The Study of Disabilities in Infancy and Early Childhood

Overview

Obsessive-Compulsive Disorder (OCD) is a common neuropsychiatric disorder characterized by the presence of obsessions and/or compulsions that are time consuming and cause distress or interference in the patient’s life (American Psychiatric Association, 2000). OCD affects all age groups independent of race, socioeconomic status or religion. Moreover, OCD has been estimated to cost approximately 8 billion dollars per year in the US (Hollander et al, 1998). Despite being frequent and disabling some studies suggest that almost 60% of OCD patients wait too long to seek treatment or do not receive treatment due to a lack of health professionals trained to identify OCD (Alvarenga PG, 2012, p. 1).

Scientists understand that Obsessive Compulsive Disorder is a neurobiological illness, caused by an imbalance in certain brain chemicals. Although the precise cause is not fully understood, the disorder appears to be at least partly genetic and, in some cases, may be activated by a strep infection. OCD is not caused by a parenting style, nor is it a sign of misbehavior or lack of self-control. Stress does not cause OCD, although a stressful event or life change can trigger its onset. Like most illnesses, the disorder is sensitive to stress, and a stressful event may worsen symptoms or lower a child’s ability to cope. The age of onset for children can be as young as three years old when there is a strong family history of OCD. More commonly, symptoms begin at around 10 years of age. Boys tend to develop OCD between the ages of seven and 12, while girls more frequently develop symptoms in adolescence.

When a child has OCD, the area of the brain that filters information tends to malfunction, causing the child to focus on thoughts that normally are easily dismissed or ignored. Abnormalities in a brain chemical called serotonin may be at the root of the disorder. The medications that have proven most effective in treating OCD affect the serotonin systems. Scientists believe some children are genetically predisposed to develop Obsessive Compulsive Disorder. Approximately 20 percent of all kids with OCD have a family member with the disorder (Obsessive Compulsive Foundation of Metropolitan Chicago, 2006, pp. 11-12).

With the increased recognition of the prevalence and severity of obsessive- compulsive disorder (OCD), increased attention has been devoted to its assessment and treatment in recent years. Currently, several different methods are used to assess obsessive-compulsive symptoms, including diagnostic interviews, clinician administered inventories, self-report measures, and parent- report measures. The use of structured diagnostic interviews for the assessment of pediatric OCD is quite common in research studies (but not uncommon in general clinical practice). Diagnostic interviews facilitate diagnostic decisions by utilizing specific questions to assess symptoms according to Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) criteria. The use of a clinician-rated inventory allows trained individuals to make informed ratings of OCD related impairment and distress in comparison to cases they have seen. Perhaps the most commonly used assessment instrument within clinical and research settings is the Yale- Brown Obsessive-Compulsive Scale (YBOCS) and its counterpart for children, the Children’s Yale Brown Obsessive- Compulsive Scale. Self-report measures have several advantages in OCD assessment as they can generally be completed quickly, independently, and administered to a number of individuals at once. They are useful as screening questionnaires, and are often employed to identify potential research participants and candidates for treatment. To supplement the above measures, other questionnaires are often given. In children, it is very common for parents to rate their child’s behavior on questionnaires such as the Child Obsessive Compulsive Impact Scale or the Children’s Obsessional Compulsive Inventory. The former assesses the presence and severity of symptoms; the latter queries impairment related to OCD. Questionnaires about family involvement in symptoms, such as the Family Accommodation Scale (FAS), are also commonly given to family members (Storch, pp. 1-2).

OCD in children can be effectively treated. Although there is no cure for OCD, cognitive-behavioral therapy (CBT) and medicines are effective in managing the symptoms. Experts agree that CBT is the treatment of choice for children with OCD. Whenever possible, CBT should be tried before medicine with children. Using a CBT strategy called exposure and response prevention (ERP), children with OCD can learn that that they are in charge, not OCD. They can learn to do the opposite of what the OCD tells them to do, by facing their fears slowly in small steps (exposure), without giving in to the rituals (response prevention). ERP helps them find out that their fears don’t come true, and that they can habituate or get used to the scary feeling, just like they might get used to cold water in the swimming pool (Wagner, 2009, p. 2).

The medicines used to treat OCD in children are antidepressants called selective serotonin reuptake inhibitors (SSRI’s). Medicines should only be considered when the OCD symptoms are moderate to severe. There is no one “best” medicine for any child because the medicines affect each person differently. Your child’s doctor will decide which medicine to try. The medicines take some time to act, so it is important to wait for 10-12 weeks for the full effect. Although medicines may decrease OCD, the symptoms often return when the child stops taking medication (Wagner, 2009, p. 2).

It is normal for many young children to have routines at mealtime, bedtime or when saying goodbye. These common routines lessen as children get older. For children with OCD, the routines continue past the appropriate age, or become too frequent, intense or upsetting, and begin to interfere with the child’s daily life. OCD can make daily life very stressful for children. Rituals usually take a lot of time, and children often are late for school or activities. This often results in tension or arguments in the family. Children are unable to enjoy time with friends or have fun when OCD takes up all their spare time. At school, obsessions and rituals such as checking, erasing and re-doing assignments affect attention and focus, completion of tasks and school attendance. Children with OCD often have lengthy bedtime rituals that they feel must be completed. They therefore go to bed late and are tired during the day. All this stress may make them sad, angry or explosive (Wagner, 2009, p. 1).

Family History and Cultural Background of the Case Study

Michael is 3 years old student, who attends private preschool. Michael’s family consists of four people, his mother, father and baby sister who is 2 years younger than Michael. Michael’s mother is a public-school teacher, but currently she stays home with Michael’s sister and come’s to pick up Michael from school. Michael has wheat gluten allergy and every day brings to school special meals, cooked by his mother. At school, boy attends art and Russian language classes. The boy is growing up in the loving and caring atmosphere, still, since the birth of his sister several changes in his behavior were observed by his family members and child care workers.

Case Study

Often, in the morning Michael struggles come into the classroom. As soon as his mother or teacher open doors, Michael screams and runs away. He runs into the office, where one of the managers, miss Sophie suggest him to see how children behaves in the other classrooms, after a short walk, the boy comes into the classroom without problems. The similar story happens in the evening, when the boy does not want to leave the classroom, at this time he runs away to his teachers as soon as he sees his mother came to pick him up.

Sometimes, the boy demonstrates an anxiety when he gets messy, he has a history of having washing hands routines in previous classroom, but as soon as the child learned how to count, he does it all the time. He counts the pieces of steak or vegetables in his plate at the lunchtime, counts steps from the table to the bathroom, counts crayons and organizes them by color, counts objects on posters on the walls. Michael never sleeps at the naptime, and often has accidents because he is that busy with counting stars on the curtains, so he forgets about his need to use a bathroom. After 6 months of such behavior, Michael was evaluated and currently is getting early intervention services. Michael enjoys math, sequencing activities, always participate in cleaning up the classroom and enjoys helping his teacher and friends. At the same time, the child easily get distracted during the story time, drawing and practice for writing skills. He may start counting objects on the page of the book and become extremely upset when teacher flips that page.

To support Michaels learning teacher can minimize triggers, for example instead of giving the boy opportunities to work with manipulatives, provide him with a sensory activities such as play-doh or kinetic activities, or instead of putting the whole bin with crayons on the table, ask students to choose one specific color. The other way to help student during activities is to keep refocusing him to the task through the questions and discussions. For example when the boy starts counting objects on the wall, his attention must be redirected on the picture in the books. The tasks which require long-time concentrations must be divided into smaller ones. Initially the amount of time required for a task should be in keeping with the child’s natural ability to sustain attention. Then, using positive reinforcement and in some cases a timer, the time on task requirement can be increased (Cook, Klein, & Chen, 2016, p. 300).

Activities based on visual and kinesthetic learning styles, which are widely used in preschool programs are not the best methods for Michael, because he tends to count everything he can see, touch, hold. But during the songs and dances, the boy can stay focused on the task, and at the same time let his energy which could turn into compulsive behavior out. While singing he can shout the words, and also he is an active dancer. So, activities where he supposed to close his eyes and listen,or say something in different voices must be effective for this particular child. Testing and related services must be conducted in accordance with Michael’s needs in having a minimum of possible triggers in the task and opportunity to be redirected with a help of teacher.

When Michael demonstrate compulsive behavior while playing with his peers, usually they find it funny and start counting with him, others just leave him and start playing different toys and games. They are still young children, but later Michael’s behavior can bring more problems into his social emotional development. Teacher can support the child redirecting him on the subject of play, asking questions and reminding that in the particular situations counting is not necessary. The family must be also informed about the strategies used in the classroom. Michael struggles in the morning because he counts cubbies or other students works in the hallway and gets interrupted. During the walk with miss Sophie he finishes counting -this can also be turned into effective strategy. Before ask Michael to complete the task which requires higher concentration, let him finish to count. Teacher can also try to suggest the child finish counting later and this way, refocus him to the assignement.