My 5 yo nephew has been having OCD behaviors for a month now. His doc said they stemmed from a school phobia.However he has had an eating disorder/been in food therapy since 2yo and his diet is very poor. He does not take a vitamin.

I have seen much written about B6 deficiency and OCD. You might want to google those two terms together.

I wonder, have they ever checked for gluten/casein or other food sensitivity in your nephew?

Given your brief description, I'd look further into both of these areas.

There is a Gluten Sensitivity/Celiac Disease forum here. If you nephew has an eating disorder and is a "picky" eater, please be sure he has been tested for guten sensitivity.

Good luck!

Cara

OCD behaviors that come up suddenly...can be Pandas. This is an autoimmune reaction to the Strep bacteria.

Some OCD can be from nutrient deficiencies. Some from genetics (temperment), and some from Pandas. Autoimmune issues can arise from gluten intolerance/Celiac as well as malabsorption of nutrients.

Kids often do repetitive things to calm themselves, as well. So it might be hard to separate out that emotional component.

I have never heard of "food therapy"... can you explain that more?
Kids with sensory issues can become "pickey" about food, how it feels in the mouth etc. Sensory Integration issues are a whole disicipline in themselves.
Does you child get enough protein each day? Enough electrolytes?
This is important for growth.

Inositol is often used for mild OCD...this is a powder and tasteless and can be mixed into juice. But I would have a doctor supervise its use in a small child, and give the dosage needed for your child.

Hi,
He sounds a little like my son at age 5.
What sort of eating problems does he have exactly? Does he restrict his food intake to particular foods and particular textures or colours. Does he like to eat the same food for days or weeks at all?

I would suggest that if a 5 year old is showing obsessive compulsive behaviours, school phobia or anxiety of any type and rigid eating habits then it would be a really good idea for him to be assessed by a team who specialize in developmental disorders and/or Pervasive Developmental Disorders just to rule out that the behaviours are not part of that.

Would love to hear more from you about the eating difficulties and also what sort of OC behaviours that he's showing.

Was he ill at all just prior to a month ago when you say the OC behaviours started? No sore throats, rashes or high fevers?

sorry for all the questions, just might help if we knew more.
take care,
Lara

Hi 3beans

sorry I didnt reply sooner...very busy day yesterday

sudden onset OCD is definitely a red flag for possible PANDAS or PITANDS
which, as mrsD has explained, are when neurological issues are triggered by infection, in the case of PANDAS it is strep (NOT just strep throat) and for PITANDS it can be a whole range of microbial agents

here is some PANDAS info from NIMH
http://intramural.nimh.nih.gov/pdn/web.htm

and here is an informative post from Ronna at Latitudes on the subject
http://www.latitudes.org/forums/inde...showtopic=2137

Many conventional docs do not know how to correctly test for PANDAS, and they assume that if a strep throat culture comes back negative, that there is no strep. However, in PANDAS, the strep is considered stealth and it often shocks these docs when correct PANDAS blood tests are done which show sky high strep antibody titres indicative of a massive strep infection. The only way to treat this is with prophylactic antibiotic use. We have reports on Latitudes of the very best results coming from correct use of azithromycin (Zithromax)

I would highly recommend finding a doctor who is knowledgable about PANDAS and who will run the comprehensive tests
My son was tested by Dr Tanya Murphy at the Shands Clinic in Gainesville, Florida
I feel sure Dr Murphy would know of other docs around the country who are aware of PANDAS and who know how to dx and treat it
Their phone number is (352) 392-3681.

Here is more on Dr Murphy
She is at the forefront of PANDAS research

http://www.psychiatry.ufl.edu/people/bios/murphy.htm


If this OCD is not PANDAS or PITANDS related, there are over the counter supplements that can really help....for younger kids, INOSITOL with vit B6 is most used
A good mutivitamin/multimineral is IMHO an essential component to the diet as vitamin/mineral deficiences have been implicated in a lot of illness.

another big thing is to avoid artificial food additives as these seem to trigger OCD big time...this includes all artificial coloring, artificial sweeteners, MSG, high fructose corn syrup etc


hope that helps

Sorry if this is all confusing to you, 3beansforme. I really do apologize for adding all this information on this thread, but I felt it necessary.

_______________

As Chemar has said, "I would highly recommend finding a doctor who is knowledgable about PANDAS and who will run the comprehensive tests". This is easier said than done in some places so I will suggest that if PANDAS is ever suspected then please contact NIH (sites listed above) and they can either refer on or give other suggestions.

It is vitally important that treatment or diagnosis is not given by a practitioner who is not aware of current findings on the PANDAS research... it changes all the time and there is even disagreement in medical circles as to criteria and treatment still to this day. It's still evolving.

Not many people on these forums these days probably know this, but my son had been (mis)diagnosed from age of 5 to 10 with a Strep. related movement disorder called Sydenhams Chorea. His treatment initially was an antibiotic and Clonidine. The antibiotic was to be given until approx. age of 21 as a preventative. This was pretty normal practice back then. Sydenham's Chorea is a condition that can occur in *some* people, not all people, who have had Rheumatic Fever after a Strep. infection. This of course was ceased when his diagnosis was later changed. PANDAS of course doesn't occur after Rheumatic Fever, but the autoimmune process involved is somewhat similar.

Anyway, I just wanted to post this somewhere in the hope that people searching out PANDAS information will realize that there is a real need for caution in both diagnosing and treating at this point in time until more clarification is forthcoming from the PANDAS studies. If anyone is seeking evaluation, please contact the Research centres such as NIMH, [or doctors outside of NIMH like Tanya Murphy or Barbara Coffey of course] because they will know what to do.

http://www.medscape.com/viewarticle/547096?src=mp

PANDAS May Be Overdiagnosed, Contributing to Overuse of Antibiotics

Paula Moyer, MA
November 2, 2006
AACAP 53rd Annual Meeting: Abstract C21. Presented October 26, 2006.

Pediatrics. 2004 Apr;113(4):883-6.

The pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS) etiology for tics and obsessive-compulsive symptoms: hypothesis or entity? Practical considerations for the clinician.

Kurlan R, Kaplan EL.

Cognitive and Behavioral Neurology Unit, Department of Neurology, University of Rochester School of Medicine, Rochester, New York

Full Text of above Article here...
http://pediatrics.aappublications.or...full/113/4/883
PEDIATRICS Vol. 113 No. 4 April 2004, pp. 883-886

SPECIAL ARTICLE
The Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infection (PANDAS) Etiology for Tics and Obsessive-Compulsive Symptoms: Hypothesis or Entity? Practical Considerations for the Clinician
Roger Kurlan, MD and Edward L. Kaplan, MD

From the the source...
PEDIATRICS Vol. 113 No. 4 April 2004, pp. 907-911
http://pediatrics.aappublications.or...full/113/4/907

COMMENTARY
The Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infection (PANDAS) Subgroup: Separating Fact From Fiction
Susan E. Swedo, MD, Henrietta L. Leonard, MD and Judith L. Rapoport, MD

[p.s. despite how it may appear, I believe they will finally sort all this out and I am not in any way at all against this research or even the hypothesis, particularly because of my own exp. with Sydenham's Chorea, however, we must be cautious and we must do no harm. Here we are in 2007 and we're still waiting for the results of that study that's been promised for so long]

Hi. Thank you all for such a wealth of information. It has taken me a while to go through it all. This is for my nephew who is 5, I know one of the posters was confused as to it being my son. To clarify the eating problems are sensory,began with a gag as a baby and has had texture issues ever since.Will not add new foods to his diet so it is very limited to point he has eaten same 3 meals daily for last 3 years. PANDAS was brought up by parents,not sure if he was tested yet.We are a bit doubtful about that as cause only b/c he has shown signs here and there over years of different behaviors and was seen many times by developmental peds when he didnt meet a milestone or did a strange behavior.Austim is ruled out. Aspergers is still a remote possibility,if so it is very slight. He is gifted intellectually,having started fully reading at age 3 complex books,does complex math at 5,etc. Doc said he is wired different for sure but not classic aspergers. They are exploring the vitamin deficiency idea as well and i am still pushing for the strept test.

Hi. Thank you all for such a wealth of information. It has taken me a while to go through it all. This is for my nephew who is 5, I know one of the posters was confused as to it being my son. OCD behaviors are including rewalking same paths in same steps, having his mom repeat 2nd sentence she has said with same pitch to her voice until it is 'right' in his mind,having mom put a ball in a hoop certain number of times before he can walk down the stairs, reputting water on himself after bath has to be same number of drops on each leg and then redrying himself again,putting toys,cups,etc back in exact same spot before he can move to to new activity, taking long time in school on projects and getting stressed b/c they are not 'exactly' right ,like if he has art class and is supposed to draw an item, is stressed it is not a replicate. Etc.Too many to list.To clarify the eating problems are sensory,began with a gag as a baby and has had texture issues ever since.Will not add new foods to his diet so it is very limited to point he has eaten same 3 meals daily for last 3 years. PANDAS was brought up by parents,not sure if he was tested yet.We are a bit doubtful about that as cause only b/c he has shown signs here and there over years of different behaviors and was seen many times by developmental peds when he didnt meet a milestone or did a strange behavior.Austim is ruled out. Aspergers is still a remote possibility,if so it is very slight. He is gifted intellectually,having started fully reading at age 3 complex books,does complex math at 5,etc. Doc said he is wired different for sure but not classic aspergers. They are exploring the vitamin deficiency idea as well and i am still pushing for the strept test.

Hi again 3beansforme,
I wish I could help more regarding the food issues and vitamins, but I don't have too many suggestions as it's still something I struggle with here with my own son. He'll eat the same thing for weeks and then switch to something else and weeks later will switch to something else etc.. He really likes routine and thrives best with routine, but I always worried myself sick that he wasn't getting enough nutrients in his diet. He's much better these days then he used to be on all sensory levels and his diet has been much improved in the past 5 years especially. (he's 19 now). He can tolerate foods he never could before. He isn't just being a picky eater, it's been much more extreme than that, so disguising certain foods in meals hasn't always been too much help.

When he was really little we tried different vitamin regimes but it was really a waste of money at the time, because he just couldn't swallow the number of pills that was suggested. He would even gag at the actual sight of certain foods let alone the smell of them or the taste and texture of them.

These days there are other ways of getting some nutients that he might be lacking, like in eggs and other foods that are reinforced with different vits. and minerals now. We were able to find one multivitamin that was chewable and tolerable for him. I'm sure it wasn't much help, but to me it was better than nothing.

The OC issues sound as if they have anxiety involved. My son has different types of OC behaviours. Those where anxiety is involved and those where it is not. He _is_ on the autism spectrum and I have read a lot of literature talking about the differences in obsessive interests often seen in autism compared with obsessive compulsive behaviours, where the OC behaviours have the obsessive thought followed through by an action or compulsion. His obsessive lining up of toys, and books and numbers and some other things does not involve anxiety. His *just right* feelings often do.

OK, I'm rattling on a bit now I'm sorry.

I think you're looking into all the right things by the sound of it. I must add that often Asperger's Syndrome can be somewhat difficult to diagnose in some young children and they often can fall through the gaps _because_ they are clever and appear to be maintaining very well. My son wasn't diagnosed ASD until he was around 14. He'd really slipped through the gaps especially in school where until he hit pre-puberty and puberty, he just tended to fit in OK and all medical attention was focused mistakenly on some physical aspects because he also has motor and vocal/phonic tics. Anyway, by the time he was about 11/12 yrs, the gap widened between himself and his peers very noticably. Autism Spectrum is just that, a spectrum. There have been times in my son's life when he's appeared to function very well and would be considered at one end of spectrum, but in other areas he's sort of in the middle.

Just curious if your nephew has any out of the ordinary motor movements or makes sounds at all?

I don't mean to harp on about the autism spectrum part, but just also curious if you know why his doctor thought autism spectrum/asperger's was very slight consideration? Just wondered if he gave reasons.

As I said, it sounds as if he's in good care medically and I sure hope they can help him. As much as I dislike labels, it can sometimes be really important figuring out why a child or person is doing something that's causing them distress because then the right sort of help can be given if it's necessary. Adding a couple of sites on the bottom here regarding OCD in children. In light of what you've written in your last post and considering the anxiety that your nephew seems to be experiencing with some of these issues, I'd be talking with a psychologist who is knowlegeable about OCD in childhood.

All the best, please let us know how he's doing. My heart goes out to him, it truly does seem so much for our little ones to deal with. *tear
Sorry about writing such a long post.
Lara.

http://psychcentral.com/lib/2006/12/...sive-disorder/

Amy Wilensky
[she also wrote an amazing book for adults which I highly recommend.
"Passing for Normal: A Memoir of Compulsion" ~ by Amy S. Wilensky.]

Good website regarding anxiety and OCD in children.
http://www.worrywisekids.org/index.html
[from The Children's Center for OCD and Anxiety, founded and directed in part by Tamar Chansky PhD who is also the author of an excellent book called "Freeing Your Child from Obsessive-Compulsive Disorder", and also of "Freeing your child from anxiety"... second one I've not read.

Hi. Thanks for your response. It sounds like you have had a long road with your son. Yes,in response to your question regarding verbal tics my nephew does have them and they are getting progressively worse.In the summer it was just whisteling,now my sister said there are 5 distinct ones, like a throat clearing over and over and other strange noises.She said school said they dont happen there but as soon as he gets home it is non stop,especially on his more stressful school days. They did end up medicating him and most of the ocd behaviors disappeared within a few days but she said he has gotten really really defiant now,talking back a lot,refusing to do homework and staying in his room for hours at a time,has tried to hit them,etc. She is very frustrated obviously. I know he went for the strept test,no word on result yet,I am doubtful that is cause b/c of all the other issues. They are trying to get a vitamin in him, he is beyond picky,like your ds it is truly a problem where he can't even see foods or have textures near him,smells of others foods can make him gag and that kind of thing. I know doc said aspergers is hard at 5 to pinpoint. He felt that nephew did not answer his questions the way an aspergers kid would (not sure what that way is but this was a developmental pediatrician who does this all day), but commented there ws no doubt he was wired different than most. Just the fact that at 2 he had no words,not even mama and by 3 was fully speaking and reading is interesting. He is extremely bright b/c he comprehends everything he reads, I know school tried to test him at at 5 he got past the 4th grade reading level and teacher ran out of testing materials so they dont have an exact level,but it is past 4th grade. Also writes out paragraphs of information, adds double digits ,even does things since he was little like can tell you what day of the week a date falls on a month away, you can see him doing the math in his head. My sister is very worried about the social ramifications for him of the tics and ocd behaviors as he grows and whether they will just go away or worrsen, there is a lot she does not know.