Whose side are you on?
So: So: you’ve got a child who worries a lot. You’re doing your best to support them, to help them let go of the troubling thoughts that intrude and command their attention. You try and respond to their need for near-constant reassurance that everything is okay, or that the terrible thing they are sure is going to happen isn’t actually going to happen. You wait (and wait) before heading out the door or starting a meal so they can just check something once, twice, three more times. You notice that they run through a mental checklist while going about their day, or that they have to arrange certain items just so; otherwise, they don’t feel quite right.
Of course, there’s a whole lot we can chalk up to the pandemic; all of us – kids included – are figuring out how to work through justifiable feelings of anxiety and depression. But there’s a part of you that wonders if what you’re seeing at home is more than just that. These behaviors you see your child doing are starting to interfere with other stuff: getting places on time (or at all), eating while the food’s still hot, interacting with others, finishing routine tasks, or going to sleep at a reasonable hour.
If any of this sounds familiar to you, it’s possible that your child is displaying signs of obsessive-compulsive disorder (OCD). The need for so much reassurance, the checking behaviors, the mental checklists, the need to arrange just so – in the parlance of OCD, these are referred to as rituals. Rituals, in this case, are actions that kids come to feel they must do (actions they feel compelled to do) in order to quiet those intrusive (obsessive) thoughts that just won’t stop. It’s how they protect themselves (or, in their minds, possibly others) from harm.
The problem, of course, is that they don’t really work.
The rituals that are integral to the upkeep of OCD may have a temporary calming effect, but they do nothing to challenge the underlying irrational and obsessive thoughts, so those thoughts just keep on coming. They do nothing to challenge your child’s belief that the wave of distress that would come at them if they didn’t perform the ritual would simply be intolerable -- that it would crush them.
The truth, of course, is that it won’t.
When a parent sees their child in distress, the overwhelming instinct is to do whatever she or he can to ease that distress. But the accommodations parents make to enable their child to carry out his or her rituals – accommodations like waiting for checking behavior to be completed, or excessive handwashing to finish, or for mental checklists to be completed, or helping to arrange every last figurine just so – those accommodations do more harm than good. It essentially puts the parent on OCD’s side – not on the side of promoting healthier, more adaptive strategies for managing anxious thoughts and feelings.
Children who struggle with OCD can absolutely learn how to free themselves from the grip of unwanted, obsessive thoughts and the rituals they’ve come to rely on for momentary relief. But they can’t do it alone. They need you on their side – not OCD’s side. Here’s how:
1. Bring in some back-up
There are treatments available for children who suffer from OCD. The go-to treatment is formally known as Exposure and Response (Ritual) Prevention Therapy, or Exposure Therapy for short. The idea, in a nutshell, is to expose kids – slowly, but surely – to the very things they obsess about and teach them how to cope with the distress they feel when they have to face those fears without the comfort of their chosen ritual. What kids learn through Exposure Therapy is that this thing they’ve been obsessing over, this deeply felt irrational fear, will not come to bear. They learn they are strong enough to tolerate distress. They learn that distress fades, eventually, and that life goes on. They learn, essentially, that the intrusive, persistent voice in their head telling them to be scared, to check just once more – well, maybe twice, or three times, or four times more – was just smoke and mirrors. That the Emperor has no clothes. That the Wizard of Oz is just a man behind a curtain with a microphone.
There are clinicians who know how to effectively deliver Exposure Therapy. Find one. Get yourself some back-up.
2. Engage in some real talk
Once you get established with a clinician trained in delivering Exposure Therapy, you’ll talk a lot about your child’s obsessive thoughts and the rituals they perform as a way to get those thoughts to stop, even for just a little while. Don’t hold back on the real talk about how you have helped accommodate your child when they feel compelled to perform their rituals. There’s nothing to feel badly about here: whatever you did you did out of love, out of a desire to try and make things easier for your child, or to just get through the day. When you make clear the part you’ve played in maintaining (inadvertently!) the OCD, your child’s therapist can give you specific guidance about what to do instead, so that you’re playing for your child’s team – not OCD’s team.
3. Cheer for the home team
Your child’s therapist is going to give you clear instructions on how to support your child through their exposures and how to support your child in their effort to try out new ways of tolerating distress. Your child can do this, and if they have you on their team… all the better. Keep in mind that therapy is rarely a linear experience. Progress is bound to stall out at points. That’s another place for you to come in. You can validate for your child how hard it can be to do this work. You can let them know that you see that they’re trying, that you are rooting for them and that you’re there.