Obsessive-Compulsive Disorder Issues - Research Paper Example

Obsessive Compulsive Disorder November 5, PART I Obsessive-compulsive behavior is characterized by time consuming obsessions or compulsions that reoccur and will usually take up over an hour per day. These behaviors cause noticeable and marked distress or they can interfere with the child’s normal daily routine, functioning, personal relationships or usual activities (Gallant, Eric, Valderhaug, & Gary, 2007, p 205). Affecting an estimated between 1 and 4 % of youth it is considered a fairly common disorder in children and adolescents. OCD is associated with an increased risk of a host of other disorders, including anxiety, eating disorders, Tourette’s and major depressive episodes. In adolescents OCD is associated with alcohol abuse and addiction. Psychosocially OCD is linked with peer isolation, impairment manifested during school, ideas of suicide, and substance abuse. Children with OCD pose a challenge for clinicians; they are usually unable to comply with behavioral management strategies. Obsessions can be persistent, they can manifest as thoughts, impulses or images that the child experiences. These repetitive behaviors can also be mental acts that the child feels strongly compelled to perform such as counting or repeating words silently, common behaviors may be hand washing, checking the order or placement of certain things continuously, or placing items in order as a rule rather than a spontaneous action (Nicoletto-Syrett, 2002, p 36). Fulfilling or acting out these compulsions in the mind of the child serve to prevent distress or a traumatic event. They apply rules rigidly to their behaviors. Symptoms can be mild to incapacitating and though it is common in childhood it is not as common as asthma, though occurs more frequently then juvenile diabetes. These children are concerned with cleanliness, aggression or checking and collecting are not able to trust their judgment (Nicoletto-Syrett, 2002, p 37). More extreme compulsions are acts of self-mutilation, an uncontrollable need to touch, spit or swallow and rub objects in a certain way. Most common are a fear of contamination, fixation on lucky or unlucky numbers, a need for exactness and symmetry and a constant doubt that is excessive. Patients with OCD may find it difficult to focus or concentrate in normal environments such as school and society. Treatment is important in order that these individuals are provided with interventions as early as possible disrupting their normal developmental stages as little as possible, ensuring they reach milestones appropriately and that their OCD, though potentiating disabling can be treated and managed successfully allowing the child to function in society. PART II OCD is considered a neurobiological disorder and Stanford School of Medicine indicates the onset of OCD is prior to the age of 25, though in children and adolescence the average age of onset for boys was 9.6 years old, and 11 years old in girls. Major symptoms and signs began before the age of 15 in about a third of adult onset cases (Stanford School of Medicine, 2012). This developmental period is known as middle childhood. In trying to determine why this is the most common age on OCD onset in children it is important to recognize milestones and emotional and social changes the child is experiencing. It is at this age that the child is becoming independent and wanting independence from parents as they begin interacting more with peers. Peer pressure becomes a strong factor in the child’s social development and children are becoming more aware of their body and the differences between themselves and their peers. Puberty may be beginning and they are likely starting to be challenged more in the academic setting, and normally a child will have an increased attention span during this period (Centers for Disease Control and Prevention, 2012). Brown University conducted a study of children with onset of OCD between ages 2 and six (Phenomenology of early childhood onset OCD, 2008). Abbe Garcia, PhD notes that children under the age of 8 have been poorly represented in the study and research of early childhood OCD. Though OCD has been diagnosed in children as young as 3, most interventions, related studies, research, treatments and intervention protocols have been defined for the average patient with a mean age of 10. Abrupt onset was seen in 24% of the study population while gradual onset was noted in 50% with the remainder being unknown. Though the sample size was relatively small those with gradual onset were younger, 20% of the sample size reported a first degree family history of OCD and 32% had family members with an anxiety disorder. Similarities were found in this study sample of younger children to those characteristics of older children. Important differences in the younger group were lower rates of depressive disorders which is in line with developmental trends, and a higher preponderance of girls as opposed to older onset OCD occurring in more males. It is known that the origins of OCD lie within the brain. The front area of the brain has shown more active in those diagnosed with OCD. It is hypothesized that those with OCD have brains whose internal alarm system remains in overdrive (Rowh, 2007, p 23). In the largest “heritability study conducted to date for OC symptoms. The sample size of 1224 affected subjects provides analytic power previously unavailable for OCD symptom dimension research, (Katerberg, Delucchi, Stewart, Lochner, Denys, Cath, 2010, p 514). This study concluded that OCD and the symptoms associated with OCD are heritable and that in addition to genetic influences there may also be a hereditary underlying factor in one’s OCD susceptibility symptoms in general. Future research needs to define the OCD phenotype for further genetic and clinical studies. Recent family studies and twin studies show that there are biologic as well as environmental aspects that contribute to OCD. Because of the responsiveness to certain medications we are better able to understand the neurophysiological effects of OCD within the brain. Because SSRI’s are effective in a portion of the patient population it is known that there is a central serotonin deficit in OCD patients (Juckel, Mavrogiorgou, Goebel, Schenkel, Zaudig, & Hegerl, 2002, p 250). There is a constantly growing group of evidence for the involvement of involvement “of a frontal-subcortical circuit, including orbitofrontal cortex (OFC), basal ganglia, and thalamus, in the expression of OCD, (Cavedini, Gorini, & Bellodi, 2006, p 3). The function of this particular loop is believed to be responsible for higher thinking and executive functions; decision making, planning future actions and processing environmental stimuli in a way that allows decisions to be made based on these stimuli. The ability of the brain to distinguish between reward and punishment stimuli also seems to be affected by this loop. .Using the Temperament and Character Inventory Scale personality traits of those with OCD were compared to this with no symptoms of OCD or diagnosis. Those patients with OCD demonstrated increased harm avoidance scores and decreased self-directedness, dependence on rewards and cooperativeness than those in control groups. Temperaments factors which are believed to remain stable throughout life are novelty seeking (NA), harm avoidance (HA), and reward dependence (RD) and persistence (P). Patients with OCD have consistently higher HA scores and these temperament factors contribute in the severity of the child’s OCD symptom’s (Se, Kang, & Chan-Hyung, 2009, p 568). OCD affects the child’s cognitive development dependent on the stage of development they are in and if their progression to the next stage. Most children with OCD experience onset between the age of 7 and 9, during the preoperational stage of normal child development. Milestones during this stage are being able to form thoughts and associations with the past and future, though they are not fully able to conceptualize time. At this age they view the world from a perspective that is fantasy like and they began to personify inanimate objects, believing that objects have thoughts and feelings similar to theirs. From around first grade to adolescents children are in the concrete operations stage. During this time they are able to think in more abstract ways and become rational in what they experience through their environment and no longer have to touch and feel things in an attempt to understand their placement in the child’s life. Piaget’s fourth stage of cognitive development begins in adolescence and is formal operations. The adolescent is able to think in hypothetical and deductive terms. Children with OCD may not reach the cognitive development stage of formal operations as many continue to need to touch and feel objects, as well as become focused on irrational thoughts of objects and potential harm. They may not be able to form associations with the past and future hence OCD symptoms continue as there is no formed relationship or memory of previous episodes and the compulsive behavior continues. The response the child gets from the continued behavior enforces the circle as the child is internally satisfied by the compulsive behavior and their irrational fears such as contamination are temporarily addressed. Normal childhood language development is disturbed as children with OCD may not reach normal milestones at the usual age; many are not able to retell a story or talk about an event without invoking further anxiety, they may not participate in or begin conversations, (ASHLA. (2012). By the second grade they should be able to take turns in conversation and use eye contact, give or repeat directions that are 3 or 4 steps and be easily understood. By the fourth grade the child should be engaging in conversations with others and using language effectively while also being persuasive and responsive in group conversations. Many OCD children tend to isolate themselves from groups and teach these milestones at different and delayed times. By adolescence language skills should reflect higher thinking and executive functions such as an increased speed in responding appropriately in communications and should be easily able to follow the shift of topics in conversations. Children with OCD will often have attachment issues such as separation anxiety disorder. A child’s attachment behavior is often an indicator of the child’s psychosocial development. It is logical that children with OCD who are delayed in their psychosocial development will also be predisposed to separation anxiety disorder, a milestone reached by the age of three usually when the child realizes that an object or person out of sight will return. Children with OCD demonstrate emotional reactions that are extremely out of proportion with the events, expecting a terrible action if their compulsion is not met. In other circumstances they may seem unemotional and unattached to outsiders such as teachers or therapists, while they are overly attached to parents and primary caregivers. They are not able to self-regulate their behaviors without intervention as they are compulsions and obsessions the child or adolescents feels must be met. Normal childhood development allows the child to self-regulate their behaviors and to comprehend between acceptable and unacceptable behaviors and to control impulses which may be unacceptable, considered abnormal or self-harming. Moral development and reasoning are also higher or executive functions that the child may not reach, moral development begins when the child is in the formal operations stage and continues throughout one’s lifetime based on environmental cues. Children with OCD may not respond to these cues as they internalize their compulsions and obsessions and remain fixated on meeting these needs without treatment and intervention. Gender development is multi-dimensional and is an important aspect of human experiences and how children and adolescence interact with each other. Usually the child’s choice in play mates, toys, activities and vocation are influenced by gender and sexuality. While females are expected to be the nurturer’s and males the aggressors these roles may be reversed in OCD children (Gender Role Development). Erikson’s theory of psychosocial developmental describes identity versus role confusion as the task that must be reached to successfully experience intimacy and relationships with others. If the adolescent is unable to achieve this task they will experience isolation. Those with strong encouragement and reinforcement of positive behaviors should have a strong sense of self, including gender and sex identity. Those with have not mastered social interaction and gained self-confidence during middle childhood will experience role confusion. Family structure changes may result from power struggles, as the parent often uses reassurance with the child, which can also be construed as accommodating the child’s behavior. This can include giving to the demands of the child in an effort to stop perceived threats or thoughts of possible harm the child may be experiencing. In this way the parent is no longer in control but the family structure becomes ruled and revolves around the temperament and actions of the child or adolescent. It is thought that parents of children of with OCD may try being supportive but can accidentally reinforce fears. Family context and structure is actually a risk factor for the development and maintenance of OCD (International OCD Foundation, 2012). The authoritarian parenting style is most associated with OCD symptoms and obsessive beliefs by the child mediate this style of parenting and symptoms. In social relationships it is necessary to understand the impact that OCD has in the child’s life in order to foster better social relationships. Social relationships can be difficult if not impossible for the child or adolescent to form as they feel the need to hide their ritualistic behaviors from peers; they must also spend a large portion of their time in performing these rituals and worrying about the reactions of friends can affect any relationship. Adapting in the academic and social scene will require anger management, self-esteem and the establishment of routine. Cultural considerations such as race and ethnicity will often affect the way the child is viewed by others and their lack of understanding or tolerance of the disease. PART III Risk factors for childhood or adolescent development of OCD are family history, stressful life events and a condition known as PANDA which causes sudden rather than gradual onset of OCD in children. PANDA’S are essentially pediatric disorders that seem to be associated with streptococcal infections. This has been researched more and more and implicated in sudden onset OCD in children. With treatment, medication and cognitive behavioral therapy it is estimated that 25 to 47% of children will become asymptomatic. Those that do not respond initially to treatment are not a reflection of the severity of their OCD, and persistence in treatment methods is essential to ensure the child reaches developmental milestones appropriately and is able to function fully in society. Though there is a wealth of information known about OCD, and continuous ongoing research and study there is very little public education or awareness of the disorder. This is becoming less the case in academic settings and teachers and caregiver’s are learning methods of working effectively with these individual’s. Across the population continuum it is essential that those who have regular and frequent contact with the child or adolescent understand and are aware of the condition and how to react to an acting out. Specialized education and therapy should be available and offered to parents of children with OCD as well as family support through therapy and support groups. Despite OCD being a chronic condition it is possible to become asymptomatic and to lead a full, healthy, and highly functional successful life. References ASHLA. (2012). American Speech-Language-Hearing Association. Kindergarten. Retrieved November 6, 2012, from http://www.asha.org/public/speech/development/kindergarten.htm Cavedini, P., Gorini, A., & Bellodi, L. (2006). Understanding obsessive-compulsive disorder: Focus on decision making.Neuropsychology Review, 16(1), 3-15. doi: http://dx.doi.org/10.1007/s11065-006-9001-y Centers for Disease Control and Prevention. (2012, August 15). Middle Childhood (9-11 years of age). Centers for Disease Control and Prevention. Retrieved November 5, 2012, from http://www.cdc.gov/ncbddd/childdevelopment/positiveparenting/middle2.html Gallant, J., Eric, A. S., Valderhaug, R., & Gary, R. G. (2007). School psychologists views and management of obsessive-compulsive disorder in children and adolescents. Canadian Journal of School Psychology, 22(2), 205-218. Retrieved from http://ezproxy.snhu.edu/login?url=http://search.proquest.com/docview/224380402?accountid=3783 Gender-Role Development - The Development of Sex and Gender Read more: Gender-Role Development - The Development of Sex and Gender - Boys, Girls, Male, and Roles. (n.d.). Retrieved from http://social.jrank.org/pages/272/Gender-Role-Development.html International OCD Foundation. (2012). Have we forgotten the children who have a parent with OCD?: Accommodation and early intervention. International OCD (Obsessive Compulsive Disorder) Foundation. Retrieved November 6, 2012, from http://www.ocfoundation.org/EO_parent_with_OCD.aspx Juckel, G., Mavrogiorgou, P., Goebel, C., Schenkel, I., Zaudig, M., & Hegerl, U. (2002). Influence of sertraline treatment on neurophysiological parameters in patients with obsessive-compulsive disorder. European Neuropsychopharmacology, 12(3), 250. doi: 10.1016/S0924-977X(02)80319-4 Katerberg, H., Delucchi, K. L., Stewart, S. E., Lochner, C., Denys, D. A., J., Cath, D. C. (2010). Symptom dimensions in OCD: Item-level factor analysis and heritability estimates. Behavior Genetics, 40(4), 505-17. doi: http://dx.doi.org/10.1007/s10519-010-9339-z Nicoletto-Syrett, L. (2002). Working with children with obsessive compulsive disorder. Journal of Psychosocial Nursing & Mental Health Services, 40(6), 36-41. Retrieved from http://ezproxy.snhu.edu/login?url=http://search.proquest.com/docview/225536212?accountid=3783 Phenomenology of early childhood onset OCD. (2008). Brown University Child & Adolescent Behavior Letter, 24(12), 3. Rowh, M. (2007), The ABCs of OCD. Current Health 2, 33, 23-25. Retrieved from http://ezproxy.snhu.edu/login?url=http://search.proquest.com/docview/211706736?accountid=3783 Se, J. K., Kang, J. I., & Chan-Hyung Kim. (2009). Temperament and character in subjects with obsessive-compulsive disorder. Comprehensive Psychiatry, 50(6), 567-572. doi: http://dx.doi.org/10.1016/j.comppsych.2008.11.009 Stanford School of Medicine. (2012). About OCD. Standford Edu. Retrieved November 5, 2012, from http://ocd.stanford.edu/about/ Read More