Children with obsessive compulsive disorder arenâ€™t getting the treatment they need, either through misdiagnosis or a lack of trained therapists, says an expert who led a recent conference in Vancouver.
â€œOCD is a very real and disabling condition and there are effective treatments for it, but the two are not getting together,â€� said psychologist Alec Pollard, director of theCenter for OCD and Anxiety Related Disorders in St. Louis, Mo., and a professor at St. Louis University School of Medicine.
The problem is manyfold, says Pollard. OCD in kids might be labelled as attention deficit hyperactivity disorder (ADHD), or some other behavioural problem if a child acts out because of it. But it is often a hidden ailment in children who work hard to keep it secret. And even if a child is correctly diagnosed, parents may have a hard time finding a therapist knowledgeable about the latest treatments.
â€œMost people have bizarre, intrusive thoughts, but they just brush them off. A person with OCD will latch onto that thought,â€� said Pollard, noting that they will dwell on the violent, sexual or just plain weird image that popped into their mind.
These thoughts make them uncomfortable and anxious so they compensate with another action or thought to calm them. Irrational fears of contamination, lengthy washing routines, or constantly checking and re-checking for potential dangers are some OCD behaviours.
â€œItâ€™s a ping-pong game: an obsession comes in and they have to volley with a compulsion,â€� he says.
â€œIt used to be considered non-treatable.â€�
And whether in mild or severe form, itâ€™s more common than previously thought.
An estimated one in 100 adults and one in 200 children have OCD, although some research has placed it as high as three per cent among adults. Thatâ€™s why OCDbc, a group of concerned parents, helped sponsor participants at Pollardâ€™s three-day training session in conjunction with the Boston-based International OCD Foundation. Thirty mental health professionals from Canada and the U.S. attended the sessions in Vancouver â€” which wrapped up Sunday â€” with OCDbc picking up the tab for five B.C. therapists who would otherwise not have been able to attend. Ten other counsellors and psychologists from throughout the province paid their own pay.
OCDbc was formed last year to support the creation of an OCD centre of excellence at BC Childrenâ€™s Hospital under the guidance of psychiatrist Dr. Evelyn Stewart, who also participated in the conference. Stewart and Pollard employ a type of cognitive behavioural therapy called exposure and response prevention, or ERP, which has proven effective in controlled clinical studies.
The basic concept is to trigger the obsession and then convince the patient to wait out the anxiety without resorting to their old rituals.
Someone who fears contamination, for instance, would be encouraged to touch an offending object and then wait before washing. As time goes on, they can wait longer or train themselves out of the compulsion entirely.
â€œItâ€™s not as tortuous as it might sound,â€� says Pollard. â€œWe do it one step at a time.â€�
Because OCD often begins in school-age children, OCDbc also hosted two sellout half-day sessions for teachers, school counsellors and principals. It focused on how OCD could be at play in unexplained absenteeism, for instance, or incomplete assignments.