OCD Chicago

Your Child Can Get Better With Effective Treatment
Information for Parents

Why Some Children’s OCD Treatment Fails

If your child has difficulty with treatment, here are some possible causes—with suggestions for how to improve the chance for success.

Most children who undergo a course of cognitive behavior therapy for OCD will experience a significant reduction in symptoms.  If your child doesn’t do well in treatment, you should consider these possible obstacles to success:

  • Coexisting (Comorbid) Disorders:  An accompanying anxiety disorder such as major depression, bipolar disorder or other comorbid disorder can interfere with success in therapy and may require separate treatment.  It’s easy to see how some of these disorders, which have distinct symptoms of their own, can cause parents, children and teens to be confused about which symptoms need treatment most, or first.  Parents should take into account that it will be difficult for a child or teen suffering from multiple disorders, including substance abuse, anorexia, attention deficit disorder or depression, to be successful in treatment for OCD—unless the parents and the doctor address all conditions in developing an effective treatment plan.
  • Poor Communication with Therapist:  Open and honest communication about the exact nature and frequency of obsessions and compulsions is a must so that the therapist can design effective exposures.  When children or their parents fear revealing all of the obsessions (either because they feel ashamed or because they think therapy can’t help particular obsessions or compulsions) they can unknowingly prevent a therapist from being effective.  Parents should also encourage the child or teen to “open up” to the therapist and be very honest about what is bothering them, because it’s possible that even the most observant parents won’t know all the obsessions bothering their child.
  • Insufficient Exposures:  Exposures must be sufficiently challenging, and “homework” of daily exposures must be completed between therapy sessions. If the child or teen feels the homework is too difficult to accomplish daily, and doesn’t perform the assignments, the therapy may fail.  Talk with the therapist so a program can be designed that will allow the child to succeed.
  • Infrequent Sessions:  Therapy sessions are generally scheduled weekly, but in some cases may need to be more frequent—even daily—or conducted in a residential treatment setting.  Talk with the therapist to determine if more frequent sessions are necessary.  (And threatening the child with hospitalization if they don’t improve is NOT an effective way to motivate the child or teen to attend therapy sessions or work hard on their ERP homework assignments.)
  • Improper Session Location:  Therapy sessions may be more effective if they are held in locations that trigger obsessions and compulsions—for example, some children or teens are able to control their compulsions in school but at home are unable to stop the compulsions. Some obsessions and compulsions occur mostly outdoors.  Some therapists will conduct sessions out of the office, in the location where the OCD symptoms are at their worst.
  • Medications:  If your child’s cognitive behavior therapist has recommended medication in conjunction with CBT, the medication may not be immediately effective, and the dosage may need to be adjusted.  Some parents have reported poor success with one OCD medication, only to find improved results when a different OCD medication is tried.  Good communication with your child’s therapist—and patience—is needed to find the right medication, or combination of medications, that will be effective for your child.  Note: medication is not a substitute for CBT, but may be effective until the child or teen learns to master their obsessions and compulsions.
  • Family Interference:  Family members who participate in the child or teen’s compulsive rituals, provide reassurances or enable avoidance behavior can actually sabotage success in therapy.  Sometimes a family member can be trained to act as a “coach” to keep track of exposures and discourage behavior by others that perpetuate the rituals.  Family members can be taught by the CBT therapist how to support—rather than hinder—the child or teen’s program to gain control over OCD symptoms.
  • Wrong Choice of Therapist:  A child or teen who does not succeed with one therapist may enjoy excellent results with another.  The personality fit may not be right, or that therapist may not design challenging, appropriate exposures.  The therapist may also be inexperienced, especially in treating children or adolescents who have OCD.  Ask for a second opinion, request a referral or interview other therapists to find a good match.
  • Inappropriate Therapy:  CBT, sometimes accompanied by medication, is the only treatment for OCD that is supported by scientific evidence.  Research does not support the use of treatments such as traditional talk therapy, hypnosis, herbal or homeopathic remedies, psychoanalysis, relaxation therapy, eye movement desensitization reprocessing (EMDR) or dietary changes.
  • Lack of Support:  Talking to others who have learned to master their symptoms can encourage success in some children or teens who have OCD.  This can sometimes help a struggling child or teen undertake the challenge of cognitive behavior therapy (and the ERP homework assignments) and boost the likelihood of success.  Parents also can learn from the success of other parents.  Joining a local support group, participating in an online support group or contacting OCD Chicago or the national Obsessive Compulsive Foundation are good ways to find people with similar experiences.  Note:  support groups should not be considered a substitute for CBT therapy.

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