Obsessive-compulsive disorder, also known as OCD, is an anxiety disorder where individuals have distressing thoughts or fears that cause anxiety, and often lead to compulsive behaviors to alleviate this anxiety. In "Introduction to Child and Adolescent Psychology," Robert Weis reports that less than 1 percent of children have OCD, with symptoms often beginning in later childhood. Examples of obsessions include fear of getting hurt or fear of germs, while compulsions may be checking, hand washing, or cleaning.
Psychotherapy
As described by Weis, cognitive-behavioral therapy is the recommended type of psychotherapy for children with obsessive-compulsive disorder, or OCD. After determining the child's obsessions and compulsive behaviors, the therapist can create a "hierarchy of feared stimuli." Over the course of therapy, the therapist helps the child to experience the things he fears, starting with the least fearful and moving upward. During this time, the therapist prevents the child from completing the compulsion or ritual that goes along with their fear. For example, a child with a fear of germs, an obsession, who washes his hands, a compulsion, constantly would be exposed to some type of germs and not allowed to wash his hands. The idea is that being continually exposed to the obsession and learning not to utilize the compulsion helps decrease anxiety over time. Including some cognitive components of therapy such as helping children challenge the negative thoughts that come with their fears can also help to minimize anxiety.
Weis reported several research studies including a study in the "Journal of the American Academy of Child and Adolescent Psychiatry" (1998) and by the Pediatric OCD Treatment Study Team (2004) in the "Journal of the American Medical Association" that indicate that cognitive-behavioral therapy is effective in minimizing anxiety in children with OCD.
Medication
The use of medication to treat OCD in children has been supported through research. Weis described research from the book "Phobic and Anxiety Disorders in Children and Adolescents" (2004) showing that both selective serotonin reuptake inhibitors, or SSRIs, and tricyclic antidepressants can minimize the symptoms of OCD. In particular, he reported studies from the "Journal of the American Academy of Child and Adolescent Psychiatry" in 1992 and 2001 that found that children who used the tricyclic Anafranil, or clomipramine, and the SSRI Prozac, or fluoxetine, showed a 75 percent improvement in symptoms over children who took a placebo. Currently, the U.S. Food and Drug Administration has approved three SSRIs to treat OCD in children: Prozac, or fluoxetine; Zoloft, or sertraline; and Luvox, or fluvoxamine. Other medications including anti-anxiety medications, or benzodiazepines and beta-blockers may also be used to treat anxiety.
Combination Treatment
Treatment of anxiety often begins with therapy, with medication added as an adjunct. The combination of both types of treatment appears to provide a well-rounded approach to treating OCD. Weis reported that the Pediatric OCD Treatment Study Team (2004) found that children between the ages of 7 and 12 with OCD examined the effects of therapy alone, medication alone, and combined treatment. Findings demonstrated that children improved with both types of treatment, but those who received the combined treatment showed the greatest improvement in their symptoms.
References
- "Introduction to Abnormal Child and Adolescent Psychology"; Robert Weis; 2008
- U.S. Food and Drug Administration: Questions and Answers on Antidepressant Use in Children, Adolescents, and Adults: May, 2007
- National Institute of Mental Health: Anxiety Disorders
