Dear Miss Faith,
My husband is has has Obsessive Compulsive Disorder (OCD) since puberty, and now my 4.5 year old son is showing some of the same signs. We have consulted a child psychiatrist who has said that it was too early to say anything, and it could just be imitative behavior. Lately, he has been washing his hands and changing his clothes repeatedly, saying they are dirty or sticky, demanding to change his clothes as he happened to step on his sister’s pj as he is concerned she might have peed in them at night. (she is 3.5 years old). He always has his own fixed spot on sofa or bed and will not sit or sleep there if someone else sat there first. He never eats or drinks from someone else’s plate. If while playing, I accidently touch a toy with my mouth, he has to go wash it. I stay at home with my 2 kids, and I wonder if you have any ideas on how I should respond to this unique behavior of his in a positive way that would help him to grow into a happy, healthy, successful individual. Your insight and wisdom is of a great value to us at this time. Please do respond.
Dear Mama,
Oh gosh! What a hard, hard situation to be in. And how scary! My heart goes out to you and your family.
I’m glad you went to the child psychiatrist, even though he said it was too early to tell. I’m also thinking about other resources for you; I know in Boulder there is a social-services group that will work with you and your child to come up with strategies to give him what he needs, all without diagnosing in any way. Are there any organizations like that where you live? They can be very helpful.
I’m happy to offer you my ideas as well, with the obvious caveat that I’m not a child psychiatrist or mental health specialist. These are simply ideas that I might use with a child who was exhibiting those behaviors in my care. If any of my readers have experience in these areas, please share your ideas in the comments.
Foster Adventurousness
I think that one “virtue” you might want to work on with your son is adventurousness. This might start in very small steps: for example, if he’s sitting in his spot on the counch, you might say, “Wow, you’re in your spot on the couch. I wonder how it would feel if you scooted over just half an inch. Would it feel different?” See if he’ll do it, and explore with him what the sensations are. “What does it feel like? Can you feel that part of the cushion is cold where you weren’t sitting before? How strange that must feel! Now scoot over to the other side of your spot, so you can feel the cool cushions on the other side! What does that feel like?” You’re just encouraging him to explore the edges of his comfort zone, and appreciating his experience. Focus on physical/somatic feelings, rather than emotions. I do this with kids who have sensory integration trouble, and it works really well because kids don’t feel rushed. Gradually, you can encourage him to venture farther.
Separate Feelings from Actions
It seems like one message you’d like to send to him is that it’s OK to want something and not act on it (or conversely, not want something and still do it). My mom cracked me up one day when there was a little girl in our group who, during the meal, looked up at my mom and quietly said, “I don’t like barley.” My mom replied, very matter-of-factly, “That’s OK. You don’t have to like everything you eat.” That was the entire conversation. As I recall, the girl still chose not to eat any of the barley that day, but no big deal was made of it. This idea, that you can notice what you like and don’t like, but you make your decisions about what you’ll do separately, is one that might be very useful for your son.
What Can He Do Instead?
Along with this, you might want to help him come up with some strategies of how to distract himself when he’s decided not to do something that he feels compelled to do– do this while he’s not triggered. I’m just brainstorming here, but you might say, “Today, you can change your clothes two times.” (it might be three times, or whatever feels feasible and not punitive). “You can choose when those two times are, but once they’re done, then changing clothes will be all done for today, until bedtime. Do you understand?” Get his acknowledgement, and then, “What will you do if you want to change clothes, but you’ve already changed your clothes twice? How can you not do it, if that’s what you want?” At 4.5, he’s definitely old enough to help you come up with some ideas. Take them seriously; in fact, you could even write them down in a list for him and post them on the fridge.
Then, when he wants to change his clothes, remind him that he has two times, and does he want to use one of those two times now, or save them for later? If he wants to save them (or they’re all used up), then remind him of some of his ideas of ways to distract himself, and help him do them (leave the room, get a drink of water, read his favorite book, come to you for a hug). Going to look at the list together might be a good first step in distraction/redirection. Be sympathetic and comforting if he’s sad and none of those ideas seem good now; the two of you are a team in this.
If putting a limit on the number of times doesn’t feel feasible, then use your judgement about how to introduce this idea of restraint.
Model Behaviors You Want to Promote
I think that the psychiatrist is right that this could well be imitative behavior on your son’s part, if he sees this compulsive behavior in his dad. Have dad start telling stories about when he was a little boy, and how he wanted to do something, but decided not to. Also, you can do this during the day: “Wow, I really want to eat a cookie right now, but I’m choosing not to. I REALLY want one! What can I do instead?” Get his ideas, and choose one that will work for you: eat some yogurt instead, go outside, play a game, etc. Ideally, make it something that you actually really want to do. Start showing him that even you, as the all-powerful adult, have to resist your urges and find ways to distract yourself.
Those are all of my ideas for now. Do any of them seem helpful? Remember, you don’t want to squash him down; you want to help him grow: to become more adventurous, and to be able to feel his desires and decide to do something else instead. Approaching things from a growth mindset may really help you in how YOU feel about it all. And be patient with yourself, and kind to yourself, as well. This is big stuff!
Warmly,
Faith
Consult with a *good* occupational therapist. I’m not a spammer, or an OT. Find one affiliated with ICDL–it’s an organization that, among other things, is gentle with, respectful of, kids. Check ICDL.com. Make some calls to people in your area, they should be able to talk with you and let you know whether they can help. They aren’t likely to insist on seeing you in person, getting paid a large fee for an assessment, and not give you any useful support. Good luck.
Thanks for this resource. I’ve worked with several occupational therapists helping children in my care, and they were all helpful/did good work. I didn’t know that some would work remotely.
Psychological interventions such as behavioral and cognitive-behavioral therapy as well as pharmacological treatment can lead to substantial reduction of OCD symptoms for the average patient. However, OCD symptoms persist at moderate levels even following adequate treatment course and a completely symptom-free period is uncommon.`…`
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