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1、Obsessive Compulsive Disorder:,Treatment of obsessive-compulsive disorder utilizing an ecological treatment package (ETP).,Susan M. Swearer, Ph.D. John W. Eagle, M.S.W. Courtney K. Miller, Ed.S Susan M. Sheridan, Ph.D.,NASP Annual Convention 2001 Washington D.C.,Objectives,Description of the disorde
2、r. Prevalence and etiology of OCD. Impact upon academic, behavioral and social performance in schools. Ecological Treatment Package (ETP; Swearer Sheridan & Kratochwill, 1992) and OCD. School related issues.,What is OCD?,Repetitive pattern of obsessions and/or compulsions. Time-consuming. Create sig
3、nificant distress or impairment.,Its not just avoiding cracks or washing your hands.,“People think its like Jack Nicholson in As Good As It Gets, but its so much more than that.”,Obsessions,Persistent ideas, thoughts, impulses or images. Create marked disturbance or distress. Most common Contaminati
4、on Doubting Need to have things ordered Horrific impulses Sexual imagery,Video Describe your Obsessions Q4,Compulsions,Repetitive behaviors or mental acts with goal of preventing/reducing distress or anxiety. Most common Washing/cleaning Counting Checking Requesting/demanding assurances Repeating ac
5、tions Ordering,Video Describe and Demonstrate you compulsive behaviors Q2,Prevalence,1 in 200 children and adolescents (Flament, 1990). 1 in 50 adolescents (OC Foundation, 1999). Generally considered to affect 2% of the total population. 3 or 4 children in each elementary school. Up to 20 teenagers
6、in most average-sized high schools.,“Hidden Epidemic” (Jenike, 1989),Only 4 of 18 high school students found to have OCD were under professional care (Flament et al., 1988). None of the 18 had been correctly identified as suffering from OCD. OCD is typically underdiagnosed and undertreated.,Other fa
7、cts,Age-of-onset for children with OCD is approximately 10.2 years old (Chansky, 2000). Males tend to develop OCD earlier than females; females develop OCD in adolescence (Adams Chansky, 2000). 80% of adults with OCD identify an onset of symptoms before the age of 18 (Pauls, Alsobrook, & Goodman, 19
8、95). Childhood OCD is typically considered a chronic condition.,Developmental Perspective,Developmentally, most children experience obsessive-compulsive symptoms as part of the normal process of achieving mastery and control over their environment. However, the difference between normative OCD sympt
9、oms and pathological symptoms is that the pathological variety produces “dysfunction rather than mastery” (March, 1995).,Video When did you first notice symptoms of OCD? Q1,Distinguishing OCD from Habits of Childhood (Chansky, 2000),OCD Behaviors Time-consuming Disruptive of normal routine Create di
10、stress/frustration Believes has to do them Appear bizarre/unusual Become elaborate and demanding with time Must be executed precisely to prevent adverse consequences,Non-OCD Habits Not overly time-consuming Do not interfere with routine Create enjoyment or sense of mastery Habits child wants to do A
11、ppear ordinary Become less important and change over time Can be skipped/changed without consequence,There is no single, proven cause of OCD,Research suggests that OCD involves problems in communication between the front part of the brain (the orbital cortex) and deeper structures (the basal ganglia
12、). These brain structures use the chemical messenger serotonin. It is believed that insufficient levels of serotonin are prominently involved in OCD. Drugs that increase the brain concentration of serotonin often help improve OCD symptoms.,Neuropathological Framework,Dysfunction of this neuropatholo
13、gical circuitry. frontal cortex / basal ganglia / thalamus / frontal cortex,OCD Orbital-Frontal Cortex,OCD Caudate Nucleus,Neurotransmitter Issues,Depressed levels of serotonin in the frontal cortex. Dopaminergic overactivity in the basal ganglia. Areas targeted by pharmacological treatments.,Impact
14、 upon academic, behavioral, and social performance in schools.,Contamination,Common obsessions focus on contamination and cleanliness Examples: Frequent lengthy trips to the bathroom. Chapped hands. Avoidance of direct contact with other kids, doorknobs, chalk, and books.,Checking and/or Repeating,R
15、ituals are performed to prevent something from happening or to make sure everything is alright. Examples: Locking and relocking a locker, Erasing and rewriting papers, Packing and repacking a bookbag, Asking the same question over and over, Difficulty leaving the classroom.,Symmetry,Student feels th
16、at to avoid disaster or bad luck, movements and/or objects must be symmetrical. Examples Tapping on one side of his/her body and then the other, Walking down the hallway in an unusual pattern, Arranging objects on desk to achieve the right balance.,Lateness,Most likely the result of rituals that the student feels must be performed. Examples Being late to school, classes, and getting home; May result from washing off contamination, packing bookbag perfectly, or getting dressed
