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Child and Adolescent Obsessive Compulsive Disorder Service

How our service can help you

Our service provides assessment and treatment for young people with obsessive compulsive disorder (OCD) and related conditions, including BDD, tic disorders, Tourette’s syndrome, anxiety and habit disorders, including trichotillomania. We also assess and treat OCD related anxiety disorders in young people with a developmental disorder, e.g. autism spectrum disorders or neurological conditions.

We provide a range of evidence-based care packages, tailored to meet the needs of the young person and their parents or carers.

Many of the young people we see are offered individual Cognitive Behavioural Therapy (CBT), which may involve parents or carers and other family members.

The video below shows young people and their family’s stories about engaging with CBT and their recovery.

We have an active research programme and are committed to increasing knowledge and understanding of the disorders we treat, and developing our treatments to help improve the outcomes for young people with OCD.

We also offer an extensive programme of training and consultancy in the assessment, treatment and management of different aspects of OCD through seminars, workshops, individual case supervision and research project supervision.

All service users referred to our service will be expected to maintain contact with their local CAMHS or GP service. These services will receive correspondence from our team throughout treatment.

  • Service Type: Child and Adolescent Mental Health Services (National and Specialist) Service Borough Covers: National (Child and Adolescent services) Treatment type: Outpatient
  • Contact the service

    Site Location: Maudsley Hospital Fax Number: 020 3228 5222
  • Disabled Access:
    • Wheelchair accessible building
    • Ground floor therapy rooms
    • Accessible toilets on all levels
    • Lift access to the 1stfloor.
  • Address: Michael Rutter Centre
    Maudsley Hospital
    De Crespigny Park,
    London,
    SE5 8AZ
  • Business Hours/Visiting Hours: Monday to Friday, 9am to 5pm
  • Other essential information

  • Conditions: Anxiety, autism spectrum disorders, body dysmorphic disorder (BDD), habit disorders, neuropsychiatric disorders, obsessive compulsive disorder, tic disorders, Tourette syndrome, trichotillomania

Interventions

Treatment for OCD

The guidelines provided by the National Institute for Health and Care Excellence (NICE) recommend two evidence-based treatment options for obsessive compulsive disorder (OCD): cognitive behavioural therapy (CBT) and selective serotonin reuptake inhibitors (SSRI) medication.

 

Cognitive Behavioural Therapy (CBT)

We offer a specialised CBT treatment package to help young people to learn about and overcome their OCD. This involves:

  • Psycho-education
  • Caregiver inclusion/training
  • Exposure with response prevention (E/RP)
  • Relapse prevention
  • Cognitive strategies

Each young person works with their therapist at their agreed pace throughout the treatment; practising tasks together and agreeing tasks that can be continued at home.

  • Typically, CBT involves meeting a therapist at the clinic once a week for an hour over an average of 14 or 20 weeks. An essential part of CBT is that the skills learnt from sessions are practised on a regular basis
  • We can also offer CBT over the telephone or video-link, in an intensive format or during inpatient stay
  • Four follow-up appointments at one, three, six and 12 months’ post treatment is offered

 

Medication

Selective serotonin reuptake inhibitors (SSRIs) can help many young people with OCD. The medication options are carefully considered for every young person and will be discussed fully with the young person and family at their assessment.

Eligibility criteria

  • Up to 18 years old
  • Suspected diagnosis of obsessive compulsive disorder (OCD) or related disorders

Exclusion

  • Presence of another psychiatric disorder or problem requiring more urgent assessment or treatment

Care Options

Assessment

The assessment in the clinic is tailored to the needs of the young person and will usually take about 3.5 hours. We ask parents to give a full account of the difficulties, and how they have dealt with these in the past. We also see the young person on their own to ask them about what they are finding challenging. At the end of the assessment, we meet the family to feedback our thoughts and to discuss our recommendations for treatment.  We will also feedback this to other professionals involved via a written report.

 

To watch a short video clip about our assessment process please click here (password: assessment) https://vimeo.com/123625522

 

Treatment

Cognitive-Behaviour Therapy (CBT)

Our specialist treatment package of CBT with E/RP involves meeting a therapist at the clinic once a week for an hour over an average of 14 or 20 sessions. We can also offer CBT over the telephone or video link, in an intensive format or during inpatient stay.  

 

Medication

Medication can help some young people with OCD and other disorders. If medication is considered appropriate, this will be discussed fully with the young person and family at their assessment.

 

Follow-up

To make sure families are supported after treatment, we continue to review progress at 1, 3, 6- and 12-months following treatment. To assist this, we ask the young person and families to complete questionnaires at these times.

Teaching and Training

We regularly host teaching and skills-based training events on body dysmorphic disorder (BDD) both at our Maudsley site and in-house at child and adolescent mental health services (CAMHS) across the country.

Our training events focus on dissemination of our manualised clinic protocol.

Our standard full day training events will cover:

  • Recognition and assessment
  • Evidence base for cognitive behavioural therapy (CBT) treatment
  • Key components of CBT treatment using a case example
  • Brief overview of pharmacological treatment
  • Challenging issues and how to overcome these
  • Working with common comorbidities
  • Small group discussion and role plays

Our training events usually focus on either BDD or Obsessive Compulsive Disorder (OCD). We are able to offer teaching on both disorders as part of a combined event, but in order to do this we would need to reduce the scope of the teaching or extend the event across two days.

 

Rates

Please contact the clinic to discuss our availability and rates.

 

Feedback

“Thank you. Such an excellent training day. Learnt so much but feel it was presented in a way that made it feel memorable and simple (though clear it wasn’t!). Confident, competent, interesting, enthusiastic, easy to listen to and inspiring speakers.”

“Scenarios and practical tips were fantastic.”

“Excellent Masterclass. Very practical and clinically orientated.”

“Fantastic. Very informative and helpful especially with videos and role plays.”

Case Studies

Naomi’s story (Trevor’s mother)

“Trevor was diagnosed with OCD at ten years old”

Prior to that I thought he always had some obsessive compulsive tendencies. From an early age, things had to be in their right place before he was comfortable in a room. To us, though, that was just who he was. We were a little worried at times, but members of our immediate family would say he was absolutely fine, so you feel torn between doing the best for your child and not wanting to make a mountain out of a molehill.

When the condition worsened, we realised something definitely wasn’t right. It was a combination of outside factors that seemed to affect him. He was leaving primary school, so six months before the diagnosis we were looking at secondary schools. And there were tests at school too, which was extra pressure.

“We did some research and decided to see the GP”

The GP referred us to the local CAMHS, where Trevor had a course of cognitive behavioural therapy (CBT). All in all, the therapy had a really positive outcome. It improved his mindset, I’d say. He was much more positive about himself, his confidence was better and he was able to do more on his own and reassure himself about things.

When he finished the sessions, his therapist told us that if he relapsed it would happen sooner rather than later, but it was the other way around for Trevor. He was okay for a good 18 months and then there was a gradual re-emergence. You feel like kicking yourself because it took us a while to notice it was happening.

“OCD can feel like a dark shadow hanging over the family”

It’s only one person going through the OCD directly, but it can affect the whole family. In the early days we accepted his rituals, thinking that was just who he was, but now we knew he could be different. Also, he was older this time around and his behaviours seemed a little darker. There were teenage things mixed in, I guess, which meant a lot more anger and upset.

Sessions would be triggered by being stressed, upset or angry – although OCD was clearly stressful for him, it was one of the ways he dealt with things. We knew we should nip it in the bud as soon as possible, but, as soon as you stop one thing, something else comes along five minutes later. It’s really hard to describe what that’s like. You want to say ‘snap out of it’, even though you know that’s ridiculous. It’s heart-breaking because you can see what’s happening to your child and you feel powerless to help.

“We were asked to be part of a research study at the Michael Rutter Centre. We jumped at the chance”

The school referred us to our local CAMHS again and we were asked if we wanted to be part of a research study for the Michael Rutter Centre at the Maudsley Hospital. We were keen because CBT had already worked well, and the fact that the study would help the centre improve their service also struck a chord. We said yes, let’s go for it.

The programme was similar to the one at our local CAMHS, but they have a different view on what’s achievable… because they believe people can be cured of OCD.

Another big difference, for me, is that family members get the chance to speak to the therapist on a one-to-one basis. I really don’t want to say anything derogatory about the local CAMHS service, because they were really good, but I never had the chance to ask questions, and that meant I couldn’t always follow Trevor’s sessions as I would have liked.

“Trevor grew in self-confidence and his outlook improved”

The therapy at the Michael Rutter Centre is very personal to each young person. Trevor’s therapist took a lot of trouble to get to know him so she could find the right things to say to get him to do what he needed to do. At times she needed to be tough, and she was. He had sessions on Friday after school and he was sometimes tired. Actually, we were all tired, but she’d say ‘come on…’ and then start an activity that kept us all focused. She was prepared to do new things, like go outside or bring objects into a session.

I’d say his improvement was more gradual this time. The need to do the rituals lessened, he grew in self-confidence and his day-to-day outlook improved. With less reliance on rituals, he had more time to do the things he wanted to do.

“You’re not alone with what you’re going through”

At times, I’ve tried to explain things to friends and you sometimes see their faces drop. I guess OCD might seem crazy to people, but at the Michael Rutter Centre you can be completely open and honest and the people there won’t bat an eyelid. Things that seem strange to you, they’ve seen it all before.

Trevor’s last weekly session was about three-and-a-half months ago now and he’s doing regular follow-up sessions at the moment, which are part of the centre’s relapse prevention programme. I wouldn’t say we’re 100 per cent clear yet, but he’s doing well and he knows they are there for him if he needs them.

The help we’ve had from CAMHS and the Michael Rutter Centre has been invaluable – for Trevor and for us as a family, especially when times seemed dark. You’re looking for a way to get through it and there’s someone there for you. There are people who can help, and they really do help. That’s so reassuring.

 

Trevor's story

Trevor’s story (Naomi’s son)

“The first thing, I think, was arranging objects in certain orders”

My OCD probably started in a minor way around the age of seven, but then the rituals grew. I think the first thing was arranging objects in certain orders. There was a bookshelf that I’d have to arrange and I banged things quite a lot – like, tapping the bedside table and the sideboard a certain amount of times.

We thought it was just a phase at first, but obviously it wasn’t. Then, when things got worse, the arranging dropped away and other things appeared. I jumped over thresholds, ran up and down the stairs, touched some things and not others, and generally spent a longer amount of time on the behaviours.

A couple of years later, it got so bad that my mum did some research into OCD and we were put in touch with Child and Adolescent Mental Health Services (CAMHS).

“At one point, I was extremely stressed out. I literally couldn’t take any more”

The OCD was getting in the way of day-to-day stuff – like, getting ready for school in the morning took a long time. It wasn’t that bad while I was at school, but I didn’t really do it there because it wasn’t in my comfort zone.

Once we’d spoken to CAMHS, I started cognitive behavioural therapy (CBT) and that was really, really helpful. I had weekly sessions, where we’d talk, choose a ritual and assign a task to it. The idea was to confront the ritual and think of ways to tackle it when I had the urge. I used to get a particular feeling before doing a ritual, so we’d talk about deep breathing, things I could say to myself and think about.

I wouldn’t go so far as to say it was a relief when I didn’t do the rituals, to be honest. Sometimes it was harder not doing the ritual, and then the urge would come back stronger than before.

“I didn’t really like CBT at first, but that changed when I could see it was helping”

About halfway through my time with CAMHS, we confronted one of my big rituals and I suddenly realised I wasn’t doing it anymore. That was a turning point because I could see the therapy working.

After the programme, things were a lot better for a couple of years, but then it got much worse again. It built up slowly and things just weren’t working out. The same rituals were reappearing and there were others too. I’d stare at things, bang things harder so they broke… there was counting, asking for reassurance a lot, washing my hands, stamping, hitting one object against another, closing my eyes a lot. It had been a stressful couple of years, so I don’t think that helped. I’m in year nine at school now but that period was roughly when I came into year eight, so I was 13 years old.

“My therapist at the Michael Rutter Centre says I can be cured of OCD and now I’m proving that to myself”

The therapy at the Michael Rutter Centre is quite similar to what I did through CAMHS. Though – and this is hard to explain – where CAMHS said I couldn’t be completely cured of OCD, my therapist at the centre completely disagrees.

From the start, we tackled one ritual a week. I had a book to write the rituals in and she would ask me to give them an anxiety rating of 1 to 10, to express what it was like to have the ritual and how anxious I was about not doing it. It was hard to rate how I felt sometimes, but I managed – I think the highest was an 8 and the lowest was a 2. It helped, because rating my anxieties told me how I felt about each ritual and how I’d find a way to get over them.

When my therapist first said I could live without OCD, it was a shock, but now I feel I’m proving it to myself. A couple of sessions in, I could see things were changing again and I realised I was already getting better.

“Doing rituals is rare now”

I had 14 CBT sessions at the Michael Rutter Centre and now have regular sessions, which are like a catch-up, and assessments to see if my OCD score has come down. Day-to-day, things are really good. OCD used to ruin my day, but it’s rare I do a ritual now. I can watch TV in my bedroom without smashing the controller, I can play my PS3, I can talk to people more easily, and it’s much easier to focus.

I hope everything’s cool and relaxed by next term because I’m starting at a new school, where I’ll be studying theatre. I’m really excited about it.

I’d really encourage young people with OCD to try out the treatment at the Michael Rutter Centre. I was quite reluctant at first, but I can guarantee that everyone will find something that’ll help them. I’d say the treatment works for most people. Day-to-day, it’s made such a difference for me.

 

Resources

Young people and families

 

Professionals

 

Other organisations

OCD Action
Website: OCD Action website 
Email: support@ocdaction.org.uk
Call: 0845 390 6232

OCD UK
Website: OCD UK website
Email: OCD UK contact form
call: 03332 120 703

 

Other websites

Funding

Assessment only

Multidisciplinary team presence for intake assessment involving:

  • Meeting with family
  • Assessment of severity of OCD and history taking
  • Mental state examination + physical examination
  • Team discussion and feedback to family
    • Confirm diagnosis and suggest treatment options

 

Assessment and treatment

Intake assessment and appropriate treatment package.

 

HS OCD

There is a national service for severe and treatment-resistant OCD, funded by the NHS England, for young people meeting the following eligibility criteria:

  • Severe OCD
  • Previous treatment with CBT including ERP
  • Previous treatment with SSRI medication, at optimal dosage and duration.

Any young person fulfilling these criteria can be referred to us for assessment and treatment.

Our experts

Consultant Child and Adolescent Psychiatrist

Dr Bruce Clark - Read more

 

Consultant Clinical Psychologists

Chloë Volz - Read more

Dr Amita Jassi - Read more

 

Clinical Psychologists

Dr Maxine Howard

Dr Lauren Peile

Dr Angie Lewis

Dr Victoria Hallett

Dr Jonathan Espie

Dr Zoe Kindynis

Dr Gazal Jones

Dr Benny Monzani

Dr Kelly Woods

Dr Sasha Walters

Dr Hannah Baker

Dr Stuart Brownings

Dr Katie Lang

Dr Elif Gökçen

Dr Sarah Lavender

Dr Safina Roberts

 

OCD and BDD Team

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