Friday, January 07, 2005

Does Your Child Have Obsessive-Compulsive Disorder?

Does Your Child Have

Obsessive-Compulsive Disorder?



Introduction

Worries and doubts are part of normal everyday life. However, when these concerns affect normal functioning, it is a sign that there might be a greater problem.

Modern psychiatry classifies Obsessive-Compulsive Disorder (OCD) as one of the Anxiety disorders. Currently, 1 in 200 children and adolescents in the United States has Obsessive-Compulsive Disorder. Fortunately, there is a lot that you as a parent can do to help your child.

Symptoms

Obsessions are persistent and recurrent impulses, thoughts, or images that are unwanted and cause distress. These are usually irrational and are not the normal products of daily living. Compulsions are repetitive actions, like washing hands or hoarding things, or mental actions, like counting or repeating words silently. As the name implies Obsessive-Compulsive Disorder is characterized by both.

Typically, the person is plagued by repetitive thoughts, images, or impulses that are disturbing, illogical, and out of the person’s control. In an attempt to make these obsessions go away the person develops and performs compulsively a set of actions to relieve the discomfort caused by the obsessions.

For example, a person who is obsessed with sickness may develop compulsive hand washing. A person who is obsessed with fear of fire might continually check to make sure that the stove is off. The person gets no pleasure from doing these actions. Rather they provide temporary relieve from his unpleasant thoughts. The person may spend hours over the course of the day doing compulsive actions to relieve his obsessive thoughts.

At some point, most people realize that the anxieties are only a product of their own minds and have nothing to do with reality. However, they are unable to control the thoughts or the behaviors.

Description

Obsessive-Compulsive Disorder can start as early as preschool age. The way OCD shows itself in a child will vary with the child’s age. A younger child may have anxiety that harm will come to him or a family member. He may repeatedly check to see if the doors of his house are locked.

An older child may be afraid of germs and that his food is poisoned or that he will get AIDS. He may constantly wash his hands or food. The child may even know and can verbalize that it doesn’t make sense. However, the compulsive behavior is beyond his control.

Children with OCD frequently don't feel well physically. This may be because of the stress their anxieties cause or it may be due to lack of sleep or poor nutrition. These children often have stress related disorders such as headaches or stomach upset.

Frequently, children are angry with their parents. This usually occurs when the parents are unable to comply with their child’s behavioral quirks. These children usually have trouble keeping friends because of their behaviors make them stand out. These children often suffer from poor self-esteem.

Diagnosis

To receive the classic the diagnosis of OCD a person must have obsession and/or compulsions that cause the person anxiety or distress and cannot be attributed to another cause, such as substance abuse. The obsessions or compulsions cause a lot of distress and interfere with normal living.

The diagnosis usually goes unrecognized for a very long time. Studies show that most people don’t receive the diagnosis of OCD until 9 years after the symptoms first appear. It may take an addition 8 years before they receive adequate treatment. The reason for this is two fold. Most patients are embarrassed by their condition, so they avoid telling anybody. Secondly, many doctors are not familiar with the condition, so that they are not quick to recognize it nor do they know how to treat it.

Causes

The current research indicates that OCD is a neurologically based brain disorder. Studies show that there seems to be a communication problem between the frontal lobes of the brain and the brain’s deeper structures. These areas of the brain use the neurotransmitter, serotonin to communicate. People with OCD have lower levels of serotonin in these areas of the brain. Drugs that increase the brain serotonin levels also improve OCD.

Obsessive-Compulsive Disorder has also been linked to strep infections. Recently, a study was done giving OCD patients anti-strep antibodies. Patients showed a significant improvement in their OCD symptoms.

Related Disorders

Children with OCD commonly have other psychiatric problems. Below is a list of psychiatric conditions that frequently occur along with OCD:

Treatment

Most children with OCD can be treated effectively with a combination of psychotherapy and certain medications, particularly serotonin reuptake inhibitors. 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.

Psychotherapy

Cognitive behavioral psychotherapy is the psychotherapeutic treatment of choice for children, adolescents, and adults with OCD. This method helps the patient internalize a strategy for resisting OCD and has lifelong benefit. This therapy focuses on changing the persons thoughts and feelings by first changing his behavior.

This form of therapy has only moderate success. 25% of patients are unable to finish the course of the program. Of those that do finish, between half and three quarters report some degree of benefit after three to five months. These benefits last after the therapy has stopped.

Therapy usually is administered on a weekly basis for at least two months. There is an intensive form of therapy in which the person works with the therapist in 2-3 hour periods three times a week. If the person chooses the faster approach, he can complete treatment in three weeks.

Medication

The serotonin reuptake inhibitors (SRIs) are uniquely effective treatments for OCD. These medications increase the concentration of serotonin, a chemical messenger in the brain. Five SRIs are currently available by prescription in the United States:

  • Clomipramine (Anafranil)
  • Fluoxetine (Prozac)
  • Fluvoxamine (Luvox)
  • Paroxetine (Paxil)
  • Sertraline (Zoloft)
  • Citalopram (Celexa)

Most people notice some benefit after 3 to 4 weeks. It takes 8-10 weeks before these medications take full effect, but most people say they are significantly better. 20% of people don’t do well on their first medication and are forced to try a different SRI.

SRI Side Effects

The most common side effects are:

  • Nervousness
  • Insomnia
  • Restlessness
  • Nausea
  • Diarrhea

Clomipramine has a broader action than the other drugs and carries with it additional side effects including:

  • Dry mouth
  • Sedation
  • Dizziness
  • Weight gain
  • Blood pressure problems
  • Irregular heart beats

Medications control symptoms, but they do not cure the disorder. When a child stops taking medication, the symptoms usually return. For this reason, the current recommendation is to use cognitive behavioral therapy in conjunction with medication.

No two children respond to anti-OCD medication in exactly the same way. Some children don’t respond to any medication. Side effects also vary from person to person. For this reason, your child may need to try more than one medication. Although we still don’t know for certain, no one has identified any long-term problems from taking these medications.

Newer Treatments

Recent studies have linked certain cases of OCD with the presence of anti-strep antibodies. In a study performed at the National Institute of Mental Health, a number of children with OCD and who tested positive for strep were given a treatment to remove circulating anti-strep antibodies. Within a few weeks some of the children’s symptoms lessen and in a few cases they disappeared completely.

Treating for circulating strep anti-bodies is still considered experimental. However, this new treatment might soon be changing the way we treat some people with OCD.

Conclusion: What You as a Parent Can Do

If your child has Obsessive-Compulsive Disorder, the most important thing you can do to help your child is to learn as much as you can about the condition.

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

Family problems do not cause OCD, but the way the family deals with the symptoms can affect the child. If your family is having difficulty dealing with a member who has OCD, you should try to consult a Family Therapist for direction.

Try to be as kind your child as possible. This is the best way to reduce the symptoms of OCD. It will not work to command your child to stop the behavior. Your child is unable to stop and he will only feel even greater distress if he is reprimanded or forced to stop his rituals. Remember, as much as your child’s behavior bothers you, he is suffering even more.

You have to be your child’s advocate in school. You must make sure that the child’s teacher and the school administrators understand the disorder.

Use support groups. Sharing common problems with other parents is an excellent way to help you feel that you are not alone and is great support. You also might gain so practical insights about what you can do to deal with the daily problems that come up.

Make time for yourself and your own life. You must not let yourself be trapped by your child’s rituals. You child does not need a martyr as a parent.



Anthony Kane, MD

ADD ADHD Advances

Get ADD ADHD Child Behavior and Treatment Help for your ADHD child, including child behavior advice and information on the latest ADHD treatment. Sign up for the free ADD ADHD Advances online journal Come to ADD ADHD Blog and add your insights.


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Sunday, January 02, 2005

God's Perfection: The Story of a Special Needs Child

God's Perfection: The Story of a Special Needs Child

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For an ezine, send an email to: perfection@addadhdadvances.com.
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I want to give a brief introduction to the following story.

This story comes from the Orthodox Jewish community in Brooklyn, New York. It is interesting that although I first heard this story almost a decade ago and haven't thought about it for several years, this story was sent to me last week by two different people, one from New Jersey and one from Florida. I have decided to share this story with you.

This story was first told at a funding raising dinner for Chush, a special needs school in New York, catering to the Orthodox Jewish community. One of the speakers at that dinner was the father of Shaya, a learning disabled boy about whom this story revolves.


The father started his speech like so many others, praising the school and the dedication of the staff. But then he went off on a tangent in a way that touched the lives of everyone in that room.

    "We know that God is perfect. We all believe this. But I ask you, look at my son. He can't learn like other children. He can't remember facts like other children. He will never understand things that they can understand. Look at my son and tell me, where is God's perfection?"

    The shocked audience sat silent, facing the pain of a father in anguish.

    "I believe," the father continued softly, "that when God brings a child like my son into the world, the perfection that He seeks is in not what the child might do, but the way people react to this child."


The father then told this story about his son, Shaya.

One Sunday afternoon, he and his son were walking by a park where the Orthodox Jewish boys in the neighborhood were playing baseball.

"Do you think they would let me play?" Shaya asked.

Shaya's father knew that his son didn't know how to play baseball. His son couldn't play baseball. But he also knows that these boys have always been kind to Shaya. If he as Shaya's father didn't speak up for his son, who would?

So he walked over to one of the boys and asked, "What do you think about letting Shaya in the game?"

The boy didn't know what to say. He looked around to his teammates for guidance. He didn't get any.

Finally the boy answered, "Well, we're about to start the 8th inning, and we're losing by six runs. I don't think we're going to win this game, so what's the difference? We'll get him a glove and he can play on our team behind second base. We'll let him bat in the ninth inning."

Shaya's face beamed. His father helped him put on the baseball glove and Shaya joined his team, playing short center field.

But things began to change. In the bottom of the eighth inning, Shaya's team scored three runs. They again rallied in the ninth inning. Now in the bottom of the ninth inning, Shaya's team had bases loaded with two outs. It was Shaya's turn at bat.

They will never let him bat, thought the father. But without hesitation, one of the boys shouted, "Shaya, you're up!" and he handed Shaya the bat.

Shaya had never held a bat before. Shaya walked to the plate. The pitcher moved in a few steps and lobbed the ball so Shaya could make contact. Shaya swung the bat clumsily and missed the ball by a wide margin.

"Hold on," said one of the boys. "Let me help him. Let me show him how to bat."

This boy came and stood behind Shaya, and put his arms around him so together they were holding the bat.

The pitcher moved in a couple more feet and lobbed the ball as softly as he could.

The two boys swung the bat together and managed to make contact with the ball, tapping it gently toward the pitcher.

"Run, Shaya, run to first!" shouted Shaya's teammates.

Run to first? Shaya run to first!? Shaya had never run to first in his life. But Shaya began running to first.

Shaya was not even half way to first base when the ball reached the pitcher's feet. The game was all but over. The pitcher picked up the ball. He now had a choice. He could throw Shaya out at first and end the game that way or he could easily outrun Shaya and tag him out. However, the pitcher decided to end the game in a different way.

He took the ball and with all his might threw it as far as he could over the first baseman's head far into right field.

"Run, Shaya, run," the pitcher shouted.

The right fielder was still chasing after the ball when Shaya reached first.

"Shaya, run to second!" his teammates shouted.

Shaya began to run to second, some of his teammates running with him. The other three base runners had already scored. Now the game was tied.

Shaya was only a quarter of the way to second base when the right fielder had the ball. Instead of throwing the ball to second to tag Shaya out, the right fielder took the ball and threw it way over the third baseman's head and out of the park.

When Shaya reached second, the opposing shortstop ran up to him, turned him in the direction of third base and shouted, "Run to third!"

Shaya began to run to third and his entire team came onto the field and was running with him. Shaya reached third base.

Now all eighteen boys were running behind Shaya.

"Shaya, run home! Shaya, run home!" everyone shouted.

Shaya stepped on home plate to the cheers of eighteen boys. They picked him up and carried him on their shoulders. He had hit a home run.

Shaya, the special needs boy who had never played baseball before, was the hero of the game.

-------------------------------------------

None of us know why we were put on this Earth. Many teach that part of our job is to try to emulate our Creator's perfection. Many of us have difficultly with our children. Some of these children have ADHD. Some of them have other problems. However, our children and we have a purpose why we were created. Most of us will probably never really know what that purpose is.

Still, I wanted to share this true story with you that took place about ten years ago: The story of eighteen boys who for a few brief moments one Sunday afternoon, at a playground in Brooklyn, were able to give us a glimpse of God's perfection.


Anthony Kane, MD

ADD ADHD Advances



Anthony Kane, MD is a physician and international lecturer.
Get
ADD ADHD Child Behavior and Treatment Help for your ADHD child, including child behavior advice and information on the latest ADHD treatment. Sign up for the free ADD ADHD Advances online journal

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