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BathMost children experience ‘bad’ thoughts but easily disregard them. However, some children and teenagers pay too much importance to their unpleasant thoughts and become fearful that a loved one will be harmed, or that they will be the one that harms them. When this happens, it may be that your child has Obsessive Compulsive Disorder (OCD).

Eleven-year-old Sarah reports: “When I help my mum bathe my baby sister, I see her slipping under the water. When she’s under the water, I blame myself. I’m terrified I will drown her.”

Fourteen-year-old George says: “I get scared when I pick up a knife. I get thoughts and images of myself going outside and stabbing someone. I see people hurt in the street and I stand back and feel shame and terror. I’m afraid that one day I will kill someone.”

5 Important Steps to Help your Child Gain Control

1. Identify the problem – It is crucial that parents assess how they feel about their child’s thoughts, images and urges. Learn to recognise that the harming thoughts that upset your child are part of the challenges associated with OCD. Next, accept that your child has a problem and needs your support. Explain that lots of children get harming thoughts; it’s just that some pay more attention to them than others. Once you and your child have an agreed understanding, you are in a better position to educate and prepare her for the challenges ahead.

2. Find your child’s triggers – One of the core areas for helping your child manage his aggressive thoughts is to find his triggers. For example, a fight scene in a video game can trigger George into obsessive thinking about knives and harming someone. Watch out for compulsive or avoidance behaviours (hiding sharp objects, or in Sarah’s case, avoiding water). Be alert to a change in mood. The child will look like he’s daydreaming but he is suffering internal distress as the harming scene plays over in his mind. Rising anxiety follows which often accompanies a panic attack.

3. Managing meltdowns – Watching your child suffer a meltdown is never easy. To help diffuse the situation become aware of her distress levels and notice how anxiety reaches a peak before settling down by itself within 15-30 minutes. In a quiet moment explain this timeline to your child so that she becomes mindful of her pattern – trigger, obsessional thinking, avoidance or compulsion, anxiety/panic, recovery time

Show her how to use breathing exercises for when she experiences distress such as breathing deeply through her nose and exhaling slowly through her mouth.

For panic states demonstrate cupping hands over your nose and mouth (there should be no gaps between fingers), and again teach her to breathe in through her nose, take hands away, and breathe out through her mouth.

During an anxiety attack let your child know you’re there but stay far enough back so that she has enough legroom. Respect the mood, allow her to recover, and suggest calmly that when she is ready you can help her with her thoughts and feelings.

4. Explaining irrational thoughts – Find somewhere quiet and comfortable to talk with your child and explain that unwanted thoughts are irrational. Describe irrational thoughts as being nonsensical and that they never come true while at the same time confirming that you understand he has a fear that his thoughts are real and might come true. Reassure him that you are on his side and help him to realise that his compulsion to hide knives, or his avoidance of them, is the doubting part associated with his unwanted thoughts, not him. Assure him he is not a threat to people and validate this belief by teaching him how to do home exposure.

5. Home exposure – Ascertain that thinking about something does not make it happen. Tell your child that this is called magical thinking and introduce her to home exposure by first playing ‘the magical thinking game’. Start the game by first suggesting a picture will fall off the wall on the count of 3. Now ask your child to have a go. Play this back and forth using the same idea until she becomes bored with the image.

Next, take it in turns to think about something bad happening and ask each other what your thoughts were. For example, the thought might be that a passer-by will trip over. This game will help her grasp that thought linked with action is non-existent. As time goes on, you can adapt this game as an exposure strategy with one of her triggers. Initially, this will be distressing, but the idea is that eventually she will begin to pay less importance to her unwanted thoughts.

Intrusive thoughts belong to OCD, not the child. Identifying the problems associated with OCD helps parents understand the obsessional pattern. They are then able to support their child by spotting triggers, avoidance and compulsive behaviours, observing meltdowns, teaching mindfulness and coaching home exposures while monitoring progress.

Disclaimer: it is advised that you seek your child’s mental health practitioner or doctor’s approval before going ahead with exposure techniques.

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Carol is a Cognitive Behavioral Therapist in the UK and manages OCD Kids. Carol works with children with OCD, Asperger’s Syndrome and Depression and offers online CBT programmes for treating OCD and related conditions. As an adviser, Carol advocates for children and families in schools and colleges.