Tag Archives: managing difficult behaviour

Not just a few worries and quirks: children and OCD

notobsessiveI had always known the 10-year old was an anxious child. Her parents had referred her for therapy as they felt she lacked confidence, was falling behind at school and seemed very secretive. I had spent many sessions with her, building trust and developing a relationship, and we had talked about her worries at school, the conflict between her parents at home.

But it took some months before she finally confessed to me that she thought she was “weird”. Thoughts invaded her mind and she couldn’t ignore them, upsetting thoughts that bad things might happen.

Specifically, she felt she had to check and recheck that she had tightened the tap after she washed her hands, as she couldn’t shake the feeling that she might leave the tap open and cause a flood.  This need to close taps and tighten them, to the point she would hurt her hands, had extended to her glue lid, the cap of her juice bottle – in fact to all items that needed closing.

She was very ashamed of her thoughts and behaviours and was sure she was a “freak”. “I just can’t stop myself,” she whispered. “What if I don’t check the tap and I flood the house?”

It was then that I knew that she wasn’t simply a nervous child, but was suffering from a serious form of anxiety disorder called Obsessive Compulsive Disorder (OCD).

It is estimated that about 1 in 200 children has Obsessive Compulsive Disorder (OCD) and that 80% of adults with OCD have had significant symptoms before the age of 18.

In children and adolescents OCD involves obsessive thoughts about things like:

  • contamination, dirt and germs,
  • illness,
  • putting things in order, arranging things symmetrically,
  • lucky or unlucky numbers,
  • the possibility of hurting others or causing something bad to happen,
  • danger to family or friends, and
  • losing or breaking things.

Children with OCD can’t simply choose not to think these thoughts; they cannot just put the ideas out of their mind and think positively. The thoughts feel intrusive and overwhelming and cause enormous distress to the child.

Children with OCD generally ‘deal with’ these obsessional thoughts, anxiety and preoccupations by carrying out particular repetitive actions. These actions quickly become compulsive rituals, examples of which are checking, hand washing, counting things, performing an action in exactly the same way every time, repeating a behaviour a specific number of times, and collecting and hoarding things.

It’s as if the child believes that the rituals will undo any possible harm and magically reduce anxiety and make things feel right. But in truth these compulsions are enormously time-consuming and increasingly interfere with all aspects of the child’s life.

Experts are not exactly sure what causes OCD, which can run in families. Some theories suggest that it involves serotonin, a chemical in the brain also called a neurotransmitter. When something blocks the flow of serotonin, the brain overreacts and misreads information. Instead of ordinary thoughts being filtered out, the OCD mind lingers on them and sparks off fear or worry like an overactive alarm system.

OCD can be a difficult condition to treat. Early diagnosis is not easy as children are often secretive about their obsessions and compulsions. But if untreated, childhood OCD tends to persist into adulthood and is associated with long-term negative outcomes, so it’s worth being proactive if you start to suspect your child is showing features of the disorder.

Below are some of the positive steps you can take.

Consult an expert

As with most difficult mental health issues, the support and expertise of an expert is often vital. First, this person will help you to distinguish between what is manageable anxiety and what is OCD. Second, even children with the most knowledgeable and accepting parents will often withhold certain worries and acts from them, but talk about them with an expert.

A combination of psychotherapy and medication might be suggested by a professional, but first do some research and inform yourself thoroughly before deciding how to move forward.

Prepare the family

If everyone in the family  understands what OCD is and that the behaviours that come with it are part of the condition, this creates a more understanding home environment. Also try to run a fairly structured home so that compulsive rituals don’t stand out as much and are less exacerbated by chaos.

Talk to your child

This is obvious. Be honest and open about the condition and talk about it with your child, without ever forcing the issue. You are a parent with a family to run and limits to set, not a psychologist. The more difficult work of dealing with OCD might need to be dealt with by an expert.

Deal with school

For the OCD child, stresses at school are usually worse than at home. Adults who teach your child will not be as well informed as you learn to become, and other children are often not tolerant or understanding. Therefore, meet all those who will come into contact with your child and help to educate them.

Managing and treating OCD is a challenge but possible – as the famous 18th century writer, OCD and Tourette’s sufferer Dr Samuel Johnson said, “Great works are performed not by strength, but perseverance.”

OCD hand

For useful links to resources in South Africa and internationally I can recommend the website of the South African Depression and Anxiety Group (SADAG) – http://www.sadag.org

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Intimate enemies: sibling rivalry

I had a second child,” a mother says, “because I want my son to have company as he grows up.” Which made me think:

  • The first murder victim in history, according to the bible, was Abel, killed by his brother, Cain.
  • A client consulted me because her 7 year old daughter fed her younger brother a potentially fatal overdose of medicine because he was irritating her and she “wanted to make him better”.
  • First-hatched black eagle chicks peck their younger siblings to death, driven by a primitive fuse.

There is an old Arabic saying that goes, “I against my brother; my brother and I against my cousin; I, my brother, and my cousin against the stranger,” that perhaps sums up how primary and instinctive sibling rivalry is. In the competition for emotional and material resources, no greater threat exists than the brother or sister living in your own home.

Of course, life with siblings can also be an enriching experience. For many people, life would not be the same without a sibling with whom they can shoulder life’s burdens or celebrate common experiences. But we should not assume that the sibling relationship is always easy. From the very beginning sibling rivalry rears its head. Toddlers want to protect toys; young school kids, having internalised the concept of fairness, will dispute a sibling receiving perceived preferential treatment; teenagers bent on becoming independent might resent doing household chores that younger brothers and sisters do not have to do.

These age-dependent conflicts could also be exacerbated if one child has special needs that require other siblings to accept less parental attention, or if one of your children has a temperament that intensifies the conflict – a child who is sensitive and needy might not be well matched to a more robust and independent child.

When fights do break out, what should you do? Wherever possible, don’t step in. It’s difficult to adjudicate the truth in these fights, with both parties making an equally impressive case for why they are the victim. Taking sides can also increase dependency on one side and resentment on the other. At the same time, you don’t want to feel like Cinderella’s father, benignly standing by while others burst into cruel laughter, mocking their younger sister.

If the heat of the moment requires you to step in because of possible violence or vicious name-calling, the advice one can give is based on common sense. Start by separating the combatants. If possible, allow a little cooling off time. Make it clear that violence and insults are not acceptable. As far as possible, encourage your kids to resolve the problem themselves. Of course, this doesn’t always work, but in doing this you are laying the foundation for a time when they are able to find a win-win solution.

Over the long haul, family problems like this are better prevented than treated. Somewhere in that busy schedule of work, school lifts, extra lessons and meetings, try to work out a preventative approach.

As disputes arise, talk about the concepts of fairness and equality. You can’t always treat children equally but you must always try to be fair.

  • Work with your kids to write up family rules governing behaviour that is acceptable and unacceptable – eg no name-calling, violence – and how disputes will be sorted out, as well as consequences for such behaviour. Stick this set of rules on the kitchen cupboard. 
  • Make special time for each child according to their interests, so they don’t feel neglected. 
  • Do fun things as a family – this reduces tension and builds bonds.
  • For specific areas of disagreement, such as who gets to watch favourite TV shows, write up a schedule that divides the time equally between siblings.

Most sibling differences are resolved over time as brothers and sisters grow up and become friends and mutual supports.

Except when they don’t.

Situations I deal with in my practice include families where siblings haven’t spoken for 20 years, a grandmother who still struggles to deal with her older sister’s bossiness and constant one-upmanship, and a man in his 30s who still bitterly resents his successful, much loved younger brother.

Perhaps if parents had from the beginning consciously adopted the sort of approach I have mentioned, a lifetime of distress might have been replaced by a valuable sibling friendship.

Calvin_and_Hobbes_1280_Wall_by_LamboMan7

The art of monster taming

In the last 24 hours my 7-year old son has done the following: stand in the middle of the lounge, mimic Michael Jackson and moonwalk backwards out the door; use a four-letter word while arguing with his friend; hug me lovingly while whispering in my ear, “I just farted’; play a computer game called Zoo Tycoon with the finesse of a teenager; shoot hoops in the back garden and sulk for an hour because he missed three shots in a row; stroke his baby cousin’s cheek tenderly; lie on the sofa watching television, smearing pizza over the cushions, pretending not to hear us telling him to tidy up and go bath.

Welcome to the rollercoaster ride. One moment your child is sweet and loving and the next a monster awakes. Trying to pin down a reason for the change is the sort of challenge that Sherlock Holmes would not relish. But parents know something Holmes doesn’t. Their child is possessed. Only an exorcism will do. Until the priest arrives, however, a number of sensible measures may be employed as holding actions when your child is being impossible.

  1. Try distraction – and try it as soon as you see the warning signs of a tantrum or meltdown looming. Point out something very interesting to your child, use cajoling, humour (sparingly though or your over-sensitive and overwrought child might feel humiliated and mocked) and judicious bribery. If the idea of parenting by bribery makes you feel uncomfortable, think of it as a reward or incentive programme, just as the management consultants did at your company recently.
  1. Offer choices. “Richard, you can either pick up all the dog mess in the garden for the next two years, or you can brush your teeth.” “I’ll brush my teeth,” he smirks victoriously. Children love the power to choose. Of all parenting strategies, this one is the simplest and most effective. Keep choices clear and limited, not “what vegetable do you want with your supper?” but “what would you prefer, peas or carrots with your chicken?”
  1. Time out. Tell her you love her but she’s going to her room anyway for a time out – a minute for every year of her life, or until she calms down. She may break things or shriek horrendously but she’s staying there until time is up. The main idea of Time Out is not to punish, but to de-escalate, defuse and calm a situation down. Many parents are concerned that sending a child to Time Out in their bedroom won’t work as there are things to do and play with in a child’s room, but that’s the point – distraction. As long as the behaviour that you don’t like has stopped. Time Outs shouldn’t happen in locked bathrooms, dark cellars etc.
  1. Walk away (emotionally). It is essential that parents stay calm in the face of the enraged child. Do not rise to the challenge of each battle, choose the ones worth fighting and then stand your ground. Stay calm. Shrieking at an already shrieking child is adding fuel to the fire. And never worry about what the neighbours will think about ignoring the prolonged wailing of your child because you’ve reminded him that no-one died from not owning a Ben 10 Omnitrix. Staying calm and walking away when necessary minimises the temptation to lash out at your child. Smacking as a way of disciplining is controversial and potentially problematic. My experience as a parent and psychologist is that smacking is not a particularly useful long-term strategy for managing children’s behaviour. It allows adults the illusion of control and temporary relief from difficult situations, but if used often becomes increasingly destructive. Children learn to hide their true feelings, obeying out of fear not respect. They learn that people who are bigger or stronger have control and that physical expressions of anger are acceptable.