Obsessive-Compulsive Disorder In Children And Adolescents

/in ,

Obsessive-Compulsive Disorder (OCD), usually begins in adolescence or young adulthood and is seen in as many as 1 in 200 children and adolescents. OCD is characterized by recurrent intense obsessions and/or compulsions that cause severe discomfort and interfere with day-to-day functioning. Obsessions are recurrent and persistent thoughts, impulses, or images that are unwanted and cause marked anxiety or distress. Frequently, they are unrealistic or irrational. They are not simply excessive worries about real-life problems or preoccupations. Compulsions are repetitive behaviors or rituals (like hand washing, hoarding, keeping things in order, checking something over and over) or mental acts (like counting, repeating words silently, avoiding). In OCD, the obsessions or compulsions cause significant anxiety or distress, or they interfere with the child’s normal routine, academic functioning, social activities, or relationships.

The obsessive thoughts may vary with the age of the child and may change over time. A younger child with OCD may have persistent thoughts that harm will occur to himself or a family member, for example an intruder entering an unlocked door or window. The child may compulsively check all the doors and windows of his home after his parents are asleep in an attempt to relieve anxiety. The child may then fear that he may have accidentally unlocked a door or window while last checking and locking, and then must compulsively check over and over again. An older child or a teenager with OCD may fear that he will become ill with germs, AIDS, or contaminated food. To cope with his/her feelings, a child may develop “rituals” (a behavior or activity that gets repeated). Sometimes the obsession and compulsion are linked; “I fear this bad thing will happen if I stop checking or hand washing, so I can’t stop even if it doesn’t make any sense.”

Research shows that OCD is a brain disorder and tends to run in families, although this doesn’t mean the child will definitely develop symptoms if a parent has the disorder. Recent studies have also shown that OCD may develop or worsen after a streptococcal bacterial infection. A child may also develop OCD with no previous family history.

Children and adolescents often feel shame and embarrassment about their OCD. Many fear it means they’re crazy and are hesitant to talk about their thoughts and behaviors. Good communication between parents and children can increase understanding of the problem and help the parents appropriately support their child.

Most children with OCD can be treated effectively with a combination of psychotherapy (especially cognitive and behavioral techniques) and certain medications for example, serotonin reuptake inhibitors (SSRI’s). Family support and education are also central to the success of treatment. Antibiotic therapy may be useful in cases where OCD is linked to streptococcal infection. Seeking help from a child and adolescent psychiatrist is important both to better understand the complex issues created by OCD as well as to get help.

Re-printed with Permission from American Academy of Child & Adolesccent Psychiatry

Children With Learning Disabilities

/in ,

Parents are often worried when their child has learning problems in school. There are many reasons for school failure, but a common one is a specific learning disability. Children with learning disabilities usually have a normal range of intelligence. They try very hard to follow instructions, concentrate, and “be good” at home and in school. Yet, despite this effort, he or she is not mastering school tasks and falls behind. Learning disabilities affect at least 1 in 10 schoolchildren.

It is believed that learning disabilities are caused by a difficulty with the nervous system that affects receiving, processing, or communicating information. They may also run in families. Some children with learning disabilities are also hyperactive; unable to sit still, easily distracted, and have a short attention span.

Child and adolescent psychiatrists point out that learning disabilities are treatable. If not detected and treated early, however, they can have a tragic “snowballing” effect. For instance, a child who does not learn addition in elementary school cannot understand algebra in high school. The child, trying very hard to learn, becomes more and more frustrated, and develops emotional problems such as low self-esteem in the face of repeated failure. Some learning disabled children misbehave in school because they would rather be seen as “bad” than “stupid.”

Parents should be aware of the most frequent signals of learning disabilities, when a child:

  • has difficulty understanding and following instructions.
  • has trouble remembering what someone just told him or her.
  • fails to master reading, spelling, writing, and/or math skills, and thus fails
  • has difficulty distinguishing right from left; difficulty identifying words or a tendency to reverse letters, words, or numbers; (for example, confusing 25 with 52, “b” with “d,” or “on” with “no”).
  • lacks coordination in walking, sports, or small activities such as holding a pencil or tying a shoelace.
  • easily loses or misplaces homework, schoolbooks, or other items.
  • cannot understand the concept of time; is confused by “yesterday, today, tomorrow.”

Such problems deserve a comprehensive evaluation by an expert who can assess all of the different issues affecting the child. A child and adolescent psychiatrist can help coordinate the evaluation, and work with school professionals and others to have the evaluation and educational testing done to clarify if a learning disability exists. This includes talking with the child and family, evaluating their situation, reviewing the educational testing, and consulting with the school. The child and adolescent psychiatrist will then make recommendations on appropriate school placement, the need for special help such as special educational services or speech-language therapy and help parents assist their child in maximizing his or her learning potential. Sometimes individual or family psychotherapy will be recommended. Medication may be prescribed for hyperactivity or distractibility. It is important to strengthen the child’s self-confidence, so vital for healthy development, and also help parents and other family members better understand and cope with the realities of living with a child with learning disabilities.

Re-printed with Permission from American Academy of Child & Adolesccent Psychiatry