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Hi , I forwarded your question to Dr. Chansky.

>

> Dear Dr. Chansky,

>

> Our 10 yo dd has OCD with primarily compulsive washing after using the

toilet. With medication and behavioral incentives, she has decreased her

washing to “only†3-5 minutes and “only†up to her elbows.

>

> However, she has not made as much progress with a related problem: she tends

to postpone going to the bathroom and as a result she has occasional daytime

enuresis. This problem first developed after a period last summer when she was

washing for up to 60 minutes at a time and only using the bathroom twice a day.

>

> She now uses the bathroom 3-4 times a day but the problem continues. She is

generally either in the bathroom or on her way there when an “accidentâ€

occurs. She is sometimes “dry†for up to 2.5 weeks, but will then have 3-4

accidents over the space of a few days.

>

> At times, she says that she knew that she had to go to the bathroom but put it

off too long; at other times she says that she did not know until the last

minute and did not have time to get to the bathroom. Most often the accidents

have occurred when she has not used the bathroom for 4-5 hours, but several

recent accidents have occurred just 2-3 hours after her last bathroom use.

>

> We have made some attempts to get her to use the bathroom on a rough schedule,

but she has been very resistant to going when she did not feel that she

“needed†to. More recently, after she insisted that she really did know

when she needed to go, we dropped the schedule but set up fairly strong

disincentives for “accidents†to motivate her to go promptly when she felt

the urge. These incentives, suggested by Lynn herself, included a week without

Internet time and a week without dessert after an accident. However, a spate of

several accidents this week suggest that this approach is not working.

>

> Are you able to suggest/recommend any alternatives? We are thinking that

perhaps we might try to go back to a timed voiding approach (which may be more

palatable since her washing time has decreased), using Internet time as the main

incentive for her to go 5-6 times a day rather than 3-4. But given our lack of

success so far, we are not all that confident in our approach.

>

> Many thanks,

>

> Lorin and Kusmin

>

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Are you aware that enuresis is a symptom of PANDAS? I don't keep up on the

list very well . I have no idea if you've looked into this but I wanted to

mention it.

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Hi , I assume you meant " " as it was her question I was forwarding.

(hope I got that name right, " " -- my memory is SHORT!)

>

>

>

> Are you aware that enuresis is a symptom of PANDAS? I don't keep up on the

> list very well . I have no idea if you've looked into this but I wanted to

> mention it.

>

>

>

>

>

>

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  • 4 months later...

Hi , I've sent this on to Dr. Chansky.

>

> Dr. Chansky,

>

> First of all, thank you so much for your wonderful work! Your guides for

parents have been very helpful to our family.

>

> I have a 9 year old daughter who was diagnosed with OCD just before her 8th

birthday. She began therapy immediately. The OCD worsened at first, but after

about five months it started to improve, and in about nine months she was 99%

symptom free. Then, about six months after that (this past summer) her OCD

returned. She resumed therapy - with a different therapist, as we have recently

relocated - and though there has been no improvement yet, we are confident that

eventually it will help her. In the meantime, though, it takes two to three

hours for her go to sleep at night, and she wakes in the night unable to go to

sleep again for hours unless she sleeps in our room. She is wracked by intrusive

images and OCD urges. We've used melatonin, which helped in the past, but it

doesn't seem to be effective time. We asked the pediatrician for help, and she

proscribed one month's worth of Clonapin. We tried that for three days. She

still woke in the middle of the night, and before falling asleep seemed more

agitated than without Clonapin, so we discontinued that and went back to

melatonin.

>

> What we want to know is whether we should pursue other medications via a

psychiatrist, or - based on her history of success with CBT - just wait it out?

She hasn't slept normally for about 2 months. On an average night, she gets

seven hours of sleep, disjointed. That doesn't sound too bad, but for an active

growing 9 year old, it isn't enough. On the other hand, she has almost no

anxiety during the day and remains a successful and productive student. Would it

be prudent to medicate a child who has no anxiety during the day but suffers at

night? This is a really hard judgement call. Would appreciate your advice.

>

> Thank you again for your help.

>

> -

>

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  • 4 months later...
Guest guest

Hi , I sent your note to Dr. Chansky.

May be a few days, she was out of town until March 8, I think.

>

> I love your book but I have an issue that is not covered. My 8 yr. old son

has OCD and desperately needs to begin his meds but refuses to do so for a

variety of reasons. I have tried every line of reasonig but of course there is

no reasoning with OCD. Any suggestions?

>

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