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Behavioral Therapy Can Treat Childhood Disorders
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Published: August 23, 2008
Betty Ray had had it with her son Nathanial's behavior.
The then-10-year-old boy was guilty of what seems an unimaginable crime: He wouldn't stop telling his parents "I love you."
How much is too much? One night, she counted him declaring his feelings 60 times. In 30 minutes.
"It's great to hear your child tell you that, but when you can't finish a sentence because he's interrupting you, it can be challenging," she says.
Nathanial's behavior, which also included constant apologies and a fear of stepping on cracks on the floor, are good examples of obsessive compulsive disorder, an anxiety-induced mayhem that consumes a person's thoughts and affects behavior in constant, repetitive ways. An estimated 2.2 million American adults suffer from it, the National Institutes of Health says.
It's not hard to find adults with OCD. Just look at game show host Howie Mandel, who says his fear of germs and dirt prompt him to avoid shaking hands with "Deal or No Deal" contestants. But identifying it in children doesn't seem as clear cut. Depending on their age or time of day, it seems most children are obsessed with something: their appearance, what they eat, a bedtime story routine.
Those behaviors are perfectly normal, as long as the obsession doesn't distress the child or impair involvement in ordinary life, says Eric Storch, a University of South Florida associate professor of pediatric psychiatry.
"The key question is: Does it screw up their life?" asks Storch, who with Developmental Pediatric Professor Tanya Murphy recently launched USF Health's Rothman Center of Neuropsychiatry at All Children's Hospital in St. Petersburg. The center uses cognitive behavioral therapy as a way to diffuse or eliminate a child's obsessions and compulsions.
"We're kind of rehabbing the mind," Murphy says of the center, which also addresses other pediatric psychiatric disorders such as autism or Tourette's. Obsessive compulsive behavior is common in children with these disorders.
The weekly 90-minute therapy sessions don't involve lying on a couch and sharing feelings. Instead, the children are exposed to an extreme dose of what they fear, and a subsequent attempt to prevent a compulsive response. For example, a child with mysophobia (a fear of germs and dirt) will hold a messy tea party in the dirt with the therapist. The challenge for the child: avoid rushing off to wash his or her hands.
"We expose you to the fear and don't let you act out," says Storch, who moved his clinic work to USF from the University of Florida in Gainesville. "Your body is set up in a way that your anxiety will decrease over time."
Nathanial Ray, now 12, had to curtail showing affection to his parents and understand that he didn't need to be constantly reassured of their love. Betty Ray says he now says "I love you" just three times a day. His fear that something bad would happen if he stepped on a crack on the sidewalk was addressed by walking right on the crevices he feared.
"Did anything bad happen?" Storch would ask Nathanial, who lives in Orlando. "Let's see what happens."
Treating OCD with behavioral therapy is in a way like teaching a child to ride a two-wheel bike. The difference is that most kids aren't panic stricken by the thought of trying. And some of the fears are serious, such as the idea that constant prayers are the only way to prevent a tragic and untimely death.
Often, children in therapy also are on anti-depressant medications. Clinical studies, however, show that the medications are only part of a solution for OCD. When medication is paired with behavioral therapy, or when the therapy is the only treatment, between 80 percent and 90 percent of patients show significant improvement, a 2004 study in the Journal of the American Medical Association says.
Medication also doesn't help teachers, parents, friends and families who want to support a child trying to tackle obsessions, Storch says. Therapy sessions often involve parents so they can help the child respond to the fears at home.
"It's really about educating parents to know what to do," he says. "Then, you have a therapist at home."
Want to share your health and fitness idea? Contact me at (813) 259-7365 or mshedden@tampatrib.com.
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