Nathan's parents reached out as he was showing signs of Anxiety and Obsessive Compulsive Disorder (OCD), though not formally diagnosed. Examples of the thoughts that Nathan would report are, that any speck of dirt or item on the ground or floor was vomit, images of the skull and cross bones popping into his mind, worries that something bad would happen to his mother if he was away from her, thoughts that there was poison in his food and poison in the air and thoughts that he had poo on his hand despite not even being to the bathroom, to name a few. As he was so young and in the very early stages of showing symptoms Nathan had not yet developed extensive rituals, but instead all his energy went on attempts to control his environment to escape or avoid anything that would trigger his feared thoughts and feelings, as well as naturally seeking frequent reassurance from his parents when distressed by his intrusive thoughts. Behaviourally this looked like refusing to eat dinner for fear it had poison in it, not eating at all in school, not wanting to use the toilet, not wanting to play outside or get anything on his hands, insisting his parents pick up anything on the floor no matter how innocuous, and showing significant distress when leaving his parents to go to school and intense distress in any feared situation where the feared trigger couldn’t be immediately removed or fixed e.g. removing the perceived “poison” in the air. The overall effect being that an outgoing adventurous fun-loving child very quickly lost his joy for life, he found any uncertainty intolerable and was showing major distress multiple times per day. His parents were filled with worry and living in fear of the next form the thoughts would take, what would be his response to them and what this meant for their sons future.
To help Nathan we met him once in person to get to know him a little and do some discrete play based behavioural observations and we provided extensive parent consultation which included a better understanding of how anxiety and OCD work, strategies from “Supportive Parenting of Anxious Childhood emotions” (SPACE) model, as well individualised supports and guidance unique to Nathan's difficulties. As Nathan's parent’s fears were alleviated, and they were supported in how to speak to Nathan about his fears, there was an observable shift in Nathan's confidence and he began to show some excitement and pleasure again in activities he had been avoiding. Nathan had a great sense of humour when not overwhelmed with anxiety and his parents were great sports as they agreed to model exposing themselves to his feared situations and then responding with dramatic and humorous over confidence, for example they would get covered in mud and be delighted, they would sniff the air dramatically talking about loving the smell of the slurry, they would watch the Mr Hankey the Christmas poo video from south park and make jokes about poo, they would drop something on the floor and then eat it pretending it was the most delicious thing they ever tasted etc. Finally, they were careful to try to not adjust family life completely to avoid all of Nathan's feared situations, to prevent giving Nathan the message his intrusive thoughts were “right” and that these everyday situations were actually threatening or unsafe.
In a very short time things turned around. Nathan was eating finger food with his hands again, eating every meal without fearing something was poisoned, he was outside playing and not at all bothered being covered in mud, running into school with excitement and generally enjoying life as a 4-year old should.
Two years post support we received this message from his father, "I still get emotional thinking about the turnaround knowing the point he came from to the boy who got his zest for life back. Our son is an example of the amazing work that you do, he’s now a fun loving older boy who is in the middle of everything and lives every day as an adventure."
