cognitive inflexibility

[smartyjones]

i am curious what those who are more experts in OCD would have to say about random episodes of cognitive inflexibility. i believe this to be related to pandas but not an 'active' symptom. my son is doing well pulling out of a recent exacerbation i believe triggered by the flu. however, he has some incidents of cognitive inflexibility. i think this is like a 'hold-over' that needs to be worked on rather than an overt symptom to be helped medically. obviously, it's an example that he's not 100% but i think it's something that would come over time with future healing and could be helped with other interventions. there doesn't appear to be a complicated web of thoughts related to these.

 

example - today he was supposed to go to a good buddy's house for a playdate. last time, my son went to this kid's house. he had wanted the friend to come to our house. the date before Christmas fell through. i hadn't gotten it together plan something else and the friend wanted my son to come over. it worked better to go there, so we planned that. last night, my son was complaining that he had wanted his friend to come to our house, then said he didn't want to go, then said he wanted me to go with him.

 

today when it was time to go, he refused. yelled, kicked, couldn't get off that it was supposed to be the friend coming to our house. ultimately, we cancelled. he took not going over going because to him, it was supposed to be the friend coming over to our house. if it was only us, i would have made him go and knew that he'd get into once we were there. however, i didn't want to expose this other kid to my son yelling and screaming that he didn't want to be at his house.

 

i don't think it's an incident of just being bratty or wanting his own way -- it's more a deep seated thought that the friend was supposed to come to our house next and he couldn't get off it.

 

any thoughts? thanks.

[fuelforall]

I don't mean to alarm you but my son had these blowups quite a lot.

They got worse as he got sicker.

Cognitive inflexibility is pretty much his middle name.

It does suggest a lingering infection.

 

 

 

 

any thoughts? thanks.

[MomWithOCDSon]

Having dealt with similar patterns for the last 6 years, I've come to think there's possibly 2 components to this sort of reaction on my son's part:

 

1. The OCD part of his brain is so cyclical that it just can't break away from an original decision or an original plan; yes, he's inflexible. I will add that this lack of flexibility has only become exacerbated by his approaching teen-hood, as he's gotten increasingly "self-righteous" and concerned with "what's fair" and "what's SUPPOSED to be," i.e. this playdate was SUPPOSED to be at his house, not the other kid's, and that's that. I can remember having a similar mindset in my teens, though, so I take that as a part and parcel of his natural maturation, though the OCD feeds on it and elevates it dramatically.

 

2. With my son, at least, there is also some underlying anxiety at play, and though he'll mask it as best he can during the planning and negotiation phases of a playdate, trip to the movies, etc., when the "rubber hits the road" and it's time to make good on the commitment, that's when he will pull out all the stops to kill the event because, frankly, he's just too anxious to follow through with it. Maybe going to the friend's house is just too trigger-filled for him, or maybe it is just unadulterated fear of being out of his own relatively safe environment. He'll start with what on the surface sound like reasonable justifications for changing or cancelling the plans; if those fail to get the desired cancellation, then he'll launch into a less-logical and more emotional attempt, such as your son's protests about how it was supposed to be at HIS home rather than his friend's, so that's the way it needs to be adjusted now. And ultimately, if neither of those first two, milder strategies work, he'll have a full meltdown and bring everything to a halt.

 

You might try asking him if going to his friend's house makes him feel uncomfortable at all.

[dcmom]

I am sorry to say that I agree with fuelforall (michael).

 

My dd also has had so many issues of "cognitive inflexibility". It leaves a parent nervous all the time, and walking on eggshells. I knew the extreme version of it (temper tantrums) was pandas related, but I got to thinking she was very particular normally. Well- after pex- I would actually term her an easygoing kid! (Although since then she had an infection and is not 100% back to baseline.) So now I know for sure- this inflexibility is not who she is- there are some medical issues going on when she is like this. That being said, I certainly think you have to deal with it behavoirally, psychologically and medically at the same time- but I think you can try to make a bit more accomodation since you know they are sick.

[ajcire]

That scene is so similar to something my son might do. He gets stuck on things and then makes demands though.. and until his demand or until he snaps out of it he is completely irrational and unreasonable to talk to.

 

I always considered my son mild and now I wonder if I have just gotten so used to it that I think it's mild... I can tell when it is going to happen with my son though... everything changes, his tone, the look in his eye, his body language.

 

 

I am sorry to say that I agree with fuelforall (michael).

 

My dd also has had so many issues of "cognitive inflexibility". It leaves a parent nervous all the time, and walking on eggshells. I knew the extreme version of it (temper tantrums) was pandas related, but I got to thinking she was very particular normally. Well- after pex- I would actually term her an easygoing kid! (Although since then she had an infection and is not 100% back to baseline.) So now I know for sure- this inflexibility is not who she is- there are some medical issues going on when she is like this. That being said, I certainly think you have to deal with it behavoirally, psychologically and medically at the same time- but I think you can try to make a bit more accomodation since you know they are sick.

[thereishope]

During an exacerbation what were his OCD tendencies? Did he have any fears?

 

Like you said there's an underlying issue. If you carefully pick at it you might find out what it is.

 

-If he had a germ/dirt thing, well, the possibilities of the friend's house could be endless.

-It could be something with a sibling, esp if the friend's sibling is a toddler.

-If he feels he need to play with a certain toy every time the child is over, that could be it.

-If he still hides OCD tendencies within your house, perhaps he is fearful he cannot complete them at the friend's house

-It could simply be he does want to break routine. That would cause a meltdown with us during an exacerbation.

-Does he go to school okay?

 

It can just be so many reasons....

[amy s]

i am curious what those who are more experts in OCD would have to say about random episodes of cognitive inflexibility. i believe this to be related to pandas but not an 'active' symptom. my son is doing well pulling out of a recent exacerbation i believe triggered by the flu. however, he has some incidents of cognitive inflexibility. i think this is like a 'hold-over' that needs to be worked on rather than an overt symptom to be helped medically. obviously, it's an example that he's not 100% but i think it's something that would come over time with future healing and could be helped with other interventions. there doesn't appear to be a complicated web of thoughts related to these.

 

example - today he was supposed to go to a good buddy's house for a playdate. last time, my son went to this kid's house. he had wanted the friend to come to our house. the date before Christmas fell through. i hadn't gotten it together plan something else and the friend wanted my son to come over. it worked better to go there, so we planned that. last night, my son was complaining that he had wanted his friend to come to our house, then said he didn't want to go, then said he wanted me to go with him.

 

today when it was time to go, he refused. yelled, kicked, couldn't get off that it was supposed to be the friend coming to our house. ultimately, we cancelled. he took not going over going because to him, it was supposed to be the friend coming over to our house. if it was only us, i would have made him go and knew that he'd get into once we were there. however, i didn't want to expose this other kid to my son yelling and screaming that he didn't want to be at his house.

 

i don't think it's an incident of just being bratty or wanting his own way -- it's more a deep seated thought that the friend was supposed to come to our house next and he couldn't get off it.

 

any thoughts? thanks.

 

I just wanted to say that this was extremely common in our house hold as well (eventually multiple times per day and lasting hours each day- unknown reasons completely!), and only got worse with life threatening rages (even at age 5-6-7) to accompany them. In fact, this was primarily the reason she became homebound. Since my daughter's recovery (remission?) after IVIg, this is GONE. Along with most all of that other stuff too. I wish I would have put her on high dose antibiotics way back when that symptom first began. (IVIg in Nov 09...felt we had near full recovery 6 or more months later). BUT no more rages < 1 month after IVIg.

As far as knowing how it related to OCD, I don't. I never could pinpoint anything that made sense to me as to why these type things happened...and thankfully she doesn't remember any of those things anymore.

 

I hope your child gets well soon.

Regards,

amy s

[Buster]

i am curious what those who are more experts in OCD would have to say about random episodes of cognitive inflexibility.... i don't think it's an incident of just being bratty or wanting his own way -- it's more a deep seated thought that the friend was supposed to come to our house next and he couldn't get off it.

 

I have to agree with all the others. The demanding defiant, cognitive inflexibility was very pronounced with our daughter -- it just had to be a certain way. Couldn't rationalize it. Couldn't see that it was odd. By the way, I mention this last one because usually they say that folks with OCD recognize that their demand is odd. That was not the case with our daughter. Technically OCD in kids doesn't require the self awareness.

 

Buster

[dcmom]

We had no "self-awareness" here....

 

For example, the fact that one day dd woke up and could no longer get dressed in anything but pjs was not unusual- it was just that none of her clothes fit anymore! There was NO ability for discussion, reason, calmly trying things out- they didn't fit, that was it, she would wear pjs. Sigh. Glad that one is over (for now).

[amy s]

By the way, the I mention this last one because usually they say that folks with OCD recognize that their demand is odd. That was not the case with our daughter. Technically OCD in kids doesn't require the self awareness.

 

Buster

 

I appreciate this comment... my dd also had NO realization that the demand (however slight) was odd or different in any way, either.

[melanie]

We had no "self-awareness" here....

 

For example, the fact that one day dd woke up and could no longer get dressed in anything but pjs was not unusual- it was just that none of her clothes fit anymore! There was NO ability for discussion, reason, calmly trying things out- they didn't fit, that was it, she would wear pjs. Sigh. Glad that one is over (for now).

 

 

This is something danny struggles with daily.We always tell him whats going to happen before we do it.That usto work when he was younger when we could control his daily life but now that he older hes on his own alot and sometimes things just dont go as planned.He does not like that at all.Today at school he bought lunch and they didnt have what he planned on getting ...Not good he got angry and flipped a chair and cursed his teacher .He forgot his shorts at swimteam and slammed the door in the club.Little things just make him angry. Thats a big issue with us.

 

Melanie

[smartyjones]

thanks for the input. so he ended the day not so good with 2 other incidents - i've started a rating system like Buster mentioned in a recent post. his day was 22, throughout the last week or so would be around 10. his recent exacerbation, probably high 20s/30s - as was Sept. initial episode months would probably be 40s/50s or higher. thanks again, Buster, for that system - i think it's going to make it easier and more objective. could i ask - you're daughter seems to be doing quite well - do you rate her near 0 or is she still with issues that you rate?

 

for him, an incident like this comes along every 2/3 months. i looked back and last was mid Oct. however, we do have the ever-present lower level potty delay. again, seems no connection of thoughts as to why.

 

the psych has cautioned me about probing to find causes and injecting thoughts that he may not even have. do you have any thoughts about how you 'carefully pick' to find the cause without giving him ideas that he didn't even have?

 

i asked tonight about the friend's house and he said yes, he'd be happy to go there the next time -- after he comes here. i really do think it's that cut and dried - it's just the way it is. his plan was that the friend came here the next time and we were doing something different.

 

does this fall into 'just right' OCD even if it doesn't have a connection to thoughts? does it matter what it's termed?

 

am i understanding that the general consensus is that this isn't something that can be worked out with other methods but is a part of the general healing of pandas? there's nothing to do but medical healing?

[ajcire]

i asked tonight about the friend's house and he said yes, he'd be happy to go there the next time -- after he comes here. i really do think it's that cut and dried - it's just the way it is. his plan was that the friend came here the next time and we were doing something different.

 

 

 

With my son it is that cut and dry....if he tells me he will do something after a certain demand is met, he will do it. It's as if nothing ever happened and he's fine... It's beyond him being a brat and just wanting to get his own way though. He truly can't get himself together until it's done. I never thought of it as ocd with him but more as an inflexibility but I don't know.

[thereishope]

It sounds like he was told one thing,expected that to happen and when it didn't all heck broke loose. We had that here before. With that one, I didn't see a cause and effect. I just warned him a few days prior to a change and reminded him many times leading up to the change.

 

As for probing, I agree you don't want to plant seeds. Even though my son is doing better, I am still cautious about that and I try to choose my words carefully. First, I would really think hard about what else sets him off or what he does at his own home that bothers him. If you tackle what bother him at home first that may cause a chain reaction into helping him in other situations.

 

It sounds like it may be nothing at the friend's house he wants to avoid. It's just not what was suppose to happen. I would consider that OCD. It's up to you if you want to try to tackle it or if you want to give it more time in the healing process.

[MomWithOCDSon]

the psych has cautioned me about probing to find causes and injecting thoughts that he may not even have. do you have any thoughts about how you 'carefully pick' to find the cause without giving him ideas that he didn't even have?

 

i asked tonight about the friend's house and he said yes, he'd be happy to go there the next time -- after he comes here. i really do think it's that cut and dried - it's just the way it is. his plan was that the friend came here the next time and we were doing something different.

 

does this fall into 'just right' OCD even if it doesn't have a connection to thoughts? does it matter what it's termed?

 

am i understanding that the general consensus is that this isn't something that can be worked out with other methods but is a part of the general healing of pandas? there's nothing to do but medical healing?

 

This isn't the kind of "just right OCD" behavior I'm familiar with because it seems to have some premeditated, logical basis, whereas the "just right" stuff seems to occur many times without any logical backstory and without any warning.

 

With the behavior tied to PANDAS, I suppose it should fade away alongside his other PANDAS behaviors as the medical intervention takes hold; however, I know from our experience, that sort of lack of flexibility or "rigid thinking" can prevail unless we work to pro-actively offer up opportunities for our son to challenge it (but then we've been dealing with the OCD for 6 years and only recently came to PANDAS). So we might ask him if he can think of another way he and we might have handled that situation better so that neither he nor his friend was disappointed. Or the next time we plan an event, we'll make sure he's in on the planning and try to prepare him for some contingencies in the event something shifts and he's called upon to "go with the flow" instead of have it 100% the way originally planned.