How do I interact with a child with OCD?

In My Humble Opinion
1

Yep, a kid. 5 years old. Some idiot of an uncle scared the bejeesus out of him with talk of “chemicals and germs” which will kill him. Now the poor kiddo is compulsively washing his hands and his toys, going into full panic mode when something touches the floor, and losing his marbles at school when another kid touches anything that belongs to him. He’s honestly afraid he’s going to die from chemicals or germs.

He is now seeing a psychiatrist and a counselor through school, who is helping him to work through his anxiety and OCD issues. So the medical advice/seek a professional stuff is taken care of.

What I’m wondering is how you, IYHO, would address this with the kid in person. When I’m babysitting and he starts sobbing because a toy touched the floor and he wants me to wash it, what do I do? Is it enabling his dysfunction to wash (or pretend to wash) the toy? How often? How often do I let him soothe himself by washing his hands, and how do I know when to stop him? How do I stop him without freaking him out?

I’m not his mom, so talking with his therapists for their advice is out. Mom doesn’t know what to do about it either, and isn’t getting concrete advice from the therapists anyway.

And can I just mention how PISSED I am at this uncle? This was the most mellow, affable, easy-going kid until three months ago. Now he’s a neurotic mess. (Although I do agree that this is evidence of a deeper issue like OCD, since a “normal” kid would simply shrug it off and go on eating mud.)

2

Having pretty much no experience at all with regard to this sort of thing, I am going to offer my uninformed opinion.

If I were taking care of a kid with OCD, my primary goal (well, beyond keeping him from hurting himself) would be to try to keep him calm, rather than trying to push him into normal behavior… If he’s going into full panic mode regularly, it’ll take less to get him to START panicking each time, since he’s already so anxious… or so goes my reasoning.

Could you put a clean sheet or something down on the floor for him to play on? If he knows that the sheet is “safe”, he may be able to avoid panicking if one of his toys hits the sheet rather than the floor. This requires convincing him that the sheet is clean enough and that it’s capable of protecting him and his toys from the floor, of course, but I think it could work.

As for washing his toys… if he has lots of them, maybe the ones that have fallen on the floor could be put in some sort of basket or box. Then you could establish that anything in the box will be washed every… well, some length of time that he’ll tolerate. Hour, half day, day, whatever. Right now, the issue is WHETHER you will wash his toy, and he can’t give up on that because he’s so afraid. If he knows that his toy will be washed, just not right now, it may be easier for him to handle the situation - just move on to another toy and wait, WhyNot WILL clean the other one. It also helps reestablish the idea that things don’t need to be washed ALL the time - just once in a while. And if he gets bored enough and calm enough, he may just start taking toys back out of the basket.

As for handwashing, I generally like the idea of employing a timer in some way - saying that he can wash his hands whenever he wants, but the water will turn off one minute after he originally turns it on. Or saying that he can’t go wash his hands more often than every thirty minutes. (again, or whatever time you think is best) For this one keep a timer running so you can tell him whether his time is up or not and how much time he has left, but don’t tell him about the time unless he asks.

My only real experience in this sort of thing comes from babysitting my sister, who made it her mission to be as difficult and demanding as possible when I was in charge. (Really! She admits it now!) So keep that in mind.

3

I’d see if there was a child behaviorist or some other specialist who’d talk with you and try to help you figure out ways to help this child get better. Look up a few specialists, and explain what the issue is, (you don’t have to name names, just tell them what you told us in the OP) and ask them if there is any way they might offer you some advice on how to help this child, explaining that you don’t want to cause him to regress. Is the child in some type of therapy, like play therapy? I hope he’s able to overcome this. :frowning:

4

elfbabe has some great ideas. She’s right, your first job is to make sure he’s calm.

5

:eek:

Go me!

6

elfbabe has it, for the most part.

I would only add that you should try to expose / prevent him from cleaning gradually, both in frequency and in magnitude (people with purity / pollution OCDs often have hierarchies of cleanliness, with some objects “dirtier” than others).

(I feel a bit hypocritical offering this advice since I haven’t been confronting my own OCD as much as I should.)

7

Thanks so much, elfbabe. Those sound like fantastic ideas which aren’t too hard to implement. I want to be as gentle as possible in supporting him to get better, without letting him run the entire household.

8

Just thought of something - if he doesn’t feel a sheet protects him enough, you could try a new vinyl shower curtain. Those are usually pretty cheap and would probably feel comfortably sanitary to him.

Anyway, glad I could help, and please let us know how the ideas work!

9

As a physician who has some rudimentary training in OCD but relies mainly on the opinions of experts, I just wanted to side with the author of post #2 re: Suggestions for just trying to ensure a calm, safe environment. You didn’t cause this kid’s problems, you can’t control the behavior, and you can’t cure the disorder. But you can provide a sense of safety and acceptance while setting reasonable limits.

Uncle didn’t cause this problem either. This would have cropped up regardless of what one relative said or did. OCD is definitely hard-wired in the brain.

A child psychiatrist is a good place to start, but a Behavioral and Developmental Pediatrician
(preferably Board Certified as such) is worth his/her weight in gold for this style of problem. Sadly they’re waaaay in short supply.

The combination of medication and behavioral therapy together seems to hold out the best hope for long-term behavior change. Don’t expect a cure.

10

Heeeey, isn’t SHE supposed to be sucking up to YOU? :wink: :smiley:

11

I have some leftover Thai food in the fridge. I think he’s angling for it.

12

and this probably does’t need to be said, but respect the child. He cannot “help” the anxiety engendered by his OCD–he also sounds pretty young(?). Try to avoid criticizing. judging etc (not that you would, just saying).

My daughter has OCD, but it manifests itself in different ways. It came to light just last year (she is now 15). It has been hellish, but workable. Hers is a mild case, from all accounts. Meds help somewhat, therapy does too, but at the end of the day-it is up to her. Sounds like this lil guy is not quite ready for full responsibility etc. I third what elfbabe says. I like the timer alot-takes the onus off you and makes for a structured approach to a constant problem.

good luck!

What of parental input here? What say the parents?

13

As the mother of two daughters who were both diagnosed with severe OCD by the age of 5, I appreciate that you want to help. What I would recommend is that you ask the parents of this child what they want you to do with regards the child’s environment. It is generally best not to provoke anxiety the child is ill-equipped to deal with, but at the same time, enabling the behavior is also not a great idea. Without medication, a child of 5 is unlikely to make much progress with behavior therapy–she’s just too young to understand.

My daughters were able to get control of OCD using John March’s protocol for cognitive behavior therapy–but with medication. In a very small nutshell, this protocol calls for gradually increasing the amount of anxiety the child deals with until the stimulus loses the effect of causing anxiety. All of this is done with the child’s cooperation and knowledge of what is going on with the brain. I don’t know if this is what is being done with this girl, but it does work.

But the important point is that to cause too much anxiety would be extremely counter-productive. Ask the parents how to respond, as I’m sure they will have discussed these things with the child’s therapist. With my daughter the washer, I would generally allow her to wash her hands once and any repeated requests to wash were discouraged, but again, ASK THE PARENTS.

14

I would advise against 52 card pick up.

15

The boy’s mom is a very young, single mother with no support from her family to speak of. Nevertheless, she is a wonderful mother, just inexperienced. She wants me to tell her what to do. I want her to ask the child’s therapists. Frankly, I think she’s very intimidated by them, because she doesn’t seem to come away with any concrete advice or techniques. Either they’re not informing her, or they’re not making sure she understands well.

While I don’t intend to replace or become another therapist, I do want to help keep him as calm as possible during my time with him and share with the mom anything that works. She’s given me a total green light to try any techniques I feel appropriate - which is a little overwhelming since he’s not my kid!

Madd Maxx —> :smiley:

16

That being the case, I’d advocate reading some of these. Also, the online support list at the OC foundation web site was a tremendous asset to me when my daughters were diagnosed. I don’t know if Drs Jenike and Claiborn still post over there, but you will undoubtedly find advice from some of the list parents.

Anything you can read about Exposure Response Prevention will be helpful.

17

There was an interesting article in the NY Times magazine today about OCD that has a rapid onset in children, like the boy you asked about. Some people think it has something to do with strep throat. Anyhow, here’s the article; it’s called Can You Catch Obsessive-Compulsive Disorder? . If the boy may have had strep throat around the time he visited his uncle, you should read this (and even if he didn’t, it’s an interesting article).