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This week on the Raising Good Humans Podcast, I sat down with Dr. Laura Braider, Assistant Professor at the Zucker School of Medicine, Director of the Behavioral Health College Partnership, and a Senior Staff psychologist for the OCD Center at Northwell Health. I wanted to piece apart OCD from the everyday worries so many parents feel, and the ways we respond to our children’s fears.
Repetitive Behaviors
Why do toddlers look like they have OCD? As Dr. Braider and I discuss, toddlers love repetition and learn from doing things over and over again. Toddlers thrive on repetition because it provides them with a sense of comfort, predictability, and control in a world that can often feel overwhelming. It also helps them master new skills - whether it's saying a word, building a tower, or understanding a story. Each time they repeat an activity, they're strengthening neural pathways in their brain, solidifying knowledge, and building a foundation for future learning. From demanding the same book every night, to setting up their toys in the same way every day, many of the behaviors that toddlers exhibit can look particular to parents. This does not necessarily mean that they have OCD. Routine behaviors are comforting and flexible, generally bringing a sense of calm and predictability. While toddlers may prefer things done a certain way, they can usually adapt with some gentle encouragement. Healthy routines support a child's overall well-being and don't significantly disrupt their daily life, or cause distress.
Toddlers love repetition. Repetition is fun for them. Just because a child does things multiple times does not necessarily mean that they have OCD, they may just really be enjoying it. When it gets concerning is when they can't move forward and do the things they actually want to do, or it gets in the way of them being able to function, and you can actually see the fear in them. Dr. Laura Braider
OCD repetitive behaviors are different. One of the aspects Dr. Braider emphasizes is the FEAR that a child with OCD has around a repetitive behavior. They have to do it or they fear that something else will happen. This fear is so powerful and so strong that the child is not enjoying the activity, but is instead COMPELLED to do it. It isn’t fun, it isn’t silly, it is required. Children may feel compelled to perform rituals to prevent something bad from happening, or to alleviate overwhelming thoughts. They struggle to deviate from their rituals, and even small changes can trigger significant distress. These compulsions can take up a lot of time and interfere with daily activities like school, play, and family life, and even cause shame.
Reassurance Seeking
Of course, another behavior that our children often do is ask for reassurance. Maybe they ask who is picking them up from school over and over again, or about what to say to their teacher about a missing assignment. Offering reassurance is part of our role as parents, but when do we cross the line? Reassurance seeking can be situational - for example children experiencing stressful events like starting school, moving, or a family illness. In this case, seeking reassurance is a normal response to cope with routine anxiety. Children can usually be comforted and redirected in stressful times, and though it may annoy you (yup), seeking reassurance doesn’t significantly disrupt their daily life or cause excessive distress.
For kids with OCD, reassurance seeking is compulsive, illogical, and difficult to control. Instead of being centered around events, it can come from anything, and become ritualistic. The need for reassurance takes up a significant amount of time, prevents them from doing things they want to do and love, and they experience intense levels of distress when they don’t get the reassurance they need.
How Do Parents Contribute?
Acknowledging that our own fears, anxieties, and even OCD diagnosis impacts our parenting is a good first step. If we have our own struggles and fears, we may double down on our worry when we start to see any behaviors in our kids. We may not be able to distinguish between a real or imagined threat, and we may overreact based on our own impression, and not the facts.
In helping ourselves, we are doing so much for our kids. Dr. Aliza Pressman
We may also be accidentally providing environmental reinforcement for anxiety. We may be creating fear for our children, or demonstrating our own fears regularly in a way that creates a culture of fear around our own triggers. That’s why getting our own treatment is essential to helping our children. We need to make sure that we are finding healthy ways to cope with fear - if not only for ourselves - for our children. When we do that, we can offer the comfort and the calm that our children need.
I really believe it is important for moms to get treatment if they know they have OCD or anxiety. Firstly, because their children are probably genetically loaded to go that direction, and secondly, because if they do not get the help, they are likely going to provide environmental reinforcement for anxiety. Dr. Laura Braider
3 Things To Try Now
Let your child be uncomfortable. Work to understand that being uncomfortable is good for your child, and that learning how to get through it, and survive it, is protective for the future. We can let go of the worries around hurting our children by giving ourselves permission to create a line, and help our children stay within it.
Discomfort is not necessarily a bad thing. We all have to sit through discomfort. It is okay, and even adaptive, to allow your child to sit and not like something. It builds that distress tolerance muscle, and they learn that they can withstand discomfort. Dr. Laura Braider
Ask “What do you think will happen if you don’t do this?” to find out more about the fear that is motivating your child. Even if your child can't identify the cause, help them to know that they can have the fear and be uncomfortable, and be safe with you. Focus on providing soothing and safety instead of fixing.
Developmentally, children are always going to try and take control. Ultimately, they want to know that we've got this. Dr. Laura Braider
Don’t accommodate. Accommodating fears and compulsions can inadvertently reinforce anxiety and make the behaviors more entrenched. Routines and rituals can become more complex, and the fear around not doing them even more severe. However, it's equally crucial that we approach fears with sensitivity and understanding. This involves acknowledging the child's feelings, providing reassurance that they are safe, and gently guiding them towards facing their fears in a supportive and gradual manner. This may mean saying, “I know that you’re feeling nervous and that this is hard, but I’m going to answer the question one time and then I am not going to say it again.” By striking this balance, we can help our kids develop healthy coping mechanisms and reduce their reliance on rigid rituals.
We can be a sensitive and loving parent without accommodating. Dr. Aliza Pressman
In discussing this topic, I hope we’ve reduced anxiety, not increased it. As Dr. Braider reminds us, both anxiety and OCD in children are highly treatable with the right approach and support. Reflecting on ourselves and our own anxiety isn’t easy, but it can put us on a path to better withstand the challenges our children will, and need to, face.
I love treating anxiety because I get to see people get better all the time. Dr. Laura Braider
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