OCD or Anxiety?

[mamajennifer]

I know I am not a familiar face around here, but I am at a loss, and hoping someone might have some advice, or a BDTD...

A couple of years ago, near the beginning of 2nd grade, my daughter starts having a problem. They'd just begun working on addition in school, and she says she can't get the numbers out of her head. This isn't something she says with great fanfare, she just mentions little things over the course of a couple of weeks, things like "I wish these numbers would stop being so loud in my head" "I hate doing math in my head all the time" just as throw away lines, in the middle of general family chaos. Finally, unobservant though I am, I realized what she was saying and asked her about it. She told me that she was "having" to do math problems in her head over and over. I asked her what happened if she stopped doing them. She hadn't tried at that point, but did, and reported back - it made her head hurt and made her feel like throwing up. I got worried, and started trying to figure out who in the world I talk to about a 7 year old with OCD, which is what my first thought was. Then, as suddenly as it started, it stopped. All in all, it lasted a few weeks.

Since then, that behavior has come and gone and come and gone. Each time it gets worse, and more complicated. It's gone from math problems in her head, to having to count the letters in the first word on a page in a book and then break all the words on the page into that many letters, (ie - if the first word is "the" all the words on the page have to be read in 3 letter increments) and all sorts of complicated counting things. But only when there is some sort of stress in her life. Good stress, like an upcoming holiday, or bad stress, like a test she's sure she's failed at school, doesn't matter. Any stress. She's 9 1/2 now, and can clearly verbalize what is going on with this. She asked me to make her an appointment with a doctor, because it hurts her head when this is going on and she hates it so much. So I have.

But I was doing research on OCD in childhood today and it just doesn't seem to fit. So much of it seems to focus on cleanliness, germ phobias, a need for order, obsessive rituals of assorted types, etc. All my daughter has are these intrusive thoughts. And only when stressed. In between the episodes, she has no symptoms at all, which isn't typical of OCD, I don't think. Which makes me wonder if this is actually OCD, or if it is something more like anxiety. I know the doctor is the one to diagnose this, but I like to have an idea of what is going on before I go in, so I can be an active part of whatever type of treatment needs to happen. With my son's autism, and then again with my daughter's ADHD diagnosis, I knew even before going in to the doctor what the issue was, and had done the research, and had an idea where to go and what the plan was. Right now, I don't really know what is going on, or how to help her, and I don't like feeling lost.

A little bit of possibly meaningless background - my daughter was diagnosed ADHD last year and is on Concerta, which has made a world of difference in her life. She also has a host of possible genetic links to all sorts of mental illness, including bipolar, OCD, depression and anxiety, and has at least 3 relatives on the autism spectrum as well as 2 who also have ADHD. If eugenics had caught on my husband and I would never have been allowed to breed.

So - any and all advice, thoughts, whatever would be greatly appreciated. And if you actually made it to the end of this post I totally owe you a cookie.

[alegna]

That is an unusual pattern. In your shoes I would get a full assessment. One of the things that sounds like to me is some gifted kids who are bored create patterns like that to entertain themselves on some level. I would find a child psychologist who is also a diagnostician and do a full battery and see what they say.

good luck!

-Angela

[ASusan]

I can only have a gluten free cookie.

It totally sounds like OCD. My cousin had a similar "version" (the needing to count) diagnosed in his mid-teens; he also had ADD (I don't think it was ADHD). I believe that they probably used homeopathics, and maybe some cognitive behavioral therapy and/or medication. He went to Tusculum College, which works on the block system, where you take only one class at a time.

Your DD also sounds like a (college) student I had once, in that the symptoms get worse with anxiety. The student had germ phobias and would use a new toothbrush every time she brushed her teeth. When things were going well, she could use a brush more than once. She said she knew when things were getting stressful when she started going through more toothbrushes. She could really keep things together and under control when she was not stressed, but stress/anxiety really brought out her OCD tendencies.

I can't do a diagnosis, but I thought I'd share my (vicarious) experiences. If it were my daughter, I would make sure she had fish oil (probably CLO) and fish in her diet as a starting point. I would have her seen by a pediatric psychologist (pediatric psychiatrist as a second choice), if you can find one locally. I think it is important for her to learn alternative (healthier) coping strategies to manage her stress/anxiety - even good anxiety - rather than the counting rituals. If she can verbalize what is going on, then she would be able to benefit from cognitive behavioral therapy. I also think it is important to get those coping skills in place before adolescence, when she may be tempted toward even less healthier coping/self-medicating mechanisms.

ETA: some other basic things about ocd --

There are people who have purely obsessional OCD. They don't have the compulsive behaviors that accompany the obsessions, but they obsess over, say, whether something bad will happen when they travel.

The compulsions (actions) can be organizing/cleaning based activities, but they can also be cognitive, like my cousin (and your daughter). It's just that when children have them, we don't tend to notice them, and if it is all the child knows, they may not realize that their counting/ritual thoughts are any different from anyone else. So, the purely cognitive compulsions tend not to be diagnosed in younger children.

It tends to increase in adolescence. (My cousin wasn't discovered/diagnosed until mid-teens. Until then, he thought the counting rituals were normal and since they were all in his head, no one else knew about them. It wasn't particularly bothersome until he was learning some kind of advanced algebra, IIRC.)


If your daughter tries to resist the intrusive thought, the anxiety and need to do the counting (or whatever) will likely increase. If she engages in the counting, then the anxiety is lessened. So, the cognitive ritual (of counting or doing math problems or...) is self-reinforcing. This is a main reason that it increases under times of stress, and will likely get worse over time. (She's not engaging in other anxiety-lessening behaviors, she's doing the counting, which self-perpetuates.)

Many people live with these to a greater or lesser extent (like my former student). They generally seek help only when it becomes a problem big enough to interfere with daily living and causes significant personal distress. If they are able to learn alternative coping mechanisms and thought processes, then their personal distress is significantly lessened.

Ultimately, if you do decide to treat with cognitive behavioral therapy, I would be sure the person is highly qualified. Many community therapists are not well-trained in this therapy. The diagnosis could probably be made by any competent psychologist, but medium-term psycho-therapy should be with someone specifically trained in CBT.

For a non-drug, alternative approach, google inositol, which has been tested in double-blind studies comparing it to placebo and SSRIs. "These results suggest that inositol has therapeutic effects in the spectrum of illness responsive to serotonin selective re-uptake inhibitors, including depression, panic and OCD, and is not beneficial in schizophrenia, Alzheimer's, ADDH, autism or ECT-induced cognitive impairment."

Also look up St John's Wort.

[mamajennifer]

Thank you so much! You've been incredibly helpful. If I had any idea how to make decent ones I'd send you a whole batch of gluten free cookies!