OCD, Kids, and Medication: Gail Bernstein

Bernstein GailMOIt’s Tuesday already! Welcome back. This week I’m hosting Dr. Gail Bernstein, who specializes in child and adolescent psychiatry at the University of Minnesota in Minneapolis. Parents, this Q&A is for you—especially so if you live in the Twin Cities. Your children are not alone, and there is hope for them! Dr. Bernstein is brilliant and kind and has dedicated her career to helping kids and teens with OCD and anxiety disorders.

Are there certain symptoms among children that are more common than others?

The most common obsessions in children and adolescents with OCD are worries about contamination (e.g., germs and dirt) and aggressive thoughts (e.g., fears of harm to self or others). The most common compulsions are checking (e.g., that doors are locked, everything is in the child’s backpack, oven is turned off) and excessive hand washing. Children are more likely than adults to show OCD symptoms of hoarding (i.e., excessive acquisition of objects and difficulty throwing the objects away). Sexual and religious obsessions are fairly common in adolescents with OCD.

I wasn’t diagnosed with OCD until my mid-20s, and I’ve met several other people with the same story, so I’m a little amazed at how many kids are diagnosed long before that. What signs are their parents seeing that help them realize it might be OCD?

Children with OCD may seek reassurance from parents repeatedly. They may want parents to participate in rituals such as bedtime rituals. In addition, parents may be asked to do daily laundry due to a child’s concern that his/her clothes or towels are contaminated. Parents may notice that it takes longer for their child to complete homework due to checking and repeating rituals (e.g., rereading, erasing answers multiple times, and rewriting answers). These behaviors can be clues to parents that their child is struggling with OCD.

How can parents help their children through therapy?

Most cognitive-behavioral therapists include the parent(s) in a portion of each therapy session so that parents can learn what skills are being taught to their child and what homework (exposure) assignments are being given each week. Parents can serve as coaches for their children in working on exposure assignments at home.

I often tell people that in order to support someone with OCD they need to go against their normal instincts—that is, constantly reassuring the person that their fear won’t be realized actually isn’t helpful, and taking over their rituals for them is just another compulsion. Is this an ongoing struggle in families?

Yes. Most parents who have a child with OCD “accommodate” to their child’s OCD symptoms. This means that they change family routines or interactions with their child in a way that allows the child to engage in the OCD rituals and they may participate in rituals with their child. Although this may seem to be supportive to the children, it is counterproductive in that it allows the children with OCD to continue engaging in their impairing OCD symptoms.

People may be surprised to know that even young children can have taboo obsessions, including sexual, violent, and religious obsessions. What might you tell a parent who can’t understand why their child is having such intrusive thoughts?

Taboo or forbidden thoughts are not uncommon in pediatric OCD. This may occur in young children and it happens frequently in adolescents with OCD. These thoughts do not represent your child’s true beliefs or values, but are a manifestation of OCD and should be viewed as “the mind playing a trick” on the child or adolescent. Antidepressant medications (such as sertraline) can be helpful in reducing the frequency and intensity of these obsessional thoughts.

What do you think about the warning that antidepressants may increase suicidal thoughts in teenagers? What can you tell us about the safety and efficacy of these medications for children and teens?

The risk of new suicidal ideation is 2 percent in children and adolescents with depression when taking an antidepressant. There is no increased risk in suicidal thoughts for children and adolescents with anxiety or OCD when taking an antidepressant.

You’re currently conducting a study at the University of Minnesota in which children ages 8 to 17 take sertraline, the generic version of Zoloft. You take a brain scan (MRI) at both the beginning of the study, before the child starts the medication, and at the end. What differences between the two scans can you share with us?

We have just published our first paper from the pilot data for our study. It shows that teenagers with OCD compared to matched healthy controls have lower connectivity (i.e., impaired connections between nerve cells) in the brain between the putamen (area in the basal ganglia) and parts of the frontal cortex and the insula. In our current study, we will be looking to see if we replicate these results and to see if these connectivity differences normalize after 12 weeks of sertraline.

How can parents get their child involved in this study?

We are looking for children and adolescents with OCD (ages 8-17) who are not currently taking antidepressants to participate in the 12-week treatment study with sertraline. Sertraline is FDA-approved for the treatment of pediatric OCD. Children will be compensated for the assessments and MRIs (noninvasive brain scans with no radiation) at the beginning and end of the study. All OCD participants will be seen regularly by Dr. Bernstein over a 12-week period for monitoring of the sertraline trial. Medication management appointments are free because the study is funded by the National Institute of Mental Health. Please call Elizabeth, the project coordinator, at 612-625-1632 to learn more about the study and to participate in a phone screen to find out if your child is eligible to participate. You may also visit our website.

If you could offer just one piece of advice to a parent whose child has OCD, what would it be?

Early identification and treatment are important to getting relief and remission of OCD symptoms. It will allow your child to get back on the normal developmental path.