OCD--I suspect a child has it. What do I do now?

[Harriet Vane]

Asking for a friend (and will delete later for privacy):

 

My friends suspects her little one (6yo) has OCD or tics or some such. She has a need to smell her hands and/or touch her nose a LOT. Sometimes it's only every ten minutes or so, but other times (particularly later in the day when tired) she will touch her nose every 30-60 seconds.

 

Friend has tried gently holding her hands, but she will pull her hands away in order to touch her nose.

 

When playing a chasing game she paused in the heat of the chase with the lava monster bearing down on her to touch her nose.

 

For a while friend thought the child was picking her nose a lot or wiping a lot due to allergies. However, child is currently doing pretty well with minimal congestion, but still touching her nose a ton.

 

Previously friend observed child looking up a lot in a characteristic, recognizable pattern. Child would flip her eyes up and back without seeming to realize she was doing it. Lasted only a second, but happened often. Child was fitted for glasses because she also has strabismus with mild nearsightedness, and child will have surgery several weeks from now. Repetitive behavior was assumed to be part of her strabismus, but now friend is wondering if it was a tic or OCD behavior.

 

Child is in foster care. There is no way to know if similar behaviors were ongoing or if this is out of a clear blue sky.

 

What type of evaluations/doctors should my friend pursue? Any resources for reading and research?

 

Thanks.

Edited February 23, 2018 by Harriet Vane

[umsami]

Talk to her pediatrician first.

 

CBT can sometimes be helpful with OCD.    There are also some meds, but I don't know if they are used with children.  

 

 

[Mergath]

I would probably get a referral to a neurologist to rule out anything neurological, to begin with. Then if that all came back clear, I'd probably try to find some kind of mental health professional who specializes in treating anxiety disorders in kids. I'd probably start with CBT, but if that didn't help I wouldn't hesitate to try meds if I could find a good psychiatrist to work with. OCD can become debilitating quickly.

[Pen]

IME friend should contact both the child's social worker and pediatrician, asap -- both can probably make further referrals for possible psych type evaluations, but it could also be a physical thing like even some form of epilepsy (eyes flipping up and back?) or just nasal discomforts (nose touching), or.... Social worker may know if it is ongoing or if it is new.

 

Chasing games requiring getting into a car might not be a good idea both for physical reasons and possible emotional PTSD that could be triggered.

 

There also could be more than one thing going on.

[klmama]

FWIW, the eye thing sounds like something several kids I know have dealt with.  One improved the eye flipping by eating more magnesium-rich foods. One went on some kind of medication.  One still does it, and I don't know if they've tried anything to alleviate it.  All have struggled with anxiety, too, but I'm not sure if that is related or not.  The one who eats a lot of magnesium foods seems to be the least anxious.  

 

 

 

 

[Selkie]

That sounds more like tics than OCD compulsions to me.

 

Dh ticced as a child and so did one of our boys. Our ds started ticcing around age 5, and the tics would periodically come and go over the next few years until he eventually grew out of it. It was mostly blinking, shrugging, sniffing, stuff like that. Oh, he did the hand smelling thing for a while, too. His tics were mild and didn't interfere with his life. He would tic more when he was tired or stressed, and he always ticced more at home than he did out in public. We explained to him what tics were but never made a big deal of it or told him to stop. (Dh has bad memories of his mom being very critical and trying to force him to stop ticcing as a child. He said that the urge to tic feels a lot like an itch that needs scratching, and it's very difficult to try to suppress that urge.) 

 

I would check with her doctor to rule out anything more serious, but if it is tics, I would just let her tic away as long as it's not negatively affecting her life. Chances are, the tics will wax and wane for a few years and then mostly or completely disappear. Definitely do not shame her or try to make her stop.

 

Edited February 22, 2018 by Selkie

[mlktwins]

Maybe look at PANDAS - blood test for strep. That can cause tics.

[MEmama]

I had tics as a child. I don't recommend doing what my mother did, which was to take me to a quack therapist friend who tried to hypnotize me (!).

 

I agree with a pp who recommends definitely no shaming. A trip to the pediatrician is where I would start, possibly to help figure out any potential underlying anxiety issues.

[Harriet Vane]

IME friend should contact both the child's social worker and pediatrician, asap -- both can probably make further referrals for possible psych type evaluations, but it could also be a physical thing like even some form of epilepsy (eyes flipping up and back?) or just nasal discomforts (nose touching), or.... Social worker may know if it is ongoing or if it is new.Chasing games requiring getting into a car might not be a good idea both for physical reasons and possible emotional PTSD that could be triggered.There also could be more than one thing going on.

FTR child was not traumatized in the least by the game, which was just silliness in the driveway. Lots of giggling and really no safety or triggering issues.

[Kathryn]

Sounds like tics to me also. IDK if it's related, but my ADHD son went through a nose-touching tic for about a year when he was 6. He literally wore the skin off several times.

[Storygirl]

That sounds more like tics than OCD compulsions to me.

 

Dh ticced as a child and so did one of our boys. Our ds started ticcing around age 5, and the tics would periodically come and go over the next few years until he eventually grew out of it. It was mostly blinking, shrugging, sniffing, stuff like that. Oh, he did the hand smelling thing for a while, too. His tics were mild and didn't interfere with his life. He would tic more when he was tired or stressed, and he always ticced more at home than he did out in public. We explained to him what tics were but never made a big deal of it or told him to stop. (Dh has bad memories of his mom being very critical and trying to force him to stop ticcing as a child. He said that the urge to tic feels a lot like an itch that needs scratching, and it's very difficult to try to suppress that urge.) 

 

I would check with her doctor to rule out anything more serious, but if it is tics, I would just let her tic away as long as it's not negatively affecting her life. Chances are, the tics will wax and wane for a few years and then mostly or completely disappear. Definitely do not shame her or try to make her stop.

Not really replying to your comment, but using them as a jumping off point.

 

One of my children has a tic disorder. I agree that trying to make the person stop doing it won't help. However, there are actually some options for addressing them, so it's worth discussing with the doctor.

 

Tics do wax and wane, but for some people, they can be severe, and they can persist throughout life. Our neurologist said that in 1/3 of people, the level of tics remains the same; in 1/3, tics decrease over time; and in 1/3, they get worse. But there are some medications that can be tried. And there is a technique called Habit Reversal that people can use to help control their tics. It doesn't work for all people, but it is an option to look into, if it is determined that a tic disorder is present.

 

[Maus]

The difference between tics and OCD (and stimming) is the motivation behind them, so an evaluation is important.  My youngest constantly smells her hands, and she does it because she is checking for germs, and germ-checking is OCD.  But I touch my face without realizing I'm doing it when I'm feeling socially anxious.  DH pulls out his beard hairs, and that could be Trichotillomania, which is more of a tic, but it appears that in his case, it's actually a form of self-harming, which would be his OCD w/ depression combo.

 

Anyway, why the individual is doing something is more important to the diagnosis than what they are doing, so get an evaluation.

 

The most thorough evaluation would be from a pediatric neuro-psychologist, but it getting insurance to pay can be an issue.  (Though I've heard that's improved in the last year or two.) 

 

A pediatric psychiatrist can do an initial diagnosis, and is the best choice for prescribing, adjusting, and monitoring medications. 

 

A psychologist with experience with children with whichever diagnosis shows up will be the best choice for CBT.  (For instance, our family psychologist treats OCD and is a great fit for DH, but he helped us find another therapist who works with autistic kids who also have OCD for our youngest.)

 

(I'm just a mom of complicated kids, not a medical professional, but one thing from the OP's story that struck me was that the child stopped a fun activity to engage in her behavior.  That is the kind of thing I was asked about when my kids were getting diagnosed.)

 

My youngest constantly smells her hands, and she does it because she is checking for germs, and germ-checking is OCD.  But I touch my face without realizing I'm doing it when I'm feeling socially anxious.

[Pen]

FTR child was not traumatized in the least by the game, which was just silliness in the driveway. Lots of giggling and really no safety or triggering issues.

 

 

I'll accept your view that there were no triggering issues.

 

But not that play involving vehicle is safe -- even just because it teaches a child that it is safe to play around and in cars.

 

I personally know children who were injured from what seemed like fun and harmless play in and around a parked and thus seemingly safe car.   The injuries I personally know of were mainly fingers caught in door of the car.  

 

But there have also been deaths, and I indirectly know someone who accidentally killed a child who thought that playing a hiding game near a parked vehicle was safe.  When he got in to drive away he ran over the child who was crouched behind it hiding unbeknownst to him.

 

Here is an example website on the matter, with some quotes from it. The bold on the last one was added by me:

 

http://www.childcarseats.org.uk/related-issues/children-in-and-around-cars/

 

"It is also important to remember that cars are not a safe place for children to play. ...

As every parent knows, young children can easily escape your supervision for a short time and get into difficulties before you even realise they have moved. It's a good idea to educate children so that they know not to play in or around parked cars.

...

 

 

Discourage children from playing, hide and seek for example, in and around parked cars.

...

 

 

One of the main issues identified was that parents and carers do not think an accident will happen to their family, unless they know someone who has already experienced one, meaning they do not take simple precautions."

 

[Harriet Vane]

 

I'll accept your view that there were no triggering issues.

 

But not that play involving vehicle is safe --

 

I am at a bit of a loss as to how to respond to this lengthy response.

 

You were not there. You do not know the context, nor who was there, nor why the game was being played or what the parameters were.

 

The child in question was not in any danger, and that child is not being taught reckless behavior.

 

My question was about OCD and tics. The example of the game was simply to show the way the child’s compulsion to touch her nose overrides other activities.

 

If you have anything relevant to offer about the question I asked, that would be appropriate to post.

[Harriet Vane]

I was not there either, but it did seem a bit alarming to me that they were playing a game that involved running to and getting into a door quickly and closing it (be it a car or room). That just seems like a great way to smash fingers or clunk someone with a door (either the one catching up to the door or not). Of course, this is coming from the parent of a child that accidentally closed a car door on his own hand in a shopping center parking lot with no one chasing him. We went to the ER for x-rays that day.

 

I hope you get some answers. I believe I had or have OCD, although I was told by a psychiatrist that she thought I just had OCD tendencies. Maybe she once heard something silly like the whole, "if you step on a crack you'll break your mother's back" but something like, "if you don't touch your nose often, then something bad will happen." I mean there are a million reasons someone may do something... that's why I suggest they ask the child about it. My mom finally asked me once why I stopped wearing one of my favorite shirts (I was in elementary school). I admitted I thought it was dirty (in my mind it was, but it wasn't). Some of the things that I thought were so embarrassing to say aloud I would have never told anyone unless they sat down and had a chat with me.

I appreciate your willingness to share your experience.

 

I do not want to derail the thread away from the original question, so I will to address the car play question.

 

As someone who has worked extensively with both foster children and domestic violence victims, I would like to challenge the notion that car play is dangerous play.

 

It can be dangerous if the keys are left in the car with the child. It can be dangerous if the child is strapped in on a hot day. It can be dangerous if someone’s fingers are smashed.

 

But conversely a locked car might be the safest place for someone small and vulnerable when an aggressor is threatening to harm them. And it is totally possible to teach a child proper parking lot manners AND use games to teach that child how to use the car as a safe place in an emergency. Games help the child learn the necessary skills and reflexes without triggering trauma and fear.

 

So please just trust that the child in question is not being taught reckless behavior. No other children were present at the time. The child was completely safe. And I would prefer to keep the thread focused on the concerns about tics and OCD.

[Pen]

Well, back to suspected tics and OCD, I think your friend needs to make appointments with medical professionals to get the child evaluated to find out what is going on. There may be more than one thing.

 

I also agree with HeartlikeaLion that asking the child her own reasons for what she does makes sense.

 

It might help to take some film footage of the child doing the nose touching, hand smelling, and the upward eye movement  thing as perhaps that could help the medical doctor. Especially in case it were to not happen in front of the doctor so that he or she could see it directly.  

 

It should also probably be relayed to the surgical team for the child's upcoming surgery in case it is relevant to the surgery.

 

Social worker might be able to learn something about if the movements are ongoing, if there is any contact with prior homes, bioparents, or medical workers.  In any case, reporting it now to social worker could help if there are future placements, for it to be known that it is something going on at this time. And social worker may play a part in setting up or approving a thorough evaluation, possibly.

[Pen]

The difference between tics and OCD (and stimming) is the motivation behind them, so an evaluation is important.  My youngest constantly smells her hands, and she does it because she is checking for germs, and germ-checking is OCD.  But I touch my face without realizing I'm doing it when I'm feeling socially anxious.  DH pulls out his beard hairs, and that could be Trichotillomania, which is more of a tic, but it appears that in his case, it's actually a form of self-harming, which would be his OCD w/ depression combo.

 

Anyway, why the individual is doing something is more important to the diagnosis than what they are doing, so get an evaluation.

 

The most thorough evaluation would be from a pediatric neuro-psychologist, but it getting insurance to pay can be an issue.  (Though I've heard that's improved in the last year or two.) 

 

A pediatric psychiatrist can do an initial diagnosis, and is the best choice for prescribing, adjusting, and monitoring medications. 

 

A psychologist with experience with children with whichever diagnosis shows up will be the best choice for CBT.  (For instance, our family psychologist treats OCD and is a great fit for DH, but he helped us find another therapist who works with autistic kids who also have OCD for our youngest.)

 

(I'm just a mom of complicated kids, not a medical professional, but one thing from the OP's story that struck me was that the child stopped a fun activity to engage in her behavior.  That is the kind of thing I was asked about when my kids were getting diagnosed.)

 

My youngest constantly smells her hands, and she does it because she is checking for germs, and germ-checking is OCD.  But I touch my face without realizing I'm doing it when I'm feeling socially anxious.

 

 

I agree with this.  And in addition an evaluation is important because it may be something different than tics or OCD.