One of my kids has emotionally struggled on and off for years with things worsening recently. She does not have an official diagnosis yet but we are working with a therapist and it’s very likely OCD. We are waiting for a psychiatrist appointment. We have a family friend who was hospitalized due to OCD for over a year. And yesterday my child’s therapist told me she might recommend intensive outpatient therapy, and then today my therapist—the one I recently started to see because I was having such a hard time dealing with seeing my child suffer—told me eventually it will get better with treatment but that I should expect it to get worse first. I am just feeling anxious about the future and was wondering if anyone has any wisdom to share.
Are you using a hospital clinic? Day program?
Many of us have kids with mental health issues… I’ll PM you.
Nothing but counseling yet. It’s really recent things that have clued us in on what might be going on in her head.
Wow, that doesn’t seem very helpful. I don’t know what symptoms your DD is displaying, but my D22 did have some struggles with OCD earlier in high school and middle school and a combination of supportive Cognitive Behavioral Therapy and medication (low dose Prozac) helped her a lot with reducing the repetitive tapping/checking behaviors. It did not get worse before it got better for her.
Obviously for your kid it might be different. For mine it had gotten to the point where it was affecting her in school (she was having difficulty writing by hand due to OCD), but she got through that and has no lingering problems. I know OCD is no longer classified as an anxiety disorder, but I do think my D22’s OCD sprang out of her issues with anxiety. She was diagnosed with GAD if I recall correctly. (You’d think I’d know off the top of my head, but her sibling’s anxiety struggles were/are much worse.)
She didn’t feel like the very low dose Prozac did that much for her mood, but I do think it helped a lot with the OCD and I think it may have improved her mood too. I believe Prozac is commonly used to treat OCD. She is off the Prozac now (stayed on it an extra year due to 2020) and definitely has no trouble with writing by hand any more. Every once in awhile I wonder about the tapping behaviors, but she seems to be doing well.
Our oldest (class of 2019) had a LOT of anxiety issues that really affected school performance. There was a lot of school refusal from pre-K to high school. We took junior year off and homeschooled (not a good fit) and then went back for senior year. It was a struggle getting that one to graduation in 2019, but we made it.
Took the Fall of 2019 off as a gap year. I was hanging back and letting my oldest chill out for the fall after the struggles of getting through high school when 2020 happened. I think 2020 was sort of a blessing in disguise for us because it meant that I did not say, “if you’re not going to go to college you need to go out and get a job” because I was too freaked out about COVID. So there was absolutely no pressure from me about school or work which, in hindsight, is what I think was needed.
Oldest ended up getting a job at Starbucks in Jan 2021 with absolutely no prompting from me (and some trepidation from me since we weren’t vaxed yet) and loves it and now is planning to go to Community College in the Fall! Really pushed through that anxiety and I didn’t pile any more parental pressure on top. Oldest is 20 now and the jump in maturity is just astounding. Huge jump in self-awareness about the anxiety disorder and positive coping mechanisms, too (recognizing the need for good sleep, good food, sometimes even exercise, definitely getting out of the house most days and going to work).
All that to say, that sometimes the brain just needs to mature some.
But do ask about a referral to a psychiatrist/medication management and Prozac for the OCD. Good CBT and medication really worked well for D22. She is still having some “I’m 17 and I know everything and mom doesn’t know anything” moments, but I am confident that her brain will mature too.
Good luck!
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Thank you for your reply.
Her therapist is doing CBT but after last week’s session D is saying she needs a break. She thinks she is better able to work through her problems by herself. She is also refusing the ssri that her pediatrician prescribed to hold us over until the psychiatrist appointment. When my older kids had emotional struggles of any kind (anxiety or depression) as teens they were very willing to go to therapy and use medication if it was recommended so I really feel at a loss this time around.
It’s also been interfering with school work which is also a bit different from my other kids, at least in terms of the degree of it. The school seems to acknowledge there’s an issue and seems to be giving her a break by letting her stay in the classes she signed up for even if she didn’t get the grades she would normally need to proceed in those subject areas.
It’s so funny that you mention handwriting. We had a lot of issues with handwriting over the years.
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I am still learning how not to add on parental pressure….
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It was a just a fluke of circumstance that my oldest was through with high school and it was 2020 so I wasn’t trying to make anybody go anywhere! I’m sure I would have been applying pressure otherwise. It’s really really hard not to.
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Refusing medication (and therapy) is not uncommon. She will either get better on her own, or worse- and if she gets worse she may be more amenable to treatment. In the meantime whatever you can do to help keep stress down. Honoring her autonomy will work best in the long run, hard as it is. To get to a place of detachment, NAMI may help. Or the therapist you already have!
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I have been a sounding board for a friend trying to get her 29 year old D into a program to begin dealing with severe OCD and an eating disorder. It is heartbreaking what this family has been going through the past 6 months. The mental health system in our country is so lacking.
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If your D wants to take a break from therapy, maybe you can negotiate an arrangement where she won’t have weekly sessions but will still have a “check in” appointment once a month or even once every two months - that way, you can avoid arguments over whether she should start again and she will have an opportunity to talk with the therapist without feeling that she has somehow failed to handle her problems on her own. We did something like this until my D “graduated” from therapy, and it worked well. As to the SSRI, not taking what the pediatrician prescribed might not be the worst idea if she will be able to see the psychiatrist relatively soon. - depending on the specific drug, it can take a while to switch from one to another between titrating down and titrating up, so taking the wrong drug can delay your being able to start on the right one. We had a weird situation where the GP prescribed a drug for my D’s anxiety and depression that turned out to be an antipsychotic. It wasn’t appropriate but it did turn out to be a blessing in disguise - when she started seeing a psychiatrist, he sent her for an EEG just to make sure she wasn’t epileptic. Well, it turned out that she was and the EEG was a doozy because the antipsychotic had lowered the seizure threshold - made it very easy to catch the epilepsy in a single go. Like everything else, it depends upon the individual child, but my D was like yours in resisting therapy, resisting medication, etc. That changed as she matured, however, and she is now a much more self-aware and collaborative patient. I think it was just really hard for her to deal with being ill on top of all the normal complexities of being a teenager.
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Interesting. · Amitriptyline lowered the seizure threshold for my daughter and clarified that she too had a seizure disorder. Some forms of epilepsy appear at first to be psychiatric in nature. Of course much of both types of problems is brain-based so I think psychiatric problems like OCD, bipolar, major depression should be viewed as medical in the same way that epilepsy is.
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In our case, it was olanzapine. I am eternally grateful to our psychiatrist for his thoughtfulness and doggedness in tracking down the real problem. I can’t imagine what might have happened had she stayed on the antipsychotic. We were also fortunate to find a very good epileptologist, and after a fair amount of trial and error, we landed on the right mix of medications - in the end, adding a medication to deal with migraine coincidentally also wiped out the last of the seizure symptoms. These are very difficult issues, and I hope that the OP’s daughter will have the same luck we did in finding good doctors. It can take persistence and advocacy, and we need to have confidence in our own judgment if things don’t feel right.
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I’m sorry you are dealing with this. S has OCD has well. We have found CBT very helpful - and because he is 15, he has no choice in whether he goes to therapy. Still, it matters a lot whether he is cooperative or whether he pushes back. Try different therapists until you find a match. It’s kind of like dating that way. And expect the OCD to ebb and flow over time and manifest itself in different ways. The best antidotes we have found are steady routines and keeping S busy.
It’s funny you mention handwriting. Our S had terrible handwriting and complained about his hands when he was in 4th/5th grade. He was diagnosed with dysgraphia in 5th grade and has received a computer accommodation in his classes ever since.
Have you considered having your D tested for dysgraphia?
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She’s had a full neuropsych eval a few years ago. I went in asking specifically about dysgraphia, but at the end, it wasn’t mentioned at all. So I brought it up at the last meeting, but they made light of it—they seemed to think it was fine if she could manage to write individual words or sentences— but tests that involved pencil and paper had much lower scores so I think there’s something there. It was part of a research study so they had their own agenda, I think.
With regards, to the ocd stuff, too, I had no clue and it wasn’t mentioned in the report , but my D brought up some issues not too much after which she related to ocd and I thought, why wasn’t this picked up? I almost wish I could take the test results to another neuropsych to look at because I have had such strange experiences with neuropsychs that I’d feel better getting a second opinion. Plus, it’s been awhile and issues can change or evolve.
I have an older child who, when she was evaluated, the neuropsych said if she had been younger she would have given a dysgraphia (coordination disorder) diagnosis but she felt there were more important things to focus on at her age. Ugh. Thankfully (?) she had another diagnosis which entitled her to accommodations which helped with the writing part (note taking and extra time). Interestingly, that older child of mine wrote with much more ease and with much more legibility than this one. I also had another one with writing issues who we had in OT for awhile when she was young. As she got older, everyone would say, don’t worry about it because everyone uses computers now. But she found there were times in high school when teachers couldn’t understand her handwriting and she herself became more concerned about it.
That does sound kind of like dysgraphia from what I know of it.
My D22’s writing issue was only OCD-related. Her actual handwriting was fine, but she just couldn’t write certain words or in certain ways because of the OCD. Kinda like the checking doorknobs or compulsively washing hands or not stepping on a crack or certain colors of tiles. She was able to work through it with her therapist.
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Maybe a psychiatrist or an OCD clinic would be a better approach than a neuropsych?
In our area MGH has an excellent OCD clinic. You also benefit from new approaches and studies.
I believe they use SSRI’s like Lexapro (plus CBT).
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