From The Nyu Child Study Center: Ask The Expert
Play It Again, Sam….Or Else
By Glenn S. Hirsch, MD
Parents and educators strive to help their children and students develop good habits. We teach them to be organized, make a homework list, wash up before leaving the house, and be neat.
Many preschool and early elementary school children go through a normal developmental period in which they develop elaborate rules around bedtime, meals, and play. Sometimes, however, when children develop their own habits, rules, and rituals that go beyond what we expect or want or are developmentally appropriate, a disorder may be present.
Obsessive Compulsive Disorder (OCD) is characterized by intrusive and unwanted thoughts or images (obsessions) and repetitive or ritualistic behaviors (compulsions). The obsessions often trigger anxiety and worry and the compulsions are often initiated to reduce the anxiety.
Some examples of obsessions include: fear of germs, contamination, dirt; fear of hurting oneself or someone else; fear of having sinned or not praying enough; and excessive doubting about having completed an action or making the right decision. Sometimes an obsession, such as the constant repetitive thought of a name, phrase, or piece of music, may be harmless or seem silly.
Examples of compulsions include: excessive hand washing; avoidance of touching certain objects such as doorknobs, knives, pencils; the need to check and recheck that a door is locked, drawer closed, or that homework has been completed; the need to line up objects such as toys; counting to a specific number; the need to do something a certain number of times; or excessively erasing while doing homework to get it neat or ‘right.’
Once thought to be a rare illness, OCD affects 3-5% of the general population and about 1 in 40 children. While it can start at any age, OCD usually first appears during childhood or adolescence. For many patients, the symptoms are so uncomfortable and embarrassing that they will attempt to hide them. As a result the symptoms often go untreated.
Historically OCD was thought to be best treated by psychoanalytic therapy because it was felt that the problem was caused in early infancy. In the last twenty years, however, there has been intense scientific research in trying to understand all aspects of OCD, and current scientific evidence, supplanting the earlier theory, suggests that there are genetic components and problems with how the brain utilizes the neurotransmitter serotonin.
Two treatments can effectively treat the symptoms of OCD.
Exposure and response prevention—a form of cognitive behavioral therapy—provides ‘tools’ to the patient to actively work on ‘fighting’ the symptoms. In this way, the youngster can begin to tackle the fears. For example, someone with a germ phobia may be gradually introduced to dirt and contaminated objects while helping him/her fight the compulsion to wash.
The medications that are most often used are what have been termed the serotonin reuptake inhibitors (SRIs), of which Prozac is the best known example.
There are a number of factors that determine which combination of treatments will work best for an individual, but the good news is that we have treatments that are extremely effective. The first step is recognizing that the problem exists.#
This monthly column provides educators, parents and families with important information about child and adolescent mental health issues. Please submit questions for ASK THE EXPERT to Glenn S. Hirsch, M.D., Medical Director at the NYU Child Study Center at glenn.hirsch@med.nyu.edu. To subscribe to the ASK THE EXPERT Newsletter or for more information about the NYU Child Study Center, visit www.AboutOurKids.org or call 212-263-6622.
