Mothers more critical of a child with OCD

By Liz Lockhart

In the past research has suggested that the parents of a child with anxiety are inclined to be more critical. Now researchers have set out to discover whether this is a character trait of the parent or whether something specific to the relationship between the parent and their anxious child.

Researchers from Case Western Reserve University found that mothers are inclined to be more critical of a child with obsessive-compulsive disorder (OCD) than they are of their other children. This criticism is associated with a lesser outcome for the child even when they received appropriate treatment.

Lead author of the study, Amy Przeworski said ‘This suggests that the mothers of anxious children are not overly critical parents in general. Instead they seem to be more critical of a child with OCD than they are of other children in the home.’

It is estimated that OCD affects one in every 200 children and it is known that this psychological disorder can become debilitating. OCD sufferers can have repetitive thoughts which often lead to feelings of anxiety. When these anxieties are acted upon exacting routines or behaviours become a ritualistic part of life making day-to-day living very difficult. Such rituals include behaviours which can include eating rituals, foot-tapping, hand washing and school or bedtime preparations.

The researchers say that their study is a follow-on from previous research which has found that critical parents are associated with reduced success in therapy and a relapse of behaviour.

Przeworski says ‘Parents’ criticism may be a reaction to the child’s anxiety. This research is not blaming the parents for the child’s OCD. But it does suggest that the relationship between parents and children with OCD is important and should be a focus of treatment. This means that parents can help children with OCD to get better. OCD sneaks up on the kids and parents.’

Przeworski said that some parents become concerned at the early signs of OCD which can include some of the following symptoms:

Rigidity in a child, with things routinely done or said in exactly the same way or order
Asking for reassurance many times in the day
Repetition of a task from tapping the foot, checking on the stove, washing hands that the child cannot stop when asked
Routines that have prescribed patterns or are excessive lengthy: An example is a two-hour shower or raw and chapped hands that look like the child is wearing red gloves
Bedtime or dinner rituals, where there is a prescribed order for eating food, placement of food on the plate, etc.
Temper tantrums where the child goes beyond being stubborn but has anxiety associated with them
Children want symmetry in appearance or things around them

It is not uncommon for parents to see these kinds of symptoms as simply part of a phase or a habit but as time goes by the behaviours dictate that both family members and the sufferer act upon them. In an attempt to curb the child’s obsessive behaviours, the parents may begin to criticise the child.

In this study the researchers filmed interviews with the mothers of a child with OCD and the child. A total of 62 pairs of mother and child were interviewed before the start of OCD treatment. The children were then treated with either medication, therapy or a combination of the two. Some were given a placebo. The child participants were aged between 7 and 17. Mothers were focused on in this study, as it is usually the mother who accompanies a child to treatment appointments.

The mothers were asked for a brief description of the relationship they had with the child with OCD and that of her relationship with the sibling of closest age to that child. The children with OCD were also asked to describe their relationships with both of their parents.

The researchers examined the descriptions for the presence of criticism and over-protective or excessive self-sacrificing behaviours in the mothers. The researchers say that they found an overall tone of criticism. However they found a more loving expression towards other siblings. As a result of criticism towards the child with OCD there tended to a poorer functioning in the child after treatment.

The study can be found in the publication Child Psychiatry & Human Development.