:18:12,060 there's a good chance that most children will be able to 366 00:18:12,069 --> 00:18:17,400 experience significant benefit and be able to live normal lives. 367 00:18:17,680 --> 00:18:20,609 Can you tell me a little bit about 368 00:18:21,079 --> 00:18:23,630 what OCD looks like in the long term, or what 369 00:18:23,640 --> 00:18:27,380 parents should expect for their children or adolescents who have OCD 370 00:18:27,660 --> 00:18:29,239 in a longer term sense? 371 00:18:29,790 --> 00:18:35,209 So, OCD is considered a chronic disorder, which means it tends not to go away by itself. 372 00:18:35,219 --> 00:18:38,569 It typically starts around age in childhood. 373 00:18:38,880 --> 00:18:41,170 So, maybe around the ages of 7 to 11. 374 00:18:42,020 --> 00:18:42,880 And 375 00:18:43,670 --> 00:18:44,150 it 376 00:18:44,589 --> 00:18:48,319 in some cases will have a sudden onset. So, it'll just kind of come, 377 00:18:48,329 --> 00:18:49,530 seems like almost out of the blue. 378 00:18:49,540 --> 00:18:52,459 In other cases, it tends to have more of a gradual onset. So, the symptoms 379 00:18:52,609 --> 00:18:57,010 tend to get worse over time and kind of a slower format. 380 00:18:57,479 --> 00:19:00,729 But without treatment, in most cases for children, 381 00:19:00,739 --> 00:19:03,790 most kids will just continue to experience the symptoms 382 00:19:03,959 --> 00:19:07,800 overtime into adolescence and even adulthood. 383 00:19:08,020 --> 00:19:08,589 In fact, 384 00:19:08,599 --> 00:19:11,520 most adults with OCD had an initial 385 00:19:11,530 --> 00:19:14,689 onset of their symptoms during childhood or 386 00:19:15,140 --> 00:19:15,579 adolescence. 387 00:19:15,699 --> 00:19:18,119 But the good news is that effective treatment can really 388 00:19:18,130 --> 00:19:21,260 have a positive impact on children's long-term functioning. 389 00:19:21,270 --> 00:19:22,239 So, if they're able to 390 00:19:22,449 --> 00:19:25,199 benefit from cognitive behavior therapy or 391 00:19:25,209 --> 00:19:27,859 even perhaps medication in addition to the therapy, 392 00:19:28,140 --> 00:19:30,089 the chances are that they may have a 393 00:19:30,099 --> 00:19:33,540 very good long term prognosis in the sense that they can go on and to lead, 394 00:19:33,739 --> 00:19:35,180 you know, normal healthy lives. 395 00:19:35,319 --> 00:19:37,550 And it sounds like, correct me if I'm wrong, 396 00:19:37,780 --> 00:19:41,000 a lot of kids or adolescents will learn skills 397 00:19:41,010 --> 00:19:44,199 for managing their symptoms that they can draw upon 398 00:19:44,859 --> 00:19:45,880 as they age. 399 00:19:46,609 --> 00:19:46,800 Yeah. 400 00:19:46,810 --> 00:19:50,380 One of the benefits of cognitive behavior therapy is that children learn skills; 401 00:19:50,390 --> 00:19:54,839 they learn strategies for coping with their OCD, for challenging their OCD. 402 00:19:55,229 --> 00:19:59,280 And just for general problem solving and coping, 403 00:19:59,349 --> 00:20:01,420 which in the long term can really be beneficial. 404 00:20:01,430 --> 00:20:03,359 A lot of children that receive treatment 405 00:20:03,449 --> 00:20:05,150 actually can serve to strengthen them in many 406 00:20:05,160 --> 00:20:07,079 ways by increasing their confidence and their 407 00:20:07,089 --> 00:20:09,680 ability to deal with other difficult situations. 408 00:20:10,630 --> 00:20:16,290 One thing I know about other mental health disorders is that sometimes one mental 409 00:20:16,300 --> 00:20:20,000 health disorder will co-occur at the same time with another mental health disorder. 410 00:20:20,010 --> 00:20:24,969 And so kids are dealing with multiple concerns at the same time. 411 00:20:24,979 --> 00:20:28,665 Does that happen with OCD? Do we see that co-occur with other disorders? 412 00:20:28,915 --> 00:20:29,244 Yeah. 413 00:20:29,415 --> 00:20:31,765 OCD quite commonly 414 00:20:31,935 --> 00:20:33,444 cours with other disorders. 415 00:20:33,454 --> 00:20:35,385 The most common other disorders are another kind 416 00:20:35,395 --> 00:20:39,285 of an anxiety disorder such as generalized anxiety 417 00:20:39,454 --> 00:20:42,685 or social anxiety fears or separation fears. 418 00:20:42,734 --> 00:20:48,165 We also see it occur quite commonly with Tourette's or Tick Disorders and ADHD. 419 00:20:48,680 --> 00:20:53,140 In adolescence or in older children or adolescents or adults, 420 00:20:53,290 --> 00:20:55,469 co-incurring depression is also quite common. 421 00:20:55,479 --> 00:20:58,680 In fact, most children with OCD or the majority of children 422 00:20:58,869 --> 00:21:00,160 with OCD 423 00:21:00,390 --> 00:21:04,449 will present for treatment or come into clinics with one other disorder 424 00:21:04,459 --> 00:21:07,750 and some kids will even come in with two or more other disorders. 425 00:21:07,770 --> 00:21:08,270 Ok. 426 00:21:08,810 --> 00:21:12,630 So, for some parents, it sounds like they report that 427 00:21:12,920 --> 00:21:17,000 they've noticed this in their children for a long period of time, 428 00:21:17,280 --> 00:21:20,420 and it might get worse as they get older or stress might make it 429 00:21:20,739 --> 00:21:22,339 more noticeable. 430 00:21:22,589 --> 00:21:23,819 For other parents, 431 00:21:23,829 --> 00:21:27,459 they might just suddenly notice that their child is experiencing 432 00:21:27,469 --> 00:21:31,500 problems with obsessions or compulsions or it's impacting their life. 433 00:21:31,510 --> 00:21:31,819 So, 434 00:21:31,829 --> 00:21:35,500 if a parent is first noticing these problems are really coming to the 435 00:21:35,510 --> 00:21:40,260 realization that it might be impacting their child or their adolescent life. 436 00:21:40,270 --> 00:21:41,739 What's the first step for them? 437 00:21:42,469 --> 00:21:43,329 Well, the first step, 438 00:21:43,339 --> 00:21:48,489 if you suspect that your child may have OCD or another problem is to not panic 439 00:21:48,780 --> 00:21:49,810 and not overreact, 440 00:21:49,819 --> 00:21:53,199 especially not in front of the child because that can be very upsetting to the child. 441 00:21:53,510 --> 00:21:57,890 But if a parent sees something that doesn't seem right or a change in the 442 00:21:57,900 --> 00:21:58,160 child, 443 00:21:58,750 --> 00:22:00,930 I think it would be important for the parent just 444 00:22:00,939 --> 00:22:03,109 to talk to the child about it. Again, 445 00:22:03,119 --> 00:22:05,310 not in an alarmist fashion, but maybe, you know, 446 00:22:05,329 --> 00:22:07,530 I've just noticed that you seem to worry about 447 00:22:07,810 --> 00:22:11,329 this or that a little bit more than you used to. Do you want to talk about it? 448 00:22:11,339 --> 00:22:12,880 Can you tell me what's going on? 449 00:22:13,069 --> 00:22:15,140 And try to get some information from the child. 450 00:22:15,150 --> 00:22:15,650 Now, 451 00:22:15,660 --> 00:22:18,614 commonly children and may not want to talk about it or may not want to 452 00:22:18,625 --> 00:22:20,535 say anything either because they're embarrassed or 453 00:22:20,545 --> 00:22:22,275 they don't want to upset their parents. 454 00:22:22,285 --> 00:22:27,295 But if the parent continues to feel that there's something that concerns them, 455 00:22:27,444 --> 00:22:29,234 it would be important to contact 456 00:22:29,244 --> 00:22:31,234 again, a qualified mental health professional, 457 00:22:31,244 --> 00:22:34,074 somebody that is an experienced child and 458 00:22:34,719 --> 00:22:34,750 adolescent 459 00:22:34,760 --> 00:22:37,699 psychologist or psychiatrist or social worker that has 460 00:22:37,709 --> 00:22:39,660 experience working with OCD or 461 00:22:39,670 --> 00:22:41,020 other kinds of disorders. 462 00:22:41,189 --> 00:22:45,979 Do kids go through phases where they'll have obsessions or compulsions? 463 00:22:46,270 --> 00:22:47,079 Meaning, 464 00:22:47,640 --> 00:22:49,420 when a parent first notices it, 465 00:22:49,430 --> 00:22:52,199 is that the time to contact a mental health 466 00:22:52,209 --> 00:22:55,060 professional or should parents wait to see the course? 467 00:22:55,390 --> 00:23:00,140 If parents see some different kind of a behavior, odd behavior in their child, 468 00:23:00,510 --> 00:23:02,109 it probably makes sense to watch it for a 469 00:23:02,119 --> 00:23:05,010 little bit of time and not overreact too soon. 470 00:23:05,020 --> 00:23:08,530 I mean, unless the behavior is clearly problematic, 471 00:23:08,839 --> 00:23:10,170 but in 472 00:23:10,729 --> 00:23:14,229 if there's something that looks a little bit different and maybe 473 00:23:14,239 --> 00:23:16,640 the parent isn't sure if it's something that serious or not, 474 00:23:16,650 --> 00:23:18,550 maybe to watch it for a little while because 475 00:23:18,560 --> 00:23:21,400 most kids go through different stages of something where they 476 00:23:21,410 --> 00:23:23,589 may be a little more anxious or a little 477 00:23:23,599 --> 00:23:28,050 less anxious or a little sad sometimes or have 478 00:23:28,199 --> 00:23:30,630 more active or whatever that might be. And that kind of 479 00:23:30,734 --> 00:23:33,194 normal in kids, but just to watch 480 00:23:33,535 --> 00:23:35,994 and continue to monitor and if things don't get 481 00:23:36,005 --> 00:23:38,135 better or if things look a little bit worse, 482 00:23:38,204 --> 00:23:40,665 then it might be time to seek out help. 483 00:23:40,675 --> 00:23:43,645 The recommendation would be that if a parent sees something 484 00:23:43,655 --> 00:23:46,844 that looks like it is interfering with the child's life 485 00:23:47,555 --> 00:23:50,635 in terms of school or friends or family functioning, 486 00:23:50,979 --> 00:23:55,520 is distressing or disturbing to the child, or is upsetting to them, 487 00:23:55,530 --> 00:23:57,280 that would be the time to 488 00:23:57,489 --> 00:24:00,599 seek some kind of professional help. 489 00:24:00,729 --> 00:24:01,119 Ok. 490 00:24:01,250 --> 00:24:03,619 Well, thank you for your time and for answering questions. 491 00:24:03,630 --> 00:24:09,239 I'm sure that many parents will be happy to review this information and 492 00:24:09,250 --> 00:24:11,160 to share their concerns with the qualified 493 00:24:11,170 --> 00:24:12,839 mental health professional in their area. 494 00:24:12,849 --> 00:24:15,099 So, thank you again. Oh, it's my pleasure. Thank you.