Q: My 13-year-old son has engaged in "odd behaviors" since he was about four. Initially, these took the form of turning light switches on and off or repeating the same word over and over again. At first my wife and I thought this was a game he was playing, but when we tried to stop him he would become upset or sneak these activities in when he thought we weren't watching. Flicking the light switch later changed to touching his fingers together in a certain pattern and then changed again to other behaviors as he grew older. We assumed that he would grow out of these habits, but he's a teenager now and he's still doing some of them. Currently he double-checks that the doors are locked at night and that the oven and stove are turned off, even though we may not have even used them during the day. I know that he's embarrassed when we mention something, but he doesn't seem to be able to explain why he's doing it. We now realize that these behaviors are not "just going to go away" and would like to know where to begin getting help for him. A: It sounds like your son may have Obsessive Compulsive Disorder (OCD). Behaviors such as repetitive thoughts or actions which interfere in daily life are typical of this condition. Historically, OCD was thought to be a problem only of adulthood, but I'm also finding it occurring among grade-schoolers, pre-adolescents and teenagers. There are many theories regarding the causes of OCD. Some researchers feel that it is due to a chemical imbalance in the brain and therefore should be treated with medication. Others believe that it is an indication of anxiety or frustration, while others believe it to be merely a habit pattern. Many, including myself, believe it to be a combination of all of the above: a genetic predisposition to the disorder which can be heightened by anxiety, repeated through habitual behavior and responsive to psychotropic medication. Kids with OCD tend to display what I call "magical thinking". The adage, "if you step on a crack, you'll break your mother's back" is similar to the thinking of the youngster with obsessive-compulsive thoughts or actions. Rationally, the individual knows that stepping on a crack in a sidewalk has nothing to do with hurting his mother's back, yet many of us grew up jumping over cracks and, guess what, our mothers never did break their backs! /tdy_rainbow_ffdd55.gif) | MSNBC CHILDREN'S HEALTH |
| | |
|
Most of us, though, outgrew this type of thinking. Some children and adults, however, continue to be convinced — perhaps on a subconscious level — that their thoughts or actions have the power to affect the well-being of themselves or others that they care about. Many kids with OCD are aware of their irrational behaviors or thoughts, and are embarrassed by them. They understand intellectually that the need to flick the light switch on and off five times does not keep the family safe, yet they can believe on an emotional level that if they do not continue this behavior that something bad may happen as a result. Some children are very specific about the danger: "Dad will get in a car accident" or "I will flunk my next math exam." Others feel a general tension if they do not engage in the repetitive thoughts or actions and cannot explain exactly what they think will happen if they cease the thoughts or behavior. The underlying idea, though, is that these kids believe that something bad will happen if they don't perform the action repetitively or think the thought several times. OCD is often difficult to treat because it is a behavior that reinforces itself. Odds are that Dad will not get in a car accident that day or the child will not flunk the math test. In other words, the magical thinking “works” and therefore it is difficult for the youngster to break the thought/action/outcome connection. When I begin seeing a kid with OCD, the first thing I do is to describe the process of magical thinking to him. In this way he can begin to understand why he is acting repetitively, including the "payoff" that occurs (such as when Dad arriving home safely each day after the child has flicked the light switch five times). I also let the youngster know that he is not the only one with this type of problem. Informing him that he is not alone in his magical thinking allows him to relax a bit and to be more open to what I have to say. | NEW — and only on TODAY.MSNBc.com! |
|  | | Each week, 'Today' show contributor Dr. Ruth Peters addresses questions about how best to bring up children. Visit the Today.MSNBC.com Parenting section every weekend for new topics. |
|
| |
|
Next, I challenge the child to try an experiment. I ask him to keep a log of the number of times each day he engages in the repetitive thought or behavior. In my experience, just having the youngster document the frequency of occurrence tends to decrease the behavior or thoughts. I've had kids keep a tally on a pad of paper of the times that they have "given in" to magical thinking. I’ve even had them start the day with several pennies in their left pocket and asked them to transfer one to the right pocket each time they find themselves obsessing about something. After a week the child brings me the log indicating the frequency of “giving in” to the obsession or compulsion and we discuss progress made. As noted, just doing this exercise often decreases the frequency of the thoughts or behaviors as the child becomes more aware of engaging in them. In addition, sometimes the parents will offer a reward if he slowly reduces the number of occurrences per day, a method that is often successful. At first, many kids report that they become anxious if they do not allow themselves the comfort of engaging in their familiar actions or thoughts. At this point it is very important to keep them on track for a few days to show them that nothing negative is going to result due to their changed patterns. Sometimes obsessive thoughts or actions are initiated by feelings of guilt — perhaps having negative thoughts about a family member, or having engaged in an inappropriate behavior that has led to anxiety. Once the child understands what magical thinking is and why repetitive behaviors or thoughts lessen the anxiety, he may be able to describe why he is embarrassed or feeling guilty. With this knowledge, he can be helped to put the past into a different perspective. As you can see, this is a quite complicated disorder. For this reason, I strongly suggest that your son receive psychological counseling for his repetitive behaviors. In addition, several medications have been found to be exceptionally helpful for treating Obsessive-Compulsive Disorder. A psychologist or psychiatrist can help determine the best treatment for your son — whether it involves psychotropic medication, counseling, behavior management or a combination of all three. Ruth A. Peters, Ph.D. is a clinical psychologist and regular contributor to “Today.” Her most recent book is "Laying Down the Law: The 25 Laws of Parenting" (Rodale, 2002). She is also the consultant psychologist for the Family Program at the Pritikin Longevity Center, a nutrition and exercise facility in Aventura, Florida. For more information you can visit her Web site at www.ruthpeters.com. Copyright ©2004 by Ruth A. Peters, Ph.D. All rights reserved. PLEASE NOTE: The information in this column should not be construed as providing specific psychological or medical advice, but rather to offer readers information to better understand the lives and health of themselves and their children. It is not intended to provide an alternative to professional treatment or to replace the services of a physician, psychiatrist or psychotherapist. |  | 'Gender Wars': Men and women on parenting |
| | |
|
| |
| | /peacock_999999.gif) | EDITOR'S CHOICE |
| | |
|
| 
/peacock_666666_02.gif){kind=small}
