Experts' Advice on treating young children with OCD

[Guest guest]

HI Everyone:

I am not sure if everyone here reads the " Ask the Experts " section on the

OCF web site. Often the advice there is very helpful and specific to some

of the questions that come up here. Also one of the experts is Dr. Chansky,

who also is kind enough to help our list too.

There has been quite a bit of discussion recently about treating relatively

young children so I thought for those who do not check out the OCF's " Ask

the Experts " section regularly I would post a recent, relevant inquiry

below. Sorry to those who have already read this for themselves.

Item Number: 1510

TOPIC: Medication Questions

My 5 year old has recently started Kindergarten. I am having a great deal of

difficulty helping her adjust to school. Is there a way to judge whether her

medication is no longer sufficient (she takes Prozac) I have read " low and

slow is the way to go " but I know that even normal size changes can affect

her level. Can I follow a scale of so many pounds/inches will require xx

increase in medication? We have been medicated for 1.5 years and increased

twice already. Or do we need Behavior Modification in addition (we do not

currently have that recommended)? ==> Cheryl

I am assuming that your daughter has OCD since you posted your

question here. I am distressed to read that behavioral treatment was not

recommended. In my opinion behavioral treatment should be tried before

medication in children and adults unless the OCD is very severe in which

case the combination would be the place to start. As for medication dosages

many people with OCD seem to need high dosages of the SRI medications for

good results.

J. Claiborn Ph.D., ABPP

[j-claiborn-phd@...]

Psychologist

if she has OCD, you clearly should have a behavior therapist

working with her and you. Some kids take larger dosages of medication and

this may need to be adjusted upwards or even medication changed as she gets

older. there is a section on medications in kids on this Web Site. Best wishes.

Jenike, MD [Jenike@...]

Cheryl: The first line of defense for OCD in children is behavior

therapy. This was the conclusion of a survey of OCD specialists around the

world, as published in the Journal of Clinical Psychiatry, 1997, Expert

Consensus Guidelines for OCD. In addition to teaching you and your child

methods for " breaking the rules " of OCD, a behavior therapist can give

suggestions for how to help her with the specific areas of adjustment which

are problematic. Best of luck.

Tamar Chansky, Ph.D. [chanskt@...]

Director, Children's Center for OCD and Anxiety

Dear Cheryl: Behavioral therapy is always recommended, and should

be part of every child's treatment. Without it, you are missing out on a

great deal. Your daughter needs to know how to control her own disorder, now

and in the future. It is never too soon to start. My youngest patients are

around 4-1/2 years old, and do very nicely. Make sure she get exposure and

response prevention type treatment. You and your husband will have to act as

co-therapists for one so young. Young children can do very nicely, and the

earlier you begin work on their disorder, the sooner they will develop the

skill necessary to manage themselves. As far as the medications go, there

are no cookbook approaches to this. Every person is different biochemically.

Just make sure you are in the hands of someone who is expert in medicating

OCD in children. Usually, if your child is not having any particular side

effects, but still seems to need more from the medication, it is okay to

increase slowly in small increments. In any case, follow your medical

doctor's advice. Be realistic about medications - if you can get about a

60-70% improvement, you are doing pretty well. Just remember that behavioral

therapy is the other half of the treatment. Best regards.

Fred Penzel, Ph.D. [penzel@...]

Western Suffolk Psychological Services, Huntington,

NY

You definitely should try to get behavior therapy, which is what

behavior mod is being called these days. The trouble will be finding someone

who both knows how to treat OCD and who works with young kids. You don't say

what your daughter's current Prozac dose is. There is no mg/kg body weight

formula, and blood levels are not useful. If you are getting partial results

from Prozac, that would be a good indication to raise the dose. In my

opinion, undermedication (using too low a dose) is the most common mistake

in treating OCD pharmacologically.

Bruce Mansbridge, Ph.D. [Mansbr@...]

Danbury, CT

Hope this is of interest, take care, aloha, Kathy (H)

kathyh@...