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----- Original Message -----

> I was hoping to get some feedback. I've written before. My 12 yr old son

has

> add and ocd and now I'm thinking possiblt a tic disorder. First, it seems

that

> many of your children are on two meds for the ocd and anxiety,tics ect.

Mine

> is on 30 mg of prozac and 18 of concerta (add). How do you know when

something

> additional is needed.

*****The only way I know is to assess whether any OCD, ADD or other symptoms

are still interfering with your son's ability to live and enjoy his life,

meet his responsibilities at school and home, etc. It's possible that

either the Prozac or the Concerta may be potentiating your son's tics. The

process of trialing meds, balancing their effects, and tweaking doses is

very overrated as a pastime IMO! But there isn't any other way to get the

best effect for our kids out of their meds. At our regular med-management

appointments I tell the pdoc about positives/improvements but also any

ongoing or new problems that have popped up.

> Second, after talking with our therapist again it seems

> she was trying cbt w/ my son and she was building up to trying erp but he

has

> been resistant to working on anything. He likes her but claims he's fine.

*****Consider that this therapist is not the one for him, either because for

whatever reason she has not been able to engage him in therapy (and she is

blaming your son for that), or because she is not effective in providing ERP

therapy. A good relationship is important too but your son will not recover

based on that alone, he needs effective ERP as well. Generally if actual

CBT/ERP has not begun in earnest within about five visits, it's probably

time to move on.

Is it possible that the content of your son's obsessions makes talking with

a female therapist awkward? I'm thinking sexual types of obsessions, which

are very common. If so a male therapist may make this situation easier for

your son.

Another thing to consider is that your son may need more Prozac at this

point. Effective medication may make it easier for him to participate in

CBT/ERP.

>Do

> I force the treatment issue or do I wait and let hime see that he needs

it. I

> told you all that I never told hime the actual ocd label.

*****He may be more motivated to work in therapy if he understood that he

has a lifelong disorder that isn't likely to go away on its own, and if

untreated is likely to worsen over time. OTOH plain fear may be keeping him

from being willing to work wholeheartedly on reducing his symptoms. The

prospect of doing the opposite of what OCD is telling them to do is

understandably frightening for kids, and the whole " lifestyle " of untreated

OCD is to avoid, avoid, avoid to control anxiety. This is why you need an

expert and experienced therapist, to break through this very natural wish to

avoid stirring up anxiety by avoiding working in therapy. Kids (and adults)

frequently say they are fine in order to avoid doing the hard work of

therapy because it is a scary thought.

He may also not want to bother with therapy because he has been going but

hasn't benefitted from it, his symptoms are not lower. IMO that's the worse

thing about an ineffective therapist/failed course of therapy--the kids

waste effort, hope, and don't get the experience of success of going against

OCD and winning.

Have you considered using incentives (prizes, bribes) for participating in

therapy and doing ERP homework? Many of us have been able to motivate our

children through therapy doing this :-) I found dangling a reward was

especially helpful early on when my daughter had no experience and no

particular belief in the idea that she could ever go against any of OCD's

" rules " , or that there would be any long-term benefit to her if she did.

Kids generally are " here-and-now " in their thinking, it's not just kids with

OCD who have trouble seeing the point in working hard now for a " someday "

payoff.

I guess you can't force anyone to participate in therapy but I do think it's

smart to keep manipulating the situation to encourage him along those lines!

> I plan to explain

> this to him and I'm also wondering if there's an online support network

like

> this one for children his age.

*****There is a similar online support group for teens. I believe it is

moderated by Kathy MacD. I don't have the details and am hoping she will

see your post and provide them.

> Maybe it would help him to talk to others with the

> same issues. Or do you think it would give him adddtional symptoms?

*****The worry that OCDers may " pick up " other OCDer's obsessions and

compulsions is a common one but apparently unfounded. My child has spent

time with other OCD kids, played with them and in one case, was in a play

with another OCD girl, but this never altered her own symptoms a bit.

Your son probably would benefit from finding a group of kids who also have

OCD and etc. problems. One of the main reasons for telling our kids that

they have OCD and providing other information about it, is that it relieves

any concern that they are going crazy or are a freak, and are the only one

who have obsessions and compulsions. I think it's always helpful to

discover you are not alone in a struggle.

Take care,

Kathy R. in Indiana

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