The ABC’s of OCD Treatment for Kids

by Charles H. Elliott, Ph.D.

Parents of children with OCD or symptoms of OCD want to help their kids get the best and most effective treatments. There are many options with many different names. For example in the treatment of OCD, we hear about CBT, BT, EXRP, ERP, E & RP. Professionals love initials! So how does a parent without a doctorate degree in psychology make an informed decision about what treatment to seek?

There is a large body of scientific literature that discusses evidence based psychotherapies for children. Despite the various names, settings, and formats, treatments that work often have common theoretical bases. In other words, whether the treatment is called CBT (cognitive behavioral therapy), BT (behavioral therapy), or one of the many initial permutations of Exposure and Response Prevention (EXRP, ERP, or E & RP), all of these treatments use elements of learning theory as a core foundation. The most widely studied and frequently used technique for treating OCD is exposure and response prevention.

Helping a child with OCD usually includes educating the parent about the disorder. Seeing a child once a week for therapy is seldom sufficient for eradicating OCD. That’s why parents will benefit from learning about how their own behaviors can influence their child’s symptoms. If your child is receiving therapy, the therapist is likely to show you exactly how these principles may be used to understand and help your specific child. Here are a few points based on learning theory the therapist may discuss depending upon an analysis of your child’s OCD:

• Positive reinforcement: When a child behaves and the parents give positive reinforcement the behavior will increase. For example, although most parents generally wouldn’t do this, if a child with OCD washes her hands for long periods of time and her parent tells her what a good job she is doing, this behavior is likely to increase. That’s because for most children, praise is a positive reinforcement. Other positive reinforcements can include hugs, treats, or special time together.
• Negative reinforcement: Negative reinforcement occurs whenever an action results in the cessation of an unpleasant, aversive event (stimulus). So when a child throws a temper tantrum (an unpleasant event) and the parent caves in, the parent has just been negatively reinforced for giving in. This fact makes it hard for parents to resist caving in (because they get reinforced, although negatively, for doing so).
• Response cost: This is a principle that decreases behavior. Response cost involves taking something pleasurable or valuable away once a behavior has occurred. This might include losing cell phone or computer privileges for an older child or a toy for a younger child. Time out is considered a response cost as is getting a fine for driving too fast.
• Extinction: When a behavior occurs and nothing happens at all, the behavior will decrease. This principle is the key to exposure and response prevention–the primary treatment for OCD. When a child with OCD is asked to expose himself to his OCD triggers and not do what he feels compelled to do (the compulsion), his level of distress will likely go up for a little while. But when nothing good or bad happens, this level of distress will eventually go down. Therapists are likely to conduct exposure and response prevention with your child and may suggest that you carry out practice ERP sessions at home as well.
• Modeling: Children learn by watching others. The most influential models for behavior are the people that children live with, usually the parents. If you don’t want your child to learn to be aggressive, then don’t act aggressively in front of him. If you don’t want your child to pick up habits such as excessive worry, try to not model excessive worry. In some cases parents may need to get therapy for their own issues to minimize modeling effects on their kids.

Again, OCD is a complex disorder with multiple causes including biology, genes, learning, and the environment. Regardless of its origins, therapists can teach parents how to augment the therapy process with the principles above.

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