OCD or tics or both?!

[patty]

Hi all,

 

My son has some symptoms that i am not sure if it is OCD or tics or tics morphed into OCDs. I am trying to identify the problem so i can figure out if cognitive behavior therapy would be helpful for him.

 

1. turning the bathroom sink faucet on/off from left side to right side repeatedly (anywhere from 3 to 12X). He doesn't really know why he does it other than he feels the urge to do. And if i turn it off for him. He is compell to do it after me because he does not think i shut off the faucet completely and it is not done right.

 

2. saying "good nite mom" repeatedly at bed time (3 - 8X).

 

3. turning on/off the light switch as he walks by the hallway or any lighted room (1 to 2X).

 

 

Most symptoms come and go, but the faucet has stayed consistently. Sometimes it is easier to stop the behavior (doing less repeatition), and sometimes it is harder to stop the behavior (10 - 12X).

 

Thx!

 

Pat

[Megs_Mom]

Hi Patty- this is all OCD - I can tell you this pretty definitely. The kind of CBT therapy that you want is called ERP therapy. It's really important to understand this, as many therapist think that CBT works for OCD - OCD is really not anxiety in a normal sense, and only ERP (Exposure & Ritual Prevention) is proven to work as well as medication on OCD.

 

You have actually done an amazing job of already doing one of the first big steps in ERP therapy below. Your son (if this is really all of the OCD) actually sounds fairly mild - I assume you have already treated him for PANDAS? If so, you may find this is mostly a "mind habit" at this point, and will be sort of easy to approach.

 

I would suggest that you start by reading a book with him (it's a workbook for kids) that you can order on Amazon for under $20.00. It's called "What to do when your brain gets stuck". It explains what OCD is, normalizes it (LOTS of kids have it) and gives you the basic tools for ERP and examples of how to use them. I'd be happy to give suggestions as well. If you and your son are pretty calm together, you may do well on your own. Also, while you are on Amazon, if you are ok with reading, pick up Aureen Wagners book "What to do when your child has Obsessive Compulsive Disorder". You'll read the exact situations that you have explained with your son.

 

You should feel great about already identifying so many issues so clearly! Does your son have PANDAS? Is he on abx, low dose? If not, you may also want to work on the medical side, as that makes the therapy so much easier.

 

Hope this helps! Susan

[Chemar]

Pat, does your son have a PANDAS dx now?

was just wondering as you usually post on the TS/tics board

 

not knowing if the dx has changed, I can only offer that what you are describing could be tourettic OCD where the tics and OCD "morph" in people with TS

 

for my son, the serotonin boosting supps combined with the magnesium and B's really helped stabilize this

[faith]

Patty

I second that these seem to be ocd habits, I would not classify them as tics.

 

If you ask him to not turn the faucet like that or turn off/on the lights, does it 'bother' him? he has to do it, or he feels 'bothered' if he doesn't? we've gone thru that with the retracing and erasing of letters. I can attest to ERP therapy helping this. it was really bad at one point, where it really upset him that he was doing this and could not seem to stop. the first step tho, I feel, is that they have to feel it is a problem and 'want' to be helped and want to find a way to have this stop. Altho, if this is not that much of a problem, in other words, if it is not interfering with anything or upsetting him, than not sure it needs to be addressed, it might make things more uncomfortable and just open up some problems, you'll have to gauge how much you feel his "OCD" is a problem.

 

 

* (don't think patty will mind if I point out that, no, she doesn't think he has PANDAS, but he does have tics and now this ocd, but the parents here seem to have more of experience with ocd in their kids.... we've been kind of on the same path for a while with our kids being somewhat similar).....

 

Faith

[Chemar]

respectfully.....for kids who have Tourette Syndrome, OCD behaviors that morph with tics ARE classified as tics...they are known as tourettic OCD. Sometimes it is very hard to differentiate between what started as a tic and became OCD and vice versa

 

so, as there is no clear diagnosis, I dont think one can emphatically state that "this IS OCD and not tics"

 

when the two morph, the lines blur

 

so, what may seem like "just OCD"...... in a child with TS may in fact be that blend of tics and OCD known as tourettic OCD and therefore be both a tic AND an OCD

 

once again I am speaking from the TS perspective, and not in any way suggesting that this occurs when a PANDAS child with no TS exhibits OCD behaviors like these

[Chemar]

just wanted to also leave a link to a 2007 study which was one of the more recent ones I had bookmarked on this *distinct* subtype of OCD, known as tourettic OCD, that seems to occur in some people with Tourette Syndrome.

 

http://focus.psychiatryonline.org/cgi/content/full/5/3/361

 

The physician who first made us aware of this is 2001 had lots of journal references as well

 

I guess I am stressing this asI think anyone who suspects TS should be aware of it and remember that it *is* distinct from "classic" OCD, not so much in the manifestation (eg the repetitive, just right, have to stuff) but in what is likely the root cause, and where that overlaps with the tic origins in the brain.

 

so the cause of the OCD behavior in the PANDAS child without TS may be very very different than that of the TS child who has comorbid OCD, of the tourettic subtype.

 

Hope that makes sense...I know what I am trying to say but the terminology doesnt lend itself to easy description )

Edited May 14, 2010 by Chemar

[Megs_Mom]

So TOCD may not respond as well to ERP, according to this study, if I read it right? However, ERP is not a medication - it's just a way of thinking. It's a tool that you can use to eliminate OCD or keep it from spreading as quickly. In fact, I use it now when I am stressed about something. The principle is to "do the thing you are afraid of", and in this case, eliminate the ritual. So I'd think that ERP would be wise to try, especially given the book reco which is pretty cost effective? I'm love the post, and am a supporter of understanding the distinctions - just want to be sure we are suggesting something to this mom that is actionable. Is there a different or blended recommendation that you'd suggest if she feels that it is TOCD rather than OCD? I'm not familiar enough with this distinction.

 

My nephew has both TS & OCD. The OCD is well controlled with a blend of SSRI's and ERP. The OCD for him, is the more debilitating of the symptoms when not controlled. This can certainly be different for many kids.

 

Look forward to hearing of the recomendations given the distinction!

[Chemar]

- just want to be sure we are suggesting something to this mom that is actionable. Is there a different or blended recommendation that you'd suggest if she feels that it is TOCD rather than OCD? I'm not familiar enough with this distinction.

 

yes, Patty is a long time member so been part of many discussions on the TS/tics board here

 

treatment really does vary very much with the individual and what other issues they may have

 

cognitive behavioral therapy is considered to be the most effective foundation in treatment coupled with whatever medications or supplements the patient takes for their tics and OCD

 

that is where the variations come in...many kids with tourettic OCD seem to react negatively to SSRI's, not because they dont need the extra serotonin, but possibly because of the mechanism by which the SSRI's work (selective serotonin reuptake inhibitors)

 

for them, often supplements that help boost serotonin are more effective

 

some take meds for the tics successfully...others have nasty side effects from them with very little help in reducing tics

 

again, it is the individual genetic make up, biochemistry etc that makes a "one size fits all" treatment difficult

 

my purpose in posting that study was more to validate the distinction, than to suggest a treatment protocol

 

for us, where my son's tourettic OCD has always been far more bothersome to him than just the tics, a supplement program combined with CBT has worked wonders! he also has found acupuncture especially helpful whenever he has been in any type of waxing mode. (my signature link has details of our treatment protocol)

 

i know Patty is already very familiar with a number of these alternative treatments...and she is in fact studying classic homeopathy at present

[tygertoo]

Hi all,

 

My son has some symptoms that i am not sure if it is OCD or tics or tics morphed into OCDs. I am trying to identify the problem so i can figure out if cognitive behavior therapy would be helpful for him.

 

1. turning the bathroom sink faucet on/off from left side to right side repeatedly (anywhere from 3 to 12X). He doesn't really know why he does it other than he feels the urge to do. And if i turn it off for him. He is compell to do it after me because he does not think i shut off the faucet completely and it is not done right.

 

2. saying "good nite mom" repeatedly at bed time (3 - 8X).

 

3. turning on/off the light switch as he walks by the hallway or any lighted room (1 to 2X).

 

 

Most symptoms come and go, but the faucet has stayed consistently. Sometimes it is easier to stop the behavior (doing less repeatition), and sometimes it is harder to stop the behavior (10 - 12X).

 

Thx!

 

Pat

 

I am going to just share my experience and defer to the experts for the clinical part....my 8 year old son began to have tics when he was about 4....it morphed into complex and verbal tics and thus he was given the TS diagnosis. When he was in 1st grade, he began showing OCD symptoms...similar to your son. turning on and off faucet/light; tactile issues with socks and tags; repetative statements; rubbing his hands etc. he had stomach aches due to anxiety issues while at school; afraid to eat certain things (choking or too chewy); afraid to wear certain clothing/colors.

 

we have been taking him to therapy for the past year for Cognitive Behavioral Therapy...I can attest that it definately helped him cope with his symptoms.

We just found out that he has a diagnosible case of PANDAS. He has never had strep throat but did have chronic Myco Plasma pneumonia. His step and myco plasma P titers are very high and with that and his symptoms it has been determined pandas.

 

we are continuing his CBT therapy while exploring Pandas.

 

Good luck and I wish you and your son the best...

[patty]

Chemar and other who have responded,

 

Thx you so much for the distinction bet TOCD and OCD. You gave me the exact info that i am looking for. I have been reading "Freeing your Child From Obsessive-Compulsive Disorder" by Tamar Chansky and "What to do when your brain Get Stuck", a kid's guide to overcoming OCD. I see the compulsion part of OCD but not the Obsessive component such as fear, ritual..... And that's what lead me to ask the question so i know how to approach my son's compulsion.

 

BTW, faith is exactly right. My son has not changed to PANDA status. I came on this board becuz most parents here are knowledgeable with OCD.

 

Pat