Guidelines for Families with Kids with OCD
Guidelines for Families With Children Who Have OCD
Family Help for Children with OCD
Family involvement is important to anyone as they strive to break free from obsessive-compulsive disorder (OCD). To children, family support and involvement is crucial. The family needs to work as a team in the fight against OCD. There are a few other areas where parents can assist their children as they struggle with OCD.
Keys to Helping Children with OCD
- Differentiate between the child and the OCD. Clearly and plainly make OCD the problem, NOT the child. Your child is NOT the OCD. The horrible thoughts and persistent worries are not who the child really is. It is only OCD.
- Explain OCD in understandable ways. Compare obsessions to hiccups, for example. They attack without warning and aren’t easily controlled.
- Try to understand exactly what obsessions and compulsions your child is having. Often children and teens are horrified by their obsessive thoughts and compulsive behaviors, thinking they are bad, or even evil. They try to keep them a secret, even from their parents and therapists.
- Give OCD a name. Mr. Worry, Mrs. Clean, Washy, Mr. Gooey, Checkers, and The Count are a few suggestions — or Fred, Sam, Pete, Molly, or Jane. This helps to “externalize” OCD. Have fun with your child as together you come up with a name for OCD. Using the name when talking about OCD reinforces the idea that OCD is the problem, not the child. It becomes an enemy rather than a bad habit. Teens may find this too childish and favor calling OCD by its medical term. That’s okay because it still helps externalize the disorder.
- Children handle OCD much better when they understand it is not their fault, and that they are not alone. This is where a support group for kids with OCD can be extremely beneficial. Contact the OC Foundation for information about parent/child support groups in your area.
- Stop blaming yourself for your child’s OCD problem. Most experts in the field regard OCD as primarily a neurobehavioral disorder that is the result of dysfunctions in brain chemistry and circuitry. Bad parenting does NOT cause OCD. You are as much responsible for your child’s OCD as you would be responsible if he/she had diabetes or thyroid disease. By giving up the guilt and blame game, you can free up your energies to target the real problem — and that’s your child’s OCD.
Acceptance and Fairness
Obsessive-compulsive disorder is not fair! It is not fair for the child with OCD, and it is not fair for brothers and sisters. They may feel their sibling gets away with things because of OCD. They’re probably right. Again, education will help the entire family understand OCD behavior. Giving OCD a name helps. Instead of blaming the child, brothers and sisters can blame OCD.
Structure and Discipline
Structure is very important in any family. Children feel more secure when they know they can depend on a daily routine. Obsessive-compulsive symptoms tend to be more severe when there are life changes. Vacations are fun, but can bring with them a whole new set of obsessive thoughts and compulsive behaviors. A structured environment will benefit the rest of the family also. Set clear rules and expectations. Post them on the refrigerator. State the rules in a positive way. “You will do your homework before watching TV,” instead of “No TV until your homework is done.” “You may watch TV 2 hours today,” instead of, “No more than two hours of TV.” Schedule activities. They don’t have to be the same every day, but let your child know what the schedule will be for each day. Try to have dinner, homework, and bedtime at the same time most days. What if things get off schedule? Help your child accept the changes. People with OCD tend to dislike changes, but this is a part of life. We need to accept that.
Sometimes children find it less scary to be punished than to fight OCD. Misbehavior could be part of a compulsion or it could be avoidance. Of course, misbehavior may or may not have anything to do with OCD. What about discipline for disobedience that has nothing to do with OCD? Use your stickers! Set up a sticker chart for all the children. Reward positive behavior with a sticker. These behaviors may be different for each child, depending on age, temperament, and personality. Get the children involved in setting goals and choosing behaviors to be rewarded. At the end of each week, give small rewards for the stickers. Accompany stickers and rewards with praise. Even when they don’t earn a reward, give praise for trying.
Children with OCD misbehave too. They need discipline for misbehavior that they can control. As medication and cognitive behavior therapy begin to help, the expectations should be increased. “People will just have to understand – I have OCD.” A qualified therapist can help you decide which negative behaviors should be disciplined.
The home can turn into a battlefield at homework time. It can be extra frustrating for many children with OCD. There are things you can do to help your child with homework:
- Schedule homework time. Before or just after dinner is a good time for many families. Plan quiet activities before homework. It’s often hard to focus on homework after playing hard outside. Try not to let your child get involved in another activity that cannot be finished before homework is done. Many people with OCD have difficulty leaving things before they are completed.
- Have a homework time every night – even when there is no homework. If your child does not have school assignments, allow reading a book, writing a story, practicing math, or other learning activities. Or give out “Mom’s Assignments” or “Dad’s Assignments.” Children soon learn that these will likely be rougher than the ones their teachers give. Try to have at least 30 minutes of homework time. Help your child break assignments into small tasks to make them seem less overwhelming. Breaks between tasks might help. Let them get up and move a bit – without getting involved in another activity.
- Homework should be done in the same place whenever possible. Provide good lighting and plenty of supplies nearby. Stock the area with paper, pencils, pens, crayons, scissors – whatever is frequently needed for homework. This reduces the need to go searching for things. Allow your child to help choose a place to do his homework. If homework cannot be done in the same place every night, put the supplies in a box that can be moved from place to place.
- Communicate with the teachers. Is your child turning in assignments? Write down how long is spent on homework. If it is excessive, maybe the teacher will reduce the amount of homework until the OCD improves some.
- Reward completion of homework – without complaints and tantrums – with praise. Incorporate homework rewards into your sticker chart. Homework completion gets a sticker good toward rewards. Homework without complaint gets another sticker.
A child’s teacher and school counselor are important team members in the struggle with OCD, but school personnel may lack knowledge about OCD. As a parent, you can help by providing information to your local schools.
- The booklet, “School Personnel: A Critical Link” by Gail B. Adams Ed.D and Marcia Torchia RN, is an excellent resource for school personnel on identification, treatment, and management of OCD in children and adolescents. It only costs $3.00 through the Obsessive Compulsive Foundation and is a valuable resource for teachers.
- Teaching the Tiger by Marilyn P. Dornbush, Ph.D. and Sheryl K. Pruitt, M.Ed is an excellent handbook for school personnel involved in teaching children and adolescents with OCD, attention deficit disorder, and Tourette syndrome. Many of the principles can be applied to the family situation.
If you have a local Obsessive Compulsive Foundation affiliate or support group, request that a representative provide an in-service presentation at your child’s school. This would help school personnel better understand OCD and its management. If no one is available, the video, “The Touching Tree” (also available through the Obsessive-Compulsive Foundation), would improve understanding. It is about a boy with OCD whose teacher recognizes he has a problem and assist him in getting help.
Communicate with your child’s teachers through visits, phone calls and notes. Inform teachers of new symptoms, medication changes, side effects of medications to look for, progress of behavior therapy and things to praise your child for.
Return to OCD in Children and Teens
Portions of this article are adapted from a continuing education course for nurses, Obsessive Compulsive Disorder, by Cherlene Pedrick RN. It was published in 1996 by National Center of Continuing Education, Inc.
Geller, Daniel A. 1998. Juvenile Obsessive-Compulsive Disorder. In Obsessive-Compulsive Disorders, Practical Management, edited by Jenike, Michael, et all. St. Louis: Mosby, Inc.
Koplewicz, Harold S. 1996. It’s Nobody’s Fault. New York: Times Books.
Leonard, Henrietta. 1989. Childhood Rituals and Superstitions: Developmental and Cultural Perspective. In Obsessive-Compulsive Disorder in Children and Adolescents, edited by Rappoport, J.L. Washington, DC: American Psychiatric Press. Washington.
March, John and Mulle, Karen. 1998. OCD in Children and Adolescents, A Cognitive-Behavioral Treatment Manual. New York: The Guilford Press.
McDougle, Christopher J. and Goodman, Wayne K. 1997. Combination Pharmocological
Treatment Strategies. In Obsessive-Compulsive Disorders: Diagnosis; Etiology; Treatment, edited by Hollander, Eric, et all. New York: Marcel Dekker, Inc.
Piacentini, John and Grawe, Flemming. 1997. Childhood OCD. In Obsessive-Compulsive Disorders: Diagnosis; Etiology; Treatment, edited by Hollander, Eric, et all. New York: Marcel Dekker, Inc.
Swedo, Susan Anderson and Leonard, Henrietta. 1998. Is it “Just a Phase”? New York: Golden Books.
Yaryura-Tobias, Jose A. and Neziroglu, Fugen A. 1997. Obsessive-Compulsive Disorder Spectrum, Pathogenisis, Diagnosis, and Treatment. Washington DC: American Psychiatric Press.