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The podcast episode discusses childhood OCD and how it manifests in children. It explains that OCD can display both internalizing and externalizing symptoms in children. The episode also mentions the role of temperament in recognizing individual differences in children. The causes of OCD are explored, including the possibility of it being hereditary or caused by environmental factors. Treatment options for OCD are discussed, including therapy and parental support. The impact of OCD on a child's social development is also highlighted, with a focus on attachment theory and its relation to OCD symptoms. Hello, and welcome to Mending the Mind, a podcast that works to help parents and get advice on how to best support their child's mental health. For today's episode, we'll be looking at- Oh, it looks like we have our first call in today. Hello? Oh, hello. Is this Mending the Mind? Yes, it is. How can we help you today? Okay. My seven-year-old son, Harry, has been recently diagnosed with OCD, but I'm not entirely sure he has it. Would you be able to better educate me on OCD in children? Well, lucky for you, our topic for today is just that, childhood OCD. So ask away. Fantastic. Can you explain to me exactly what OCD is? I don't really understand it. Certainly. In a study done by Goznik et al., OCD is said to be typically characterized by internalizing behaviors, and it is seen as an internalizing disorder. However, this study and many other recent studies have shown that some children display externalizing symptoms. These symptoms are characterized as more disruptive than internalizing symptoms. Wait. What are internalizing and externalizing behaviors? I've never heard of that before. Well, the American Psychological Association describes internalization as, and I quote, the non-conscious mental process by which the characteristics, beliefs, feelings, or attitudes of other individuals or groups are assimilated to the self and adopted as one's own. And the American Psychological Association describes externalization as, and I quote again, a defense mechanism in which one's thoughts, feelings, or perceptions are attributed to the external world and perceived as independent of oneself or one's own experiences. Okay, but how does OCD manifest in children? I hardly hear of children being diagnosed with it. It makes sense you haven't heard much about childhood OCD, as most research is done on adults. There was a study done by Guthick et al. that describes the manifestation of both internalizing and externalizing symptoms in children with OCD. The study says that internalizing symptoms manifest in children as intrusive thoughts and feeling the need to act upon unwanted compulsions. As for externalizing symptoms, those manifest in children through more aggressive action, such as imposing their compulsions onto others and becoming upset when their parents don't accommodate their compulsions. It's important to remember that not all children with OCD will display the same symptoms, and some may display a combination of both internalizing and externalizing behaviors. And to add to that, temperament is what helps us recognize certain individual differences in children. According to Rothbard's model of temperament, there are three dimensions. We have positive reactivity, negative reactivity, and attention-susability regulation. Positive reactivity refers to children who react to stimuli with a smile or even a laugh and embrace whatever environment they are in positively. Next, we have negative reactivity. This is when you have a child who is a bit more difficult and may have a tantrum or a meltdown in a particular environment. Lastly, the dimension of attention-susability regulation refers to how well a child can control their impulses and emotions whilst adapting to their environment. This child would also be deemed as a dandelion child because of their ability to grow no matter what environment they are in, according to Allison Kofnick. And just going back to Rothbard's model of temperament, there is no such thing as one or the other. Temperament is seen as a continuum. So for example, a child with OCD may be high in negative reactivity, low on positive, and moderate for attention-susability regulation. There is so much variability from child to child that psychologists have been to discern. Could I have somehow passed this down to him? Gosh, I wish I knew if anyone else in my family had it. You're asking about heritability or the effect that genes can have on acquired traits, yes? Yes, that sounds right. Tell me more. Okay. Unfortunately, the causes for OCD have less research than they should, but hopefully the research we do have will help answer your question. It has been proven that OCD is heritable, but it doesn't have to be. An article published last year titled Genetics of Obsessive-Compulsive Disorders states that OCD is very easily passed down within an immediate family. They wrote about something called a proband, which in your case would be your son, Harry. A proband is the person who is diagnosed first and prompted genetic investigation. The people directly related to the proband, who would be Harry's hypothetical future children, would be very likely to be diagnosed with OCD because he has it. But in your case, that means if either of Harry's biological parents had OCD, that could be a big possible reason of why he was diagnosed. Hmm. Neither me nor his other parent have OCD that we know of, so what could it be then? Well, exactly. OCD doesn't have to come from a relative. While genetics are important to consider, there are many environmental factors that can lead to OCD developing in kids. It could be inadvertently caused by the way they were raised, it has been linked to also having other disorders such as anxiety, and of course, it could always just be by chance. There are some studies that prove it is caused by just a chemical imbalance in the brain. Yes. Although you or your husband do not have OCD, it still could have skipped a generation. It is also important to note that about 50% of individual differences in temperament come from genetics, so it does play a big role in the determination of it, as well as environmental factors in the child's experiences, according to a learning module from the University of Washington. So, for example, where they stand in social groups can affect their temperament positively or negatively. Like a child with a bully victim, they may end up having a temperament of high negative reactivity, whereas a child who has many friends and is well recognized as a good student may be on the higher end for positive reactivity. Fascinating. Now, here's what I feel could be the tricky part for you all. Is it OCD treatable? Like, would I be able to just put my son in therapy, or is there anything I myself could do to help him? This reminds me of a great novel I read by psychologist Alison Gopnik, titled The Gardener and the Carpenter, which discussed how to deal with variability in children, and I feel like it would apply to your question. Essentially, Gopnik tells us that parents should meet variability with more variability, so this means that if we keep an open mind about how children are developing and experiencing social situations, then we can best support them when a potentially unwanted change occurs. I'll have to check that book out, thanks. I just have one last question about how I can help my son. I now understand how much of a cognitive toll OCD has on Harry, so I can't even imagine how much this could potentially be damaging him socially. What is the best way I, or a trained professional, could socially help him? Well, in this case, we can turn to attachment theory coined by Mary Answorth, which addresses behavior and its evolutionary context. In a journal published by Van Leeuwen et al. in 2020, attachment insecurity, both anxiety and avoidance, has been found to be directly related to OCD symptoms. As a result, it is proposed that an insecure attachment style promotes sensitivity to OCD. Attachment avoidance is linked to having unrealistically high and rigorous personal standards of perfection similar to what we see in people with OCD. Wow, thank you all for your help. I finally feel like I understand OCD and how it impacts my little Harry. I look forward to using my new knowledge about OCD to help him. You all have a fantastic day. You too. Thank you so much for calling. We hope you enjoyed our podcast on Child OCD and found it informative. Tune in next week for how to relieve birthday jitters. Bye! you