My ds is a bit like this too - he likes double light switches aligned, he straightens things, has to have things on his right etc.
Tanya Byron does a column every Monday in The Times and this week's is about OCD in a 7 year old girl. It's behind the paywall, so I'll c+p for you in case you're not a subscriber.
Q. I am very concerned about my daughter, who is seven and a half years old and has had a habit cough for nearly a year. Physical causes have been ruled out, but she has had three episodes where the cough has been every few seconds lasting from one to six weeks. It is so intense it gives her headaches and aching muscles and is awful for me to watch, I feel so helpless. Now she has a permanent cough that is milder but still very regular.
There seems to be nothing specific that she is anxious about, but she is a worrier and likes routines. We tried hypnotherapy for the cough with no success and now we do not mention it at all in the hope she will grow out of it.
But recently she has had this strong urge to cut chunks off her hair. The first time she mentioned it I thought she was joking, then she cut a chunk off and got really upset. She says she sometimes sees scissors and then gets this strong urge, but other times the feeling comes out of nowhere. From what I have researched this seems to be linked to OCD. Could this be the reason and could that also explain the cough and her need for routine?
Please help, I don’t want this problem to escalate and affect her life more than it already does, but I just don’t know how to handle it.
Rosa
A. Anxious children make anxious parents so to begin with I advise you to focus on how you are thinking about your child and her behaviour and your fears for her in future. She does show anxious tendencies and what sounds like tic behaviour, but you can teach her ways to manage them in a calm way without your own sense of understandable powerlessness increasing hers.
Given that physical causes for the persistent cough have been ruled out and the intensity of it seems to have decreased, it is probable that your daughter is demonstrating a behaviour called a tic.
Tics are more common in boys than girls and generally start in childhood. At a more extreme level they are seen in about 1 in 100 children. They are linked to anxiety and are thought to show a genetic inheritance. Tics are rapid, repetitive, involuntary contractions of a group of muscles that can be mild and infrequent or frequent and severe as in the case of your daughter’s cough.
Tics present as either bodily movement motor tics, eg, blinking, facial twitching, grimacing and shrugging the shoulders, or sounds (phonic or vocal tics), which include coughing, grunting, throat clearing and sniffing.
Tics are difficult to control even when brought to the child’s attention and this can cause stress and frustration to the child, increasing the urge to tic. A child will describe an overwhelming compulsion to perform the tic and exhibit extreme discomfort if asked to stop the behaviour. While some tics are mild, others can leave a child in physical discomfort and can interfere with their normal functioning.
Tics may occur for a few seconds and then fade — they are labelled as transient tics. A chronic tic disorder would be defined as when the tic is persistent. When multiple motor and vocal tics are present for more than a year without more than three consecutive months tic-free, then a child may be diagnosed with Tourette syndrome; see worrywisekids.org.
The aim is to enable a child to understand their tics as behaviours that they are compelled to do and that they will feel stressed and anxious if they don’t. For your daughter the coughing has become a habit that drives itself and habit-reversal therapy (HRT) is a useful way to help her address this.
HRT is a form of behaviour therapy that is effective in reducing tics, although a child should never feel they can or should eradicate the tic completely. Stress driving a parent’s support of their child and unrealistic expectations about eradication of the tic will be self-defeating.
Using the idea that a child should “catch what they can”, HRT enables the child to recognise when the tic is beginning, identify and “catch” the thoughts to perform the tic. If they understand that these are intrusive and unwanted, they can then be empowered to say “no” to their brain. Then a child will learn to implement competing responses, sometimes called “blocking moves”, to prevent physically the tic from happening or to reduce it and make it less noticeable.
For your daughter, a competing response could be for her to take a deep breath or make a small swallow when she has the urge to cough. Sit calmly with her for “practice sessions” for a few minutes and get her to do her tic in slow motion, using a mirror so she can focus on herself and her body. Rehearse her talking back to the intrusive thought and taking charge of what she thinks she is being told to do, do her tic slowly and then practise the competing blocking move with lots of praise and encouragement.
For the strong urges that your daughter feels to cut her hair when she sees scissors, again she needs support to understand that she can block this urge and find a blocking behaviour (eg, cut up some paper). To do this you could have little practice sessions that expose her to the “triggering stimulus”, in your daughter’s case a pair of scissors, and help her to use breathing and relaxation techniques to calm the rising tension (see kidsrelaxation.com), talk back to the thoughts as described above and employ a blocking behaviour. This is called exposure therapy, which systematically desensitises your daughter to the triggering stimulus by mastering the anxiety and helping her to learn that she can control the urges, that nothing bad will happen and that her anxiety will soon dissipate.
You might want to talk to your GP and contact your local Child Development Centre for advice and professional support or look for a child clinical psychologist in your local area via bps.org. However, given that this is part of who your daughter is, it may be best to first try to calmly address it with her, help her to understand what is happening and find strategies that she can use to master these overwhelming urges.
I advise that you read Overcoming Your Child’s Fears and Worries by Cathy Creswell and Lucy Willetts and Freeing Your Child from Anxiety by Tamar Chansky. Also buy the excellent workbook for children What to Do When Your Brain Gets Stuck by Dawn Huebner. With your support your daughter can learn to master her tics rather than having them master her.
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