Ben Assan Senior Clinician and family Therapist Austin CAMHS, Melbourne.

Ben Assan Senior Clinician and family Therapist Austin CAMHS, Melbourne.

Introduction OCD in adolescents Current treatment models Review of cases Rethink of current treatment models Current treatment plus Role of admission Addressing family emotions

The key diagnostic feature of obsessive compulsive disorder (OCD) is the presence of persistent, intrusive, and distressing obsessions or compulsions, with marked impairments in quality of life. Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV-TR; American PsychiatricAssociation,2000)

Obsessive Compulsive Disorder(OCD)is common, afflicting 1 3% of children (Douglass, Moffitt, et al.1995).

Jack The case of the school bag. Jim Long showers with a cake of soap Jay Outdoor father and cooking direction Jan Special, secluded space in family home Jill Instructing sib and young visitors to wash hands

LOSS OF A CHILD LOSS OF THE A RELATIONSHIP WITH THE CHILD LOSS OF FATHER/SON RELATIONSHIP (no fishing trip, no bike ridding) FAMILY IMMOBILISED BY OCD ( it affects the whole family

ACCOMMODATION (Gordon et al, 2013) GIVING AUTHORITY TO CHILD WHO OWNS THE HOME? (Lebowitz et al 2011) BEHAVING AS IF THEY HAVE OCD

Children s Yale Brown Obsessive Compulsive Scale ( CY- BOCS) Family Accommodation Scale for OCD

Family accommodation(fa)in obsessivecompulsive disorder (OCD)refers to family members or significant others participation in or facilitation of patients rituals and/or avoidance (Norman et al, 2015) Nearly 90% of persons with OCD live with family members who accommodate their symptoms in some significant way(pinto et al, 2012)

WORRIES THAT THINGS MAY GET WORSE HE WILL BECOME VIOLENT (Krebs et al, 2013) TO CARE FOR HIM MAKE SURE HE HAS A GOOD MEAL every day I WANT TO KEEP THE PEACE

WORRIED THAT MY ACTONS WILL MAKE THINGS WORSE WORRIED ABOUT NOT CONTROLLING MY ANGER I KNOW HE IS TRYING BUT IT IS ALL BULLSHIT

ocd adolescent family accom Parents/couple

AACAP (2012) Recommendation 6. For moderate to severe OCD, medication is indicated in addition to CBT, six to eight sessions of E/RP Exposure ------- Response Prevention (Lebowitz et al, 2011) plus Parent coaching prevent accommodation (Lebowitz, 2011)

FAMILY EMOTIONS

FAMILY EMOTIONS Fear Anger Sadness Shame Guilt

Medication CBT Parent Coaching Attention to Family emotions Admission To break accommodation pattern Role modeling by NS Medication CBT Parent Coaching success challenge

1. acknowledge the challenges in PA 2. list PA and link the emotions attached 3. priorities areas for attention 4. select a PA that parents are ready to address 4. link addressing PA to intent and desire to assist recovery 5. develop and negotiate plan to address PA

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