Questioning/Statement Rituals

[coco]

The strongest compulsion my dd has is repetitive questioning or statements rituals. My husband and I do not know how to help her get out of them and it usually ends up making us crazier than we already are. Here's an example: I will ask my daughter to put her shoes on as we are preparing to leave the house. She dilly-dallies and I ask her again. Still no shoes on. She is sidetracked with saying goodbye to the dog, still no shoes on. Then, I will ask her again in a more forceful voice (but still calm) to put her shoes on because we are leaving. She will then ask, "Are you mad?" I reply, "no." She says, "Because I want to make you happy...are you happy?" "Yes, I am happy." BUT, if I say "I am FINE or OK, or just YES" instead of using the word "HAPPY" in my reply, she will then say, "Are you mad...I want you to be happy!!" She will NOT STOP until the word HAPPY is used. I can switch topics, and she will come back to that until the word "HAPPY" is said. If I completely do not give in she will often start to cry, melt down, escalate the tension and this happens over and over and over. If she even slightly THINKS I am a bit cross or just tired or don't respond in just the right tone of voice ABOUT ALMOST ANYTHING, she will again begin the "MAD/HAPPY" ritual. It can go on for an hour, or intermittently all day. If we could eliminate that alone, life would be SO MUCH BETTER! I have read about ERP and understand how it works for objects, like fear of scissors, or handwashing, etc., but what about verbal compulsions? Do any of your kids do this? Any suggestions?

[thereishope]

I hated when my son did that. Either reasurrance questions over and over or I had to answer a very specific way.

 

As for reassurance, If I knew he eard me and he asked again, I would tell him to look me in the eyes and I would repeat my answer once. I would tell him I was not going to answer agian.

 

If it was something I knew he knew the answer to, like holding a red crayon and saying "Mommy is this red?" I would simply say you know what color that is. He'd ask again and again and as long I knew he knew the answer, I wouldn't answer him.

 

As for scripting, I would not do it. "Mommy,say ____'. My respnose "no". Or I would reword it a different way and tell him that I know he understands what that answer means.

 

I didn't do this when these things first surfaced. It just got to the point that I could hande it anymore. He did get upset, he gave me ultimatums, but I just had to stick with the plan. Eventually it worked.

[matis_mom]

The strongest compulsion my dd has is repetitive questioning or statements rituals. My husband and I do not know how to help her get out of them and it usually ends up making us crazier than we already are. Here's an example: I will ask my daughter to put her shoes on as we are preparing to leave the house. She dilly-dallies and I ask her again. Still no shoes on. She is sidetracked with saying goodbye to the dog, still no shoes on. Then, I will ask her again in a more forceful voice (but still calm) to put her shoes on because we are leaving. She will then ask, "Are you mad?" I reply, "no." She says, "Because I want to make you happy...are you happy?" "Yes, I am happy." BUT, if I say "I am FINE or OK, or just YES" instead of using the word "HAPPY" in my reply, she will then say, "Are you mad...I want you to be happy!!" She will NOT STOP until the word HAPPY is used. I can switch topics, and she will come back to that until the word "HAPPY" is said. If I completely do not give in she will often start to cry, melt down, escalate the tension and this happens over and over and over. If she even slightly THINKS I am a bit cross or just tired or don't respond in just the right tone of voice ABOUT ALMOST ANYTHING, she will again begin the "MAD/HAPPY" ritual. It can go on for an hour, or intermittently all day. If we could eliminate that alone, life would be SO MUCH BETTER! I have read about ERP and understand how it works for objects, like fear of scissors, or handwashing, etc., but what about verbal compulsions? Do any of your kids do this? Any suggestions?

The way they say to deal with reasurance questions is not to answer them. My son does this a lot in the evenings before bed (did I close that right? Are you going to turn off the lights? Is it OK if I...) I might answer once and then say "I already answered that", or "That's an OCD question", or "You know the answer to that"

It sounds like your daughter needs emotional reasurance right now that you are not upset at her, so trying to keep your cool is very important. Maybe just change the routine a bit, you could just take her hand and walk over together to get the shoes and put them on. Or just give her the "happy" before she asks, like "I'm so happy we are on time today, let's get those shoes on now." I know how it is when you are running out the door and trying to get other last minute things done, but you might have to adapt a little bit, make sure you make eye-contact and follow through to make sure she does it the first time you ask.

I don't know where you are in the learning curve with OCD, and how much your daughter understands it and can recognize it, but slowly you will both learn to deal with these things, and it will get easier, but sometimes during exacerbations there is little that can be done...

[Suzan]

OMG, this is almost exactly what my dd8 does and it makes me completely crazy. She does the same task avoidance that you mention and when I start to drop the sugary, happy tone, she starts in with the "Are you mad". She will say "I'll do it if you won't be mad", I'll say "OK, I'm not mad" but then she doesn't do it. We can start to go back and forth where I say "Just do it and I won't be mad" but she can't stop and just do whatever it is that I need her to do and will keep asking if I'm mad and saying she'll do it if I won't be mad. This is one of the 2 things she does that can set me into a childish tantrum and huge explosive situation if I'm not careful. I knew it must be related to OCD somehow but I didn't know how.

 

Susan

[Megs_Mom]

Questioning or reassurance rituals can be so frustrating because they tie up the entire family in OCD. I remember just wanting to scream from frustration when my daughter asked me the same thing for the 100th time that day. I think that feeling is how she felt all the time during an exacerbation. But actually, this kind of OCD can be relatively "easy" to tackle with ERP. (for PANDAS families, this is OF COURSE assuming that you are treating your child medically, and are at a place where there are remaining issues that you need tools to help deal with.)

 

As always, the first step is to educate your child a little. I think you have already done this, but for others, I suggest reading "what to do when your brain gets stuck" (on Amazon: http://www.amazon.com/What-When-Brain-Stuc...922&sr=8-1) - it was the ah-ha moment for our child. Discuss the "question and answer compulsion" and brainstorm some ways that you can beat up this compulsion. There are a few tools that you can use: Delay, Change it up, Limit It, and reward tickets.

 

The basic tenant is that you stop answering the question and feeding the compulsion. But if your child is like mine was, and if "question answer rituals" are suddenly in the hours or hundreds of times a day, then "stopping" is just not an option. You need to know that it will take a good 2 weeks to slowly and empathetically help them to stop and to teach them to use a different part of their brain. The first thing you do is a detective tool - as a family, put up a piece of paper & chart how many times a day that OCD makes your dd ask a reassurance question, and what it is (so you may only have one category: happy. Other might have: weather questions, did I do it right questions, are you leaving questions, what time are you coming back questions, etc). (I like to cheat a little here & use "Delay" right away. Before answering a question, ask your child to go put a tick mark on the chart & then come back to you for the answer. In this way, you have already started to beat up the OCD). Once you figure out how much of the day is taken up by this OCD ritual, then you discuss with your child, what initial goal you want to use to beat up OCD. Let's say they ask 50 times a day "are you happy". So maybe the first goal will be 49 times. Make some tickets with your child, with numbers on them 1-49. Agree on a reasonable but motivating reward if she makes it to 49.

 

Then make a little box to put them in. Each time she asks "are you happy", say "I am sorry that OCD is making you waste your time asking about that. It must be frustrating for you. Go put a ticket in the box and come back". Then answer the question and give them a hug. They have just succeeding in "changing the ritual" just a tiny bit. Once they get to around 40, start reminding her that you are only going to answer 49 times, so is she sure that she wants to ask that question right now? Remind her how proud you are of her efforts in trying this, and say that you think she can do it. Then let her make the decision & don't be disappointed when she says "yes, she is going to ask". Just say "ok, then put your ticket in the box". Once she hits 49, remind her that you will not answer the question anymore, because it is not OCD's turn anymore. At this point, you need to make a call - was the goal realistic? If you used all 49 tickets by 1 pm and the rest of the day is ahead of you - maybe the goal was not good. In which case, be sure to acknowledge this to your child. Don't reset the goal, just go back to doing detective work for 2 days & try to set a better goal.

 

If it was realistic, and the day is nearly done, and she has not make the goal, be ready for a temper tantrum the first time that you don't answer the question. But hold firm, and don't escalate the situation. Say things like "You know that I can't answer that question again today - but you are making a great effort today & I am really proud of you. We are going to work on the goal again tomorrow & I know you will be able to do it". Then move on to a planned activity if possible, or let them be angry for a while. When we hand the 49th ticket, we usually have the "answer to the question" written down on a large piece of paper. So after the 49th time, I can also say "I can't answer that question again, because we are working together to not let OCD be so mean to you. But you do have the answer written down, so how about if you go look at that right now". Now you are "changing it up" - still a reassurance in a way, but they have to do it on their own! But really, you want to keep this situation from happening until around the 5th day if at all possible. You want SUCCESS!

 

If the goal is set realistically, then you will very likely have had SUCCESS on the first day. This is what you want!!! Honestly, if you are spending 4 hours a day answering the question, then make the goal 5. If they ask 50 questions a day, then make the goal 60. You WANT them to succeed for the first week. After this success of 60 times, then ask her to set a new goal. If she says 40 - nope, let's make it realistic. Maybe 57! In a couple of days, you will be below the initial "real" number, and then you start whitling down. It is fine to have the same number be the goal for a few days. Basically, by having them use the tickets, they are slowing changing the ritual in a number of ways - most importantly, by acknowlging that this is a ritual, not something that they want to do - but something that they are being forced to do.

 

As you get down into the 20's for example, you may want to add something like "change it up" to the plan. I like to use humor, so I'd suggest that whenever Meg wanted to ask the question, she first had to do a "delay" like "do 3 cartwheels or stand on your head for 10 seconds" or I'd ask permission to change my answer - like instead of "yes, I am happy" change it to "happy yes I am". Then maybe start to whisper the word "happy" or spell it. All the while continuing to limit the number of times. You may also ask when she asks the question "are you sure you want to use a ticket? Can you just check your answer sheet?"

 

When you get to the very end - and the compulsion is down to only a few times a day - this is the real work. And your child will need to be active in choosing the next tool if possible. If the last few tickets are just really hard to eliminate, try adding another component, such as an alarm clock. Now, instead of answering the question immediately, you set the clock for an agreed upon time with each ticket - maybe start with 30 seconds - work up to 5 to 10 minutes. They ask the question, then put the ticket in & set the clock. When the timer goes off, you ask if they still want the answer. If they say yes, you answer calmly. If they say no, they are good - big celebration, hugs, pride, etc! While the 30 sec to 10 minutes is going by, have an activity that you go to. We had a 10 minute box, full of short games, crafts, drawing, etc - and would reward my dd for delaying by sitting down & doing something positive that WE wanted to do, instead of what OCD wanted her to do. This was really helpful, and often allowed her to delay longer because she wanted to finish the game.

 

Ok, that is enough for a really long post . I never know how to do this short! The nice thing about using these tools over a few weeks is that it eliminates a lot of the parental frustration as well. You have a plan - the expectations are realistic everyday. You don't feel so bad about feeding the compulsion - she does not feel so bad about asking - and the anxiety levels for everyone is reduced. Just keep it realistic but still a slight challenge. When you read "what to do when your brain gets stuck" you'll learn other tools that you can incorporate as well. A lot of ERP therapy is really about creativity & adjusting it to work for your child's ability at any one time. Good luck! (FYI, our child is on Azith, and it lowered the anxiety by about 70% - to the point that using ERP tools became SO much easier!)

[coco]

Thank you all so much for these suggestions, and that you have seen this in your kids as well and understand how exasperating this is. We are sitting in the family room right now as she is watching a home improvement show on TV...and the questions are coming (nonsense questions) fast and furious...I just asked her if she could just "tell" me that thought instead of forming it into a question. Instead of "What's that paint color, Mom??" I said, "Why don't you just tell me what the color is since you know what that color is?" She rephrased and said "The color is green." EEEEESH! This is going to be very hard...she is sooooo strong-willed about this. Sometimes it seems like she almost "enjoys" the aggitation that this brings. Thank you again for your thoughts, I really appreciate it.

[momaine]

Reassurance questions are my dd's biggest OCD hurtle and the biggest hardship on our family. They drive me INSANE becasue it drags me into her rituals. During an exacerbation however, she seems to have no control over it and though we went to therapy and learned ERP tactics they just do not work with her when she was really struggling. She is overwhelmed with those thoughts and cannot move forward even though she knows it is driving me crazy and even though she wants nothing more than to please me.

 

That said, sometimes I just get so overwhelmed myself that I need to take a break. Sometimes I just have to remove myself from the situation and leave my husband to deal with it. She will melt down in a big way, but then she does better for a time because we did not reinforce it. It is not someting that I think is good for her though becasue she feels totally left to deal with the wolves on her own. She feels abandoned and neglected and left to struggle on her own.

 

She's on antibiotics and things are improving slowly. The need to ask is less frequent and the intensity is down. Other OCD issues have faded away and others have become less intense. I keep trying to focus on the positive but its hard when overwhelmed with all the questions sometimes.

 

I know it is not her fault and she does not want to ask them and she knows they don't even make sense, yet she cannot stop herself. It is so sad. I try to keep all those things in mind so I dont' take out my frustration on her. It is hard though.

[smartyjones]

Sometimes it seems like she almost "enjoys" the aggitation that this brings.

 

 

i'm not saying this is your issue . . . but one of the red flags for us for exacerbation is when he does something which he is seemingly purposefully trying to challenge me for his amusement. it is not when he may be doing something wrapped up with other rituals like you're talking about. it's more a quick, reactive type thing.

 

he mostly presents with obnoxious behaviors. he does have cognitive inflexibility issues which may have OCD basis and separation anxiety. so it may be that that just goes along with the territory of obnoxiousness, which i'm not sure is one of your daughter's symptoms.

 

he's a 5-yo boy so there is some challenging to be expected but there is a different type of energy around it than just what may be 'normal'. today, at breakfast i asked him not to do something and he did it on purpose while just looking at me. i sent him away from the table and he was mad and sad. that, however, i'd term normal. the other is wound up with something different that i can't explain but i just know it's different and he did do it recently when having an exacerbation.

[MomWithOCDSon]

Meg's Mom seems to have a great handle on addressing these sorts of OCD behaviors, and I would agree that in utilizing most of the same techniques with our son over the last 6 years, we have made significant gains. With every new exacerbation, though, reassurance questioning is one of the first behaviors to resurface.

 

One thing suggested by our new therapist just this past week, however, is that instead of responding with something along the lines of "I'm not answering an OCD question" or in some other verbal response pointing out that his question is, in fact, borne of the OCD rather than of healthier, logical, cognitive thought, we should ask him, "Is that an OCD question?" Then it is his responsibility to determine the "validity" of the question, recognize it as OCD or demonstrate that it is, in fact, a legitimate, logic-based inquiry, and then move forward. I guess by our automatically stamping it as an OCD question for him, he was being absolved of some of the accountability for recognizing it for what it was all by himself. As a result of this new technique over the last 6 days (in conjunction with abx), he's nearly completely ceased from engaging in this behavior at all anymore! I guess maybe we were "feeding" it without realizing it.

 

In thinking about it, this latest technique may work well for an older kid, but not sure that a preschooler or even grammar school kid would be cognitively prepared to make use of it . . . .

[dut]

Hi

 

No advice, I'm afraid but know your frustration.

 

Our dd6's 1st episode had this in the form of something like this... "my hand just touched my face. It had just touched the wall and my nappy (diaper) was near the wall. Will it be okay?" We had this type of question up to 200 times a day and I had to reply that it was okay or all ###### would break loose. Having read "Freeing your child from OCD" I explained to her what was happening (she was 5 at the time) by likening it to sales calls.. some calls we want some we don't.

 

She got that these were worry tricks her brain was playing on her and I rejoiced when, as the next question came, she was okay with the "this is a sales call, we won't answer it" response.. seemed too easy... I realised that she was taking that as her "okay". I was still fulfilling her ritual. And so it continued. I'd change it up but she'd change it up with me.. as long as I responded verbally, it completed her ritual for her. The only thing that didn't was to ignore it totally.. look at her, make eye contanct but not respond. That was at the worst point of her 1st episode and thankfully she responded to abx quickly 'cos I don't know how we would have coped for more than a few weeks with it. It was driving me and her crazy. Don't know if I did it wrong or she was too young or just smarter than me (probably the latter)...

[Megs_Mom]

Meg's Mom seems to have a great handle on addressing these sorts of OCD behaviors, and I would agree that in utilizing most of the same techniques with our son over the last 6 years, we have made significant gains. With every new exacerbation, though, reassurance questioning is one of the first behaviors to resurface.

 

One thing suggested by our new therapist just this past week, however, is that instead of responding with something along the lines of "I'm not answering an OCD question" or in some other verbal response pointing out that his question is, in fact, borne of the OCD rather than of healthier, logical, cognitive thought, we should ask him, "Is that an OCD question?" Then it is his responsibility to determine the "validity" of the question, recognize it as OCD or demonstrate that it is, in fact, a legitimate, logic-based inquiry, and then move forward. I guess by our automatically stamping it as an OCD question for him, he was being absolved of some of the accountability for recognizing it for what it was all by himself. As a result of this new technique over the last 6 days (in conjunction with abx), he's nearly completely ceased from engaging in this behavior at all anymore! I guess maybe we were "feeding" it without realizing it.

 

In thinking about it, this latest technique may work well for an older kid, but not sure that a preschooler or even grammar school kid would be cognitively prepared to make use of it . . . .

 

Actually, this is a great technique, it's just kind of advanced. It's a good sign - for us, this stage would come as the OCD was really starting to go into remission. Generally, they need a while of just essentially practice to identify OCD, being motivated to fight it with a lot of support, being motivated to fight it on their own - and finally to learn to identify the compulsion & fight it on their own. Our child is now 8, and is really just this year able to handle some of the more advance cognitive tools. Before that, it was mostly a daily plan to motivate the next step - she would do great and was really brave - but if another exacerbation hit her, we'd have to start over, as she was very coached by all of us to get through it. Cognitively, she was not really ready to do the process on her own. Our therapist feels that this age can vary by child, and is really around the age of 10 or older. If we have another exacerbation, we still expect this to be a very coach intensive process. But even at 8, we were able to give her more control over using the tools this time around. I felt like the mom of a teenage for a while, trying to learn myself when to get involved & when to let her fight alone. Very challenging times.

[Megs_Mom]

Hi

 

No advice, I'm afraid but know your frustration.

 

Our dd6's 1st episode had this in the form of something like this... "my hand just touched my face. It had just touched the wall and my nappy (diaper) was near the wall. Will it be okay?" We had this type of question up to 200 times a day and I had to reply that it was okay or all ###### would break loose. Having read "Freeing your child from OCD" I explained to her what was happening (she was 5 at the time) by likening it to sales calls.. some calls we want some we don't.

 

She got that these were worry tricks her brain was playing on her and I rejoiced when, as the next question came, she was okay with the "this is a sales call, we won't answer it" response.. seemed too easy... I realised that she was taking that as her "okay". I was still fulfilling her ritual. And so it continued. I'd change it up but she'd change it up with me.. as long as I responded verbally, it completed her ritual for her. The only thing that didn't was to ignore it totally.. look at her, make eye contanct but not respond. That was at the worst point of her 1st episode and thankfully she responded to abx quickly 'cos I don't know how we would have coped for more than a few weeks with it. It was driving me and her crazy. Don't know if I did it wrong or she was too young or just smarter than me (probably the latter)...

 

We went to a therapist due to an issue very similar to this - our latest exacerbation was so bad, that we needed help in finding the right tools. We had whittled down reassurance to a minimum, but I felt that at the end, I could just be standing there, not even responding, and I was still part of the reassurance compulsion. By not freaking out over what she was telling me, that was reassurance alone. We had to find a different way to help in this case, by changing it up in a different way, as it became more of a confession ritual. We did get through it. You were doing it right - but if you only have a few weeks, it would be hard to build up the tools - congrats on getting it under control in just a few weeks! These tools are more for the family that has struggled for some time. We were not as smart as you - and despite efforts, accepted docs telling us "not PANDAS", and did not use abx for way too many exacerbations. I can't tell you how many people told us that the sudden extreme changes in her were "normal for kids with OCD". If they really think this, I now wonder how many kids they are actually seeing with PANDAS!!! Thank God for Prednisone and for parents on this forum, and for abx - and for a few very special doctors that were willing to take some risks for us.

[dut]

Yeh, our episodes have so many different components that vary from episode to episode and even during the epsiode itself, that I know if I were to take our dd to 6 different drs (non PANDAS ones) I'd get 6 different dxs. We'd have OCD, transient tics, HDHD, ODD, Sensory Processing etc etc. It scares me rigid to think how many kids are being treated incorrectly. I also feel absolutley certain that some PANDAS kids might only show behavioural stuff or for those with OCD, their OCD is hidden from others, as is common.

[coco]

So today I tried "identifying" her repeated questions to her as "OCD questions" and I would not reply, other than to say that she was asking an OCD question she already knew the answer to. I think m-a-y-b-e she is beginning to understand a bit, but she is wise to upping the anti. Maybe just "any response" is enough to satisfy her itch, but I will have to watch it. I will try the tickets and the chart and see what happens. She is currently on 1200 mgs of augmentin (she's 10 and 60 lbs) for months, and we have seen other very nice improvements, but this is hardest to go. I fear that we have been "feeding" the questioning itch for way too long, as there were so many other issues that seemed greater, but now that we are down to mostly this I am regretting not trying to beat it sooner. I realized today that my dd speaks in mostly questions!! No wonder I am exhausted!