The American Academy of Child and Adolescent Psychiatry (AACAP) states that OCD is found in as many as 1 in 200 children and adolescents. The behaviors of OCD severely impact their ability to successfully function in school and at home, and they interfere with socialization. Medication may help, but therapeutic activities are the key to treating OCD.
Symptoms
Obsessions are persistent anxiety-causing thoughts or images. Compulsions are repetitive behaviors related to the obsession. These behaviors turn into rituals that must be completed before the child can move on to do anything else. Common obsessions for children revolve around fears of being harmed, fear of a parent dying and fears about illness or germs. A related compulsive behavior might be constantly washing their hands to be rid of the germs. Other common rituals revolve around arranging toys or objects in a specific way and hoarding items. These behaviors can't be controlled and they consume time and attention, leaving children unable to focus or complete tasks.
Therapy Factors
The child's age can create challenges to implementing therapy. Depending on their level of development, children may not be able to make the connection between obsessions and compulsions. Younger children may also have a hard time describing their fears and may not understand why they perform compulsive rituals. At any age, they are less motivated to engage in work now for a future benefit that they don't fully comprehend, and their potential anxiety over entering treatment may render them less able to participate. Still, therapeutic activities are critical. The AACAP states, "The younger the child, the more one would first attempt a non-pharmacological treatment such as cognitive-behavioral treatment."
Cognitive Behavioral Therapy
Cognitive behavioral therapy uses structured activities such as a workbook, daily or weekly activity sheets, maintenance of a diary, and specific assignments. The goal is to record anxiety-producing thoughts, feelings and behaviors so that the information can be reviewed later with the therapist. In this way children learn to recognize the negative obsessions and compulsions and can begin to learn to replace them with positive thoughts and behaviors.
Exposure and Response Therapy
The first activity in this therapy is to create a list of all of the child's fears and related rituals. Then, beginning with the one that causes the least anxiety, the child is purposefully exposed to whatever triggers the fear. They are always with someone trained to help them through the anxiety, and most importantly, to prevent them from performing the compulsive behavior. When their feared consequence doesn't happen, they learn that their fears are not based in reality and their anxiety goes down without having performed the ritual designed to relieve it. Frequently repeating the exposure and preventing the response results in decreasing the anxiety until eventually the obsessions stop.
Cognitive Restructuring
This therapeutic activity gives children and adolescents a tool to help manage their anxiety. They are taught to realistically relabel their thoughts and actions. For example, they may learn to say, "I will not get sick from touching the doorknob, that's just my OCD talking." These statements are reinforced by activities such as using a graph to rate the level of anxiety. This provides immediate feedback and helps the child better manage their response.
Behavioral Rewards
This method provides a way to show progress and motivate children to continue the therapeutic activity. A chart is created with spaces to indicate the specific number of times a therapeutic task must be completed to achieve a reward. Stickers or even a simple check mark are placed in the space for each success, and when the spaces have been filled, the reward is given. For younger children, a more immediate but small reward (piece of candy, TV time) may be used in addition to the marks on the chart. Over time, the rewards should be phased out and replaced with simple praise and encouragement.
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