Treating OCD in Children

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Does Your Child Have Obsessive-Compulsive Disorder?

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The most successful treatments for children with OCD are behavioral therapy and medication. Cognitive-behavioral psychotherapy (CBT) helps children learn to change their thoughts and feelings by first changing their behavior. CBT involves exposure, or exposing the child to his fears to decrease his anxiety about it. For example, a child who is afraid of dirt might be exposed to something he considers dirty until he no longer fears it.

For exposure to be successful, it is often combined with response prevention, in which the child's rituals or avoidance behaviors are blocked. For example, the child who fears dirt must not only stay in contact with the dirty object, he also must not be allowed to wash repeatedly. Some treatment plans involve having the child "bossing back" the OCD, giving it a nasty nickname, and visualizing it as something the child can control.

Behavioral treatment with children works best when the whole family is involved, according to Dr. Sheslow. "Treating children from a behavioral perspective requires a high degree of cooperation," he says. "Without a considerable amount of family support, you won't have a high rate of success. Because cognitive behavioral treatments often provoke considerable anxiety, a good deal of support is needed. As well, it is important to find a therapist who knows about how to treat OCD. OCD can worsen if not treated in a consistent, logical, and supportive manner."

Medication for OCD in children is often combined with CBT to get more complete and lasting results. Research shows that selective serotonin reuptake inhibitors (SSRIs) are most effective in children with OCD. These include medications such as fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), and sertaline (Zoloft). Another medication that may be prescribed is clomipramine (Anafranil). Most experts agree that medication should be used to treat children as a second choice to CBT. "Medication often can reduce the impulse to engage in ritualistic behavior. Therapy will help the child and family learn strategies to manage the waxing and waning of OCD symptoms," Dr. Sheslow says.

"Many children can do well with CBT alone, others will need a combination of behavioral therapy and medication. It's important to use the treatments appropriately to avoid the long-term adverse effects of OCD on children's development," Dr. March says.

Does Your Child Have Obsessive-Compulsive Disorder?

cont.

Treating OCD in Children

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