Re:OCD with children

I've been waiting in the hopes that some forum participants who work with children would respond (I don't do individual therapy with kids under 15). However, since no one else is chiming in, I'll share my approach to sharing the rationale for exposure and response prevention with adolescents. I think the same approach would work with younger kids.

After establishing a good working relationship with the adolescent and finding out how they see their OCD, I start by using guided discovery to share a simple CBT understanding of OCD. It boils down to this: Suppose a thought runs through my head and I find it upsetting or scary... on the one hand I might try not to think about it but on the other hand we're wired to focus on anything that scares us (i.e. if I'm walking through the woods, turn a corner, and see a bear standing there I'm immediately going to be focused on the bear, not the flowers and trees). The more a thought bothers me, the more likely I am to get focused on it, the more I focus on it, the more it bothers me, and so on. A thought can get stuck in my head pretty easily this way. If an upsetting thought is stuck in my head, that can be pretty uncomfortable. If I find something that makes me more comfortable, such as [insert one of the kid's compulsions] I'm likely to do it. But if it only makes me feel better for a little while, I end up having to do it over and over again. Does that sound like what happens to you?

Assuming that this explanation makes sense to the kid, I go on to: So what can I do about this? (I wait for any suggestions the kid has and then go on to:) Let's take a simpler situation... Suppose a person has a fear of heights. When they get up on a ladder it scares them, if they get off the ladder they feel better. The person's likly to stay the heck off of ladders... but is this really a good idea? If they stay off of ladders as much as possible, what will happen to their fear? (if the kid doesn't know that the fear will persist or get worse I explain that) Suppose I want to overcome my fear of heights, what do I need to do? (If the kid doesn't already know that I need to face my fears, I explain that)

We then can go on to: So if being scared or upset by a thought tends to get it stuck in my head, what do I need to do? (It may seem strange but I need to get to the point that the thought doesn't scare or upset me so much by facing the thoughts) If [insert one of the kid's compulsions] makes me feel better for a little while but keeps the problem going, what do I need to do? (I need to find a way to keep from performing the compulsion and need to tolerate the discomfort in order to break the cycle and get to the point where I don't have to keep doing it over and over.) This isn't easy or fun, but it works and I can help them do it.

I then answer whatever questions the kid has and we can start planning their exposure and response prevention.

I'm also going to need to share this understanding of OCD and the rationale for E&RP with the parents and get their buy-in too. With adolescents, I usually go through this individually with the kid and then the kid and I meet with the parents and explain it to them. With pre-adolescents, I might do this jointly with parent and child.

With kids too young to sit and talk face to face, we might use play as a communication medium. For example, I might introduce a stuffed animal that happens to have the same compulsions as the kids and explain this to the stuffed animal with the kid's help.

What do participants who work with kids think? Are there better ways to introduce Exposure and Response Prevention?

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