If you are concerned that your child may have Obsessive Compulsive Disorder, they are entitled to an assessment to consider whether a referral to a mental health professional is appropriate. The relevant professionals are normally based at the Child and Adolescent Mental Health Service (CAMHS) although this can vary.
The referral can be made via your GP or the school nurse, however this may not always be straightforward. Occasionally parents are thought to be worrying too much or the GP may consider that it is just a phase which will go away by itself untreated. After all, most children have little fears and worries as they mature through childhood. Often general practitioners do not like to have people self-diagnosing, after all it will take a team of mental health professionals at CAMHS to do that after weeks or perhaps months of assessments.
Self diagnosing is also problematic as many of the childhood mental health conditions have similar symptoms. For example a child who fears telling a lie in case something bad happens to his family could have OCD, equally a child who has high functioning autism may also struggle to lie because lies are bad and truth is good and there are no grey areas in between.
It is better to tell the general practitioner what behaviours your child is exhibiting, how distressing it is and to make notes of how long this is taking out of an average day for them rather than telling them what you think the condition might be. Request that the child be sent for an assessment by a mental health professional.
The school nurse can also refer to CAMHS and will be able to see your child individually in school time. It is important that you keep the school informed, particularly as children with OCD can be very smart at hiding their compulsive behaviours. The school nurse will be skilled in enabling the child to discuss their thoughts and fears. The school nurse cannot diagnose but they can refer to CAMHS independently of the GP.
There is a waiting list in most areas to be seen by CAMHS and your referrer will be able to advise you of the waiting time. If your child’s condition deteriorates whilst on the waiting list you must go back to the referrer and explain this to enable them to assess if more urgent action is required.
CASE STUDY
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Sean was suffering from OCD type symptoms. He feared he had sworn with his hands and God would punish his family, just as God had done when he sent the flood and only saved Noah. He felt that he needed to continually apologise to God to stop his family from being drowned in the flood. Sean’s Mum visited the GP who advised that it was just a phase and Sean’s Mum so wanted to believe this that she was relieved and waited for the phase to pass. Two weeks later Sean’s “phase” was tormenting Sean’s every waking moment and Mum returned to the GP insisting politely but firmly on a referral to CAMHS. Sean was then put on a six month waiting list for assessment in her area and advised this was fortunate as it had been as long as eighteen months the previous year.
After a few more weeks Sean found the thoughts so troubling and his teacher so unsympathetic that he actually became suicidal as he could not cope any more. His OCD was both severe and debilitating although Mum or Sean did not have a name or understanding of the condition at the time. Mum went back to the GP again and informed him that the child was suicidal and she was frightened as he was not coping. She also went into the school and got an appointment with the school nurse sharing her concerns with her. The school nurse had already been made aware of Sean’s obsessive thoughts and recognised that this was a child in need of urgent help. The GP and the nurse both contacted CAMHS who did a house visit the next day and he was seen by a child psychiatrist a few days after that. Sadly, the severity of his condition meant that Sean jumped the waiting list and was given immediate professional mental health intervention as he was a suicide risk. |
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National Institute for Health and Clinical Excellence (NICE) Guidance.
NICE have created a guidance publication which is called "Treating obsessive compulsive disorder (OCD) and body dysmorphic disorder BDD) in adults, children and young people". It is an excellent guide that tells you of your medical rights and takes you through the process step by step. It does consist of 44 pages which can be read in full by following this link. (Nice Guideline)
We have extracted some important information from the guidelines to help you to shortcut to questions that are most commonly asked by sufferers, their parents and carers until you have the time or need to read the document in full.
The Nice Guidelines are as follows:-
Treatments for children and young people with OCD
What should happen when I first see a healthcare professional?
When you first see a healthcare professional about your OCD they will ask you some questions (this is called an assessment) such as:
- Do you wash or clean a lot?
- Do you check things a lot?
- Is there any thought that keeps bothering you that you’d like to get rid of but can’t?
- Do your activities take a long time to finish?
- Are you concerned about putting things in a special order or are you very upset by mess?
- Do these problems trouble you?
What treatments can help me?
Treatments for children and young people are like those for adults but there are some special things that healthcare professionals (doctors and therapists) need to think about when offering them to you.
Because it can help you to get better, your family and the people who care for you (and sometimes other people such as teachers) should be involved in your treatment.
Can I choose what treatments I have?
Yes, you can usually choose what treatments you get. But this does depend on your age and whether or not you are able to fully understand all the information that your healthcare professional should give you about treatments. If you are over 16 you can give your own agreement, if you are under 16 and you fully understand all the information you may also be able to give your own agreement.
If you are too young or have not fully understood the information about treatments, your parents and carers may also need to agree to your treatment.
Psychological Treatments
The main treatments for children and young people include talking to someone and getting help if you are feeling anxious or nervous because of your thoughts or actions.
If you have OCD and your symptoms are mild (they do not trouble you very much and you are mostly able to get on with your school work) they may first give you a book to help you with your thoughts and actions. Your healthcare professional should help you to follow some of the exercises in the book. At the same time, your family or carers may also be given information about OCD and the treatments you can have.
If the exercises do not help you, you should be offered a special type of treatment called cognitive behavioural therapy including exposure and response prevention. We call this ‘CBT with ERP’ for short. Your family or carers should be involved in the treatment and you should all be offered the choice of having the treatment alone, or with a group of other people with OCD.
If you have OCD and your symptoms are more severe (they trouble you a lot and you are not able to get on with school work and other activities), you should be offered CBT with ERP.
When you have therapy, your healthcare professional should be understanding and support you. He or she should talk to you and your family or carers about what the treatment will involve. Depending on your age, your agreement will be needed for the healthcare professional to talk to them about your treatment.
If therapy has not helped you after 12 weeks, your healthcare professional should suggest that you see a range of other healthcare professionals who are experts in OCD. They will look at the treatment you have had so far.
They may then offer you medicine in addition to therapy if your OCD is severe. If you do not want to have therapy, your healthcare professional may also consider offering you medicine.
Medicine
Medicines can help children and young people with OCD, but you should be offered therapy before you are offered medicine.
Medicines called SSRi’s often work best for people with OCD. These medicines are also used for people with depression and so are called anti-depressants.
You should only be offered medicines after you have seen a psychiatrist (a doctor who is an expert in mental health problems such as OCD) who specialises in treating children and young people. You should usually be having CBT with ERP while taking medicine. If for some reason you are not having therapy, your healthcare professional should take extra care while you are taking medicines on their own. Whether you are offered medicines also depends on your age (very young children are less likely to be offered medicines) and how you are feeling.
If CBT, ERP and medicines have not helped you, your healthcare professional may offer you another type of SSRi or other medicines but this may depend on your age.
What should I know about medicines?
If you are taking an SSRi your healthcare professional should arrange with you and your family or carers to see you regularly so that he or she can see how you are feeling. This should be agreed between you and your family or carers and your healthcare professional and written in your medical notes.
If you are offered medicines, your healthcare professional should tell you and your parents or carers the following before you and/or your parents or carers agree:
- about why you have been offered medicines
- that the medicine may take some time to work
- how long the treatment should take, and how it might help you
- about any possible unpleasant reactions (called side effects) to the medicine
- that you must follow the instructions in the packet about taking the medicine
You should also be given written information about the medicine you are taking.
The amount of medicine you are given (the dose) should be small, but you can be given more gradually if a small amount has not helped you feel better.
OCD: Religious and cultural practices
If you have OCD and you have obsessions that may be related to your religion, or that are specific to your culture, healthcare professionals may ask for advice and support from local religious and community leaders. This can help the treatment process. You should be asked for your permission first.”
Please Note: The above are all extracts from the NICE Guidelines. The NICE Guidelines are far more comprehensive but these are the pertinent parts to know until you have time or need to read the document in full.
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