Contact information• University of Houston – Clear Lake Psychological Services Clinic• Offers Psychological, Marriage and Family, and School services• Specialty services include Anxiety/OC-spectrum treatment• 281-283-3330• http://www.uhcl.edu/portal/page/portal/HSH/HOME/CENTERS_IN

STITUTES/PSYC_SC• Sliding Fee scale clinic (no insurance)

• Fees range $15-$50 per session (can be reduced if needed)• Intake is free

• Hours M-Th: 9-9, Fri: 9-5• All ages welcome

• Chad Wetterneck• 281-283-3364

• E-mail – wetterneck@uhcl.edu

OC-spectrum in Children and AdolescentsChad T. Wetterneck, Ph.D.

University of Houston – Clear Lake

Objectives• Provide a brief overview of OCD and related

spectrum conditions

• Discuss presentation and difficulties in school

• Review Treatment and provide options

• Questions?

Obsessive Compulsive DisorderDiagnostic criteria includes:• Presence of obsessions AND/OR compulsions

• Obsessions or Compulsions are present for one or more hours per day

• Significant interference in daily life functioning

• Symptoms not related to medications or another medical condition

Epidemiology• Prevalence• 1% to 2% of the general population meet diagnostic criteria at

any given time• 2% to 3% lifetime prevalence• 4th most common psychiatric disorder• 50% to 65% have at least one other mental disorder• Affects males and females equally• Male onset (6-15 years of age)• Females (20-29 years of age)

• Pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection (PANDAS)

Symptom Dimensions• Contamination• Symmetry / “Just Right” • Sometimes appears as perfectionist tendencies

• Harming• Blasphemous• Sexual• Violent• Superstitious• Hoarding

What Might You See in School…• Contamination• Opening doors, lockers, desks, or books with elbows or with

tissue in hand, holding hands in the air to avoid physical contact, refusal to shake hands or share pencils or other supplies

• Frequent trips to the bathroom, either to use the toilet or wash hands

• Getting upset if others touch his or her belongings, wanting to clean or wipe them off

• Sore, chapped or bleeding hands

Symptoms in school• Symmetry/Just Right• Over-focus on neatness. Lining up, ordering or arranging items on

desks, in backpacks or lockers repeatedly• Wanting to complete assignments “perfectly,” checking and re-

doing it• Sloppiness or carelessness in completing assignments, which is

not typical for the child• Erasing repeatedly until the paper has holes in it, the ink is

smudged and the writing or drawing is illegible• Reading letters, words or sentences repeatedly, repeating

syllables until they sound right• Filling in scantron sheets very carefully; getting upset if they are

not perfectly filled in

Symptoms in school• Symmetry (Cont.)• Very slow and deliberate work, resulting in incomplete

assignments. • Incomplete assignments or homework, although the child is

capable of doing them• Checking homework, backpack, lockers, pockets, or under the

desk and chair repeatedly, ensuring that locks and zippers are fastened.

• Frustration or anger when things are disorganized, when interrupted, or when routines change unexpectedly.

• Asking the teacher or other students the same questions repeatedly, even though the child knows the answer

Symptoms in school• Superstitious• Counting or focus on lucky and unlucky numbers• Sudden avoidance of familiar things or reluctance to try new

things• Odd behaviors such as walking in specific patterns through

doorways, counting tiles or syllables, touching or tapping in symmetry or sitting and standing repeatedly

• Secretive or unusual behaviors for which there is no obvious explanation

Symptoms in school• Harming thoughts may be associated with things that look like

symmetry concerns• Depends on the function

• Feeling Just Right or Belief that an action can prevent harm

• Taboo thoughts (i.e., sexual, scrupulous, violent) are often harder to spot and less likely to be shared due to stigma and shame

Tourette’s SyndromeDiagnostic criteria includes:• Presence of multiple motor AND one or more vocal tics

• Symptoms occur nearly every day or intermittently for a period of one year

• Impairs functioning

• Childhood onset

• Symptoms not related to medications or another medical condition

Prevalence• Occurs 3 to 4 more times in boys than girls

• Affects 1 in 1,000 or .10% of the population of the United States

• Symptoms first noticed in childhood

• Occurs in all populations and all ethnic groups

Examples of Simple Tics

Motor

• Eye blinking• Sticking tongue out• Head-turning• Muscle-tensing• Flexing fingers• Kicking• Twitching

Vocal

• Throat-clearing• Sniffing• Barking• Coughing• Yelling• Hiccupping• Belching• Animal sounds

Examples of Complex Tics

Motor

• Adjusting/picking at clothing

• Flapping arms• Facial grimacing• Jumping• Shaking feet• Pinching • Poking• Kissing• Spitting

Vocal

• Talking to self• Different intonations• Echolalia• Coprolalia• Repeating parts of words

or phrases

Trichotillomania/Chronic Skin-PickingDiagnostic criteria includes:• Recurrent pulling of one’s hair resulting in noticeable

hair loss

• An increasing sense of tension immediately before pulling out the hair or when attempting to resist pulling

• Pleasure, gratification, or relief when pulling out the hair

• Pulling causes significant impairment in an important area of functioning

Phenomenology• .06-1% of population

• Typical onset between ages 9-13

• More common in females (TTM – more equal in CSP)

• Results in a variety of physical and psychological effects--avoidance of social/pleasurable activities, intimate relationships, shame, etc.

Detecting TTM/CSP at school• Most obvious are missing entire sections of hair (or bleeding

areas/scabs in CSP)

• Students may cover areas of pulling/picking• Often twirl hair or touch areas affected

• May be very embarrassing to point out even individually

How we identify/diagnose OC-spectrum issues?

• Diagnosis is made through observations and interviews with the patient and caregiver(s), examination of family history, and ruling out other secondary causes of disorders

• Comorbid conditions are also examined• Comorbidity may be the norm

Factors influencing OC-spectrum conditions• Parenting style will impact symptoms• Reassuring, punishment, attention, etc.

• Family support tremendously important• Families must also be their child’s advocate• Are there school factors that may cause behaviors to

intensify?• YES!

• Anxiety, Stress, and Fatigue

Treatment• Behaviorally-based treatments• Exposure and Response Prevention (ERP) for OCD• Habit Reversal/Comprehensive Behavior Intervention for

Tourette’s Syndrome for TS & TTM• Key components• Exposure• Family Support

• Additional interventions• Mindfulness and acceptance strategies• Behavioral rewards/incentives

• Success of treatment

Where you can get more help

http://www.ocfoundation.org - International Obsessive Compulsive Disorder Foundation. Resources for those who have OCD, caretakers/parents, and educational and mental health professionals

http://www.tsa-usa.org – Tourette Syndrome Association, Inc. offers many resources (publications, videos, training sessions, etc. that are aimed at helping students, parents, families, and especially educators understand Tourette’s as well as tips to properly handle the symptoms – EXCELLENT resource

http://www.trich.org – Trichotillomania Learning Center: Website for TTM and CSP for the whole age range and treatment providers