Hannah

Thu, Dec 01, 2022 3:44PM 1:09:38 SUMMARY KEYWORDS ocd, kid, compulsions, parents, students, anxiety, obsessions, people, accommodations, support, question, hannah, talking, thought, happening, iep, impacting, life, teachers, called

00:00 Get into everything. I know you mentioned there was like, I don't think it's specifically in my questions. But I know you we had talked about it like, just this. I guess the sexual part of OCD. I don't know how to say that. Yeah, my frame that like? 00:16 Well, I think I think honestly, I think that I probably can go into it a little bit just with like thequestion of like, what is OCD? I think I think I can just touch on what some of the, you know,what some of the common themes are. And you know, that that is one of the, you know, one of the most common themes that we see. So, no, no, I mean, it's up to you, but, but that could be an easy place for that to come up. 00:47 Perfect. Because I was thinking, I was like, I know, Hannah, and I talked about this, but I don'tknow how, like, phrased that question in a way that like, she made it professional. 00:58 Great. So tell me about the secretary. 01:03 Chase. And then, how should I refer to you? Um, Hannah is fine. Okay. I will have you do your own introduction. I will introduce, like, I will record our intro and outro after our conversation, but I just want to make sure like, you know, midway through if I say, oh, Hannah, something Iwant to make sure that I'm referring saying the right. 01:27

01:30 Okay. And then, so I'll just jump in. I'll say welcome. I'm so glad that you're here. And, you know, ask you to tell me a little bit about yourself. Okay, sounds good. You do I didn't make this up. You do have like a personal story with OCD? I do. Yeah. Okay. Is that okay for me to ask you about it? Are you like, don't ask me that. Sure. Yeah, yeah, definitely. Okay. I just wanted to make sure I didn't say anything and know that I can cut out anything. If I say something you're like, No, no. All right. So here we go. Okay. Hello, Hannah. Thank you for joining us today. And I am really interested in our conversation about OCD. So welcome, and thanks for joining me. 02:15 Thanks so much for having me. I'm so excited to talk about this topic. 02:20 So before we get into talking about OCD, can you tell me a little bit about yourself and how yougot into this line of 02:28 work? Sure, sure. So I am a clinical social worker, which means that I have my master's in social work. And then I have sort of a additional period of time where I get some training and trainingunder under a more seasoned clinician. And I work independently, I have a private practice in Maryland, right outside the DC area. And I specialize in working with folks that struggle with OCD and struggle with anxiety. And then I have a little bit of a sort of sub niche and workingwith autistic and neurodivergent individuals that also struggle with OCD and anxiety. 03:11 Can you tell me I think you have a little bit of a history yourself or a story that makes it morepersonal of why you got into your line of work? 03:21 Yeah, yeah, I do I do it. And it's always an interesting question. Sometimes people don't don't expect me to answer that way. When they're like, how did you get into this? I'm like, Well, it's,it's a little hard to describe if I don't disclose, because otherwise it would be somewhat random. But yeah, so I was diagnosed with OCD when I was nine. And I remember it very vividly. It was a really, really tough time in my life. And I had no idea what was going on. And I did everythingI possibly could do to hide it from my parents and to hide it from everybody else. Because honestly, I thought, if people knew, then I would be in trouble. Maybe I would go to jail, maybe I would be put in. You know, I didn't have a good understanding of what you know, the mentalhealth system look like but I just imagined Hogwarts, but you can't get out, you know, like gooff and you never come back type situation. And so I had no idea what was going on. And I mean, you know, I think in elementary school, especially they, you know, tell you to, you know,don't smoke Don't do drugs and all these things and they don't tell you what to do if you havelike intrusive thoughts. And so that was really quite jarring for me at that age. And and I still identify as somebody who has OCD. I think there's a part of my mind that I call it just my sort oflike creative part of my mind will occur occasionally throw really interesting thoughts smile.And I don't know that there's a way to turn that off. But I've gotten much, much better atlearning how to recognize it and learning how to respond when that does happen.

05:16 Well, I appreciate you sharing such the personal side of this journey for you. And I think that is really adds such great insight for the folks that are listening because you can truly thenunderstand what parents and children are saying when they are explaining what they're feelingand their thoughts are and then you can kind of relate through that journey. And I think that really helps a parent navigate something that is probably pretty scary for everybody in thefamily in terms of just trying to get resources and support and understanding and then beingable to turn around and advocate 05:56 for that child. Yeah, yeah, sure. I hope that it does that. And and I know that I think one of the things that was really important for me, and my journey was to be able to see that people thatthere was hope, you know, that people had been in my place before and they had gotten help,and they had come out on the other end, and they were they were doing well, right. They were living living their life. And it wasn't this, you know, they weren't, they weren't in a nonescapable Hogwarts up on some, you know, remote island or something. 06:31 Right, exactly. So can you help us understand what exactly OCD is? 06:37 Yeah, yeah, sure. So OCD is, is, you know, well, sort of in the name. It's characterized by obsessions and compulsions. And obsessions are, it least defined by the diagnostic manual? Iknow, obsession has, there's like sort of a colloquial usage of it. But it's slightly different, maybe than how we use it diagnostically. obsessions, at least for the purposes of OCD are, likeunwanted or intrusive thoughts or images. Sometimes they can also be experienced as likesensations, you know, so like, a sensation that you don't want or you don't feel like is in linewith who you are, and that sort of thing. But that is really one of the big hallmarks of OCD.Now, when we're talking about younger kids, sometimes it's the obsessions. You know, especially whatever yours can, can sometimes seem like, they get a little overshadowed by the compulsions, and partly because the compulsions are the things that oftentimes people arepicking up on, right, they're picking up on the, you know, that and compulsions being anythingthat you would do in order to neutralize or attempt to get rid of that unwanted or intrusivethought. And the compulsions are, can range very, very widely. So there are ones that are more visible, and you might think of things like you see on, you know, some of the morepopular renditions of OCD and the media like hand washing, or touching or tapping or doingthings repeatedly turning light switches on and off, making sure that they something is lined upjust so. But they can also be more invisible or, you know, are were difficult to to observe. And that can be because there are also mental compulsions going on so sometimes, you know, youmay have somebody who, you know, to the outward eye, right, it doesn't look like there'sanything going on, but they may be spending all of their time and energy in this sort of, youknow, mental world war three back and forth with themselves, right? Because there's maybe a,you know, an obsession, and then they're like, Well, no, no, that can't be true. And here's Reason one, here's reason to hear certain theories, you know, like, you know, and sort of goingback and forth they call it Ping Pong Ping sometimes. And then there are also ones that are like, for example, you know, saying a prayer to yourself, right, trying to mentally push away thethought. I think there was one that I found myself doing one time, and it was I don't know if youremember, probably 1015 years ago there was this game called like Fruit Ninja where therewould be this like fruit lobbed up right and you'd like Ninja with your finger on the iPad. And I did I realized one day I'm like, why am I like moving my toes back and forth like all the timethat's weird. Why am I doing that? And I realized what happened actually was that anytime Iget a bad thought I would imagine myself frui t and enjoying you know like the thought right?Like I got it like essentially decapitate all These bad thoughts, right? Like, go away, go away, go away. And that was, you know, it was a small compulsion that didn't really impact my life,right? That's why I just realized it, but, but those, they can start to impact your life and they cangrow and they can become pretty substantial. So, all that to say, you know, we would look forobsessions, we look for compulsions, and we would also look for, you know, the obsessions andthe compulsions to impact the person such that they are, you know, struggling to, you know,function, you know, in their daily life do that be looking at some of those, those majorcomponents that make up especially, you know, for looking at a kid might be looking at schoolmight be looking at friendships might be looking at, you know, their their home life, theirrelationships with loved ones, that sort of things. So that's, that is sort of OCD in a nutshell. But it that, that encompasses such a wide, wide, broad range of presentations as well. So, youknow, I refer to some of the more well known types of OCD, like contamination, maybe justright, OCD, I think a lot of times people have sort of heard of those, or they they have sort of abasic understanding of what that looks like. And those certainly are, you know, very, verycommon presentations of OCD, but they're also ones that people are not as familiar with, youknow, things like sort of scrupulosity or sort of religious based OCD. There are forms of sexual obsessions, right? So it might talk about, think about, like, any sort of sexually unwanted orintrusive thought, right. And that can depend on the person what that is for them rate. But, but they can be incredibly distressing. And, you know, they're just all sorts of presentations. It's really not limited to any type, really, all we're looking for is does it meet those that thosecriteria of, you know, having the obsessions and the compulsions, and it's impacting theperson's daily life?

12:15 So for the criteria, I imagine that's through the DSM five, is that right? Correct. Is there a certain timeframe that an individual would have to present with those obsessions or

12:30 compulsions? Right, right, I believe let's see here. It's been a while since I, most of the people I work with it's like pretty cut and dry. It's been going on a while. I believe that it is maybe I think it might be four weeks or something like that. But again, usually, by the time people get to me,it's been going on for a pretty steady and full amount of time. Yeah, yeah. I would 13:05 imagine you're probably not the first person somebody is like, not you personally. But they'reprobably think they probably go to their pediatrician or something of that nature first to kind ofthink more of that school age or younger category of seeking that. So how, how does OCD manifest? Well, we talked about kind of how it manifests itself, but how does it start? And like, how would a parent kind of start to pick up on? Hmm, this is something a little bit more that weneed to get support for? 13:41 Yeah, that's a really good question. Um, I think one of the early things that you might notice is,you might notice avoidance, right? So in the context of OCD, and this is, this is avoidance issomething that's transdiagnostic, meaning that it could kind of overlap between OCD andother, maybe other forms of anxiety, or you can see it pop up with trauma or something likethat. But avoidance can be a really, really can also sort of be categorized in theory as acompulsion or a safety behavior, we might call it. And that might might be something that younotice, right, like maybe the kid is, like, not wanting to go to school, or maybe they're, youknow, suddenly not wanting to hang out with this friend. Maybe they suddenly are, you know, not wanting to do this activity that they enjoy doing. The other thing to look out for would bethings that are repetitive, and again, that's something else that's transdiagnostic right? Youmight see that in in other you know, for talking about other conditions, but that is, you know,also sort of can be a hallmark of of, you know, a compulsion or that sort of like stuck, you know,the stuckness of OCD. Yeah. So, parents, one of the really common ways that parents getpulled in is by is sort of these like, repetitive questions, right? Or, you know, asking forreassurance over and over again, is this okay, you know, well, I had this thought, is that okay,or that sort of thing? But, you know, I think in, in, you know, in my case, there probably werecertain themes or flavors that I asked questions about when I was young. But there were other ones that I was so incredibly, like, ashamed of or afraid of, that I didn't ask questions. And really, the only way that my parents found out was that I was avoiding things that I otherwisewouldn't have avoided. So I think I think it can be sort of a difficult thing to see upfront, but Ithink if you notice those things, you know, maybe following up with questions, and, andopening it up opening up the conversation so that, you know, the kid feels comfortabledisclosing what's going on? Yeah. So 16:29 does there have to be a certain event that kind of triggers OCD condition to develop? Or at kindof what is there a certain age? Or is it really doesn't

16:39 have an application that way? Yeah, I'm not necessarily. There's there's some interestingresearch going on between the connection between trauma and OCD. But But I think we probably are actually fairly early on in that research, as far as does, is there a triggering event,I think, for the majority of the folks that I've worked with, there's not a one specific, quote,unquote, triggering thing, right? There may be something that even that maybe the child or theindividual points to and says, like, hey, this was kind of tough. But oftentimes, that events, it's not something that's like so far outside the realm right of like, what you would expect, in that,that any child would, you know, confront at some point in their life, right? Like, it might be thatI don't know, a friend gets a cold, right, or something like that. And it's, so it's triggering, in thatit brings it up, but really, what is different is how that child is handling it, and how they areresponding to that triggering event. 18:00 Or their higher rates of occurrence and the neurodivergent population. Yeah, yeah, there. There Absolutely. 18:08 Are. And actually, I realized I didn't answer part of your last question, which was that, that thereare actually ages that sometimes they're, they're sort of higher rates of incidence. If you look atit on sort of a, a graph, timeline, right, there are there are these little like bumps in a couple ofdifferent places. And the first place is between the ages of sort of, like, nine to 12. And so that is, you know, a pretty frequent age for like, you know, if somebody's coming to see me for thefirst time, you know, their parents just noticed something, this thing just sort of feels like itcame out of the blue, right, you know, or maybe they've always been a little anxious, but itdeveloped into a whole nother, you know, type of type of thing. So that's a common age, alsothe sort of late teens early adulthood, that that transition period is also a time when we wouldsee, you know, a higher incidence of OCD showing up. And as far as sorry, with regard to theother question with the neurodivergent population, yes, there is definitely a higher rate ofcomorbidity. And I think we are still trying to suss out exactly where you know exactly how highI've heard, you know, the the most recent meta analysis that I saw, put the number around17% of individuals that meet criteria for for autism also meet criteria for OCD. And that is, that's significantly higher than the US average population average population, at least. Most recently, that I saw when we were talking about children was, like, sort of up to 3%. So it's a pretty significant system, significantly higher rate and, and the 17%, I would say, from thenumbers, the more recent numbers that I've seen, it's almost sort of like a at least 17%. They've gone much higher than that, or some of the studies I've seen have have come backmuch higher than that. So 20:41 why do you think OCD would occur? Like, between the ages of nine and 12? And then like thatlater transition? Is there something with the brain development? Or what does the researchshow us of kind of why those pockets are tend to be where OCD comes to light? Yeah

21:03 I've, I've heard a few different theories, I think it may be that there are a number of factors atplay here. I think that the nine to 12, when you think about what's happening between the agesof nine to 12, there, you know, there's a lot of sort of, there are a lot of changes happening.And while we're talking about changes between both like in setting, you know, we might belooking at moving to middle school, we might be, you know, moving to these more maturesettings, there are also things happening with the body that are happening, and that that aresubsequently happening with the brain during that timeframe. I also think that, you know,there's, there's, when you think about the nature of OCD, we're talking about something thatlives and thrives in these areas where there might be, that might be more sort of, there mightbe shame around or there might be, you know, that might even be somewhat taboo, right? Youthink about like, you know, a lot of people around that age are first having, you know,experiencing, you know, like, their sort of sexuality and in a very different way than they everhave before, right. And, on top of that, again, there are just all of these transitions, thesechanges that are happening, there are stressors because of that. And, and there's just so muchuncertainty, right? I mean, you're really not sure when, when you're going from elementary tomiddle school, I mean, it's, it can be quite jarring. And, and likewise, right, when you're lookingat these sort of like young adults, there's this huge transition. And there's also in the midst of that transition. So much uncertainty, I mean, like, just try, I just tried to, like put mysel f backthere, what that was like, and that's so, so hard. I know, for myself, I know, one of the big thebig the sort of major times in my life, when I would have this, like resurgence of symptoms waswas like right around that time, sort of the year leading up to those major transitions, youknow, and I think it was because there was a lot of stuff that was outside of my control, likethere was nothing once you submit those college applications right out of your and you are justyou know, fingers crossed, you're like twiddling your thumbs over here, you know? And I thinkthat, you know, in some ways, even though OCD is, you know, by definition, like not helpful andnot adaptive, right, it still is something that there's, there's this one I, at least in my life, youknow, I was very familiar with it, right? It was kind of a safe, a safe thing. I knew it right? It wasn't I didn't like it, but at least I do it. And, and I also think that, you know, when your stresslevel is that high, I mean, stress and anxiety can just go hand in hand and when you're at thissort of peak already, you know, it's just takes one little thing for you to reach that thatthreshold where you are willing to do anything to just To get some relief, and that's how theOCD cycle kind of works anyway. So I can imagine. And these are, you know, these are just some of the theories as to why it happens then. But, but also just sort of, you know,anecdotally, I think, I think that tends to have those things tend to coincide during those thosetimes of life.

25:27 Yeah, I Well, I have, I'm a mom of three boys and I, so I have a sixth grader. And then I have a senior, and we have one, an eighth grader as well. But I'm just as you were just talking about,like college applications and middle school, I'm thinking, Oh, I mean, a for me personally, like,well, it's a lot and then for them living with them in our house that I think wow, that is, it's a lot.That's a lot of stress that goes with that. And then I could see where that impact can really almost be debilitating. I would think, right?

26:00 Yeah. Yeah, absolutely. Absolutely. And I think that's the other thing, too, is that it may be thatsome of these things have been going on for a while, right? I mean, now that I look back, andyou know, now that I'm an adult, to my mom will like, share with me like, oh, yeah, when youwere five, bla bla bla, bla bla bla, right, you know, but it didn't, it didn't reach that threshold ofimpacting my daily life. And I think that, part of that is that, you know, when you're when you'reyounger, you know, I think I didn't have as much on my mind. Like, I didn't have as much homework and like, it just, you know, even those things that don't seem particularly related. It I had enough, like a buffer in between, you know, me and the time that I had, and, you know,like OCD and, and, and I think that starts to diminish. Sometimes as we get older, we gothrough middle school, high school, college, like, there's not that time for you to, I don't know,have some goofy bedtime routine, right? Or whatever you're like, No, I gotta, like, I gotta get upat 6am. And then I've got sports all night. And then I've got to be able to do the homework. And you know, like, it's just yeah. 27:27 I think so You brought up a couple of things in terms of our students that are neuro divergent.And I hear a lot of what you're saying in terms of anxiety and stress. So it really seems that thatpartners can you kind of just ascribe also just the CO occurrence of autism or the COoccurrence of another? Something else that would go hand in hand with OCD so that parentsare professionals, educators could kind of keep that as top of mind as they're trying to supportthe students that they're working with? 28:06 Yeah, absolutely. Yeah, there are, there are a few things that that we see pretty frequently. I mean, autism is one of those things, if you're somebody who works with, with OCD, I mean, ifyou're any mental health provider, and we know that, that there are much higher rates ofautism than maybe we sort of were previously aware of, so you're going to encountersomebody, you know, an autistic person or somebody with autism, however they prefer to bereferred to, and, but if you work with OCD, it's gonna definitely join to happen. And, but beyondthat, also things like Tourette's and tics, you know, even are going to be seen, you know, inhigher rates in kiddos with OCD, other forms of anxiety, right, I mean, generalized anxiety,social anxiety, you know, ADHD, you know, there are a number of things where there are thesesort of, like, you know, meeting points are these overlaps a little bit or overlaps just enough orthere's just enough sort of common neural circuitry that like, it makes it a little bit more likelythat you know, you could could struggle with with one of those other things, but even within thecontext of so interestingly, in the diagnostic manual, and the most recent Well, actually, I guessit's the anyways, recently they changed they took OCD out of the anxiety disorders. Chapter and they gave it its own chapter. And in that chapter, there's OCD and there are the BF Arby's,the Body focus repetitive behaviors. So hair picking, or hair pulling skin picking, things like that hoarding disorder is also in there. And body dysmorphic disorder. So so all of those things have quite a bit of overlap. And part of the reason they did that is because as we get more and moreresearch, they're seeing a pretty significant amount of, of overlap. And in that grouping, so they felt comfortable enough to group those things together.

30:35 What can teachers do then off the top of your head to support students? 30:40 Yeah, that's a really good question. Because it's a lot, because I know teachers have a lot to lot on their plate already. But I think one of the big things is to, first of all, be aware, right, and not not aware. But like, if you notice something that something's off, and even if the student isn'tperforming poorly academically, you know, if you notice, like a change in maybe like, hey, thiskid got really quiet all of a sudden, or, you know, this kid is, was really participating in class,and now they don't participate, or now this kid is going to the bathroom, like 20 times, orsomething like that, again, with the total knowledge that teachers have a lot going on, and theyhave a lot on their plate. But if you notice that, you know that that's worth mentioning, becauseit may be, I can't tell you the number of times where, you know, I've started working with aparent, and they'll go to the teacher and be like, Hey, did you ever notice anything? You know,they've been kind of doing this than this at home? And they're like, Oh, well, not. You mentioned that, actually. Yeah, that is, has been going on, and I didn't really think much of it.And so, you know, I think just, you know, talking and you know, you guys, the parents and theteachers getting together and recognizing, oh, wait a second, we both have been seeing this,this isn't just a fluke type, you know, type situation, I think the big thing beyond that is going tobe, you know, hopefully, you know, working or working with another professional, you know,who can help support outside of session and then get a treatment plan in place. And that youwere the reason I'm not giving specifics this because it may be very specific to each kid, whatthe sorts of approaches. There are, you know, I think general things right, that I think it'd begood for all kinds of kids, like, you know, modeling flexibility, you know, kind of, if you havesomething, you know, weird happen, you can even sort of label your own feeling right and kindof speak it out loud, like, oh, man, I noticed I'm kind of feel a little tense right now. I'm gonna do it, you just sort of like narrate. Or, you know, sort of being a cheerleader booking confidencein your students when they do have really strong feelings? Because that's ultimately what if I'mworking with parents, you know, one on one that that we would work on is how do we supportthe child without feeding the, the OCD beast? But yes, I There are so many things, but butdefinitely just, you know, trying to keep your eyes open and, you know, communicating if youdo notice something kind of off. 33:55 So, perhaps absolutely, you know, every kid is different, and I can certainly understand kind ofmore of that broad suggestions, have you come across and still, just with that preface, thatevery student is different, every child is different, and that a treatment plant really is where itcan be incredibly individualized and supportive of that student? Can you think of just ancreative accommodation or solution, something out of the box that you've seen work for astudent? 34:29 Yeah, yeah. So I think this gets a little bit into what sort of the, the treatment typically looks like Yeah, yeah. So I think this gets a little bit into what sort of the, the treatment typically looks like for for something like OCD. So just as a brief overview, so for thinking about OCD is likeobsessions and compulsions and how the compulsions that are intended to neutralize that theyactually end up feeding into and you know, I'm reinforcing the obsessions. Our approach isoften one where we are working to, you know, cut back on the compulsions, right? And theremay be even situations where we are, you know, we typically start together working on this, wedo things called, I do things called exposures, right? Or sometimes we'll call them experimentswith my kids, right? Where we'll sort of be like, Oh, well, let's, because right, if we just don'tlisten to OCD, right, what, you know, let's try this out. If you every time you see this video feellike you need to do, you know, you need to spin around 10 times, well, let's, let's watch thisvideo together. And let's try this out. So with that in mind, you know, one of the things that'sbeen really, really awesome, I think, with in school settings, has been when, like, teachers willsort of jump in and kind of, you know, encourage and be like, you know, oh, you know, what,it's a great opportunity for us to, you know, for us to show how brave we are, right, or this is,you know, this is kind of hard, and these are kind of gifted feelings right now. But this is such a great opportunity for us to grow and as for learn, and this to be brave, and, and even for u s toget curious, you know, I think when I was talking about modeling, I've seen so much, whetherwe're talking about parents, we're talking about teachers or other adults in these kids lives. You know, we're, I think, as adults, we're all doing these things, but it may or may not be veryapparent, right? I can't tell you the number of kiddos who come to me and they're like, well,nobody else around me, is this upset. There are nobody else's this distress. And it may be that not everybody is having the types of thoughts that they're having. But but everybody does getweird thoughts, you know, like, we all get kind of like, okay, well, that was that was kind of, youknow, so I think, you know, modeling and narrating it as if like, you know, you can be like, Well,that was kind of a weird feeling. Or that was kind of a weird thought. But I wonder if you canget curious about that, you know, and so you can think about in the context of like a teacherworking individually with a kid on a homework assignment or something, you know, some sortof classwork thing, you know, oh, you know, the kid says, Oh, this is too hard. Oh, well, that's an interesting thought, well, that's what happens. I mean, you know, and kind of movingtowards it moving towards that thing that maybe would typically trite, you know, the kid mytrain will void or try to push out of their mind or whatever it is. Doing that, even if it's notdirectly related to the theme of OCD, I think really, you know, hits home with the message thatwe're trying to send.

37:56 Yeah. So. And you you mentioned, you know, a therapy type, can you break down the threetypes of therapy for OCD and anxiety? 38:11 Yeah, yeah. So, I, the, 38:15 probably some, there's a lot of letters, if you're looking at looking at different interventions, lots of lots of lettersto get very confusing very quickly. You know, in the the very large umbrella that spans, most ofthe treatments that we use for OCD are under this CBT or cognitive behavioral therapyumbrella. Now, that is, there is sort of a kind of traditional form of CBT. And sometimes that is, you know, is well, I would say more often than not, right, that's going to be what people arereferring to when they're saying CBT. But under that umbrella, we have things like ERP orexposure and response prevention, which is kind of, I think, you know, kind of the first thingthat OCD therapists like pull out of their pocket rate is is exposure and Response Preventionthat's doing exactly what what I was describing earlier, right, we do the thing where wepurposefully maybe move towards the scary thing and then we do the response preventionmean we don't do the compulsions, we work on that and we practice it we practice it indifferent contexts and with different things and you know, we practice being curious and beinginterested instead of just avoiding or running away, which actually is where there's such a niceoverlap with these third letters mashup, which is act or a CT Acceptance and CommitmentTherapy, where there really is a focus on on trying to minimize what is called experientialavoidance, and experiential avoidance, and as you can imagine, right, it's like this, it might beavoiding, like a certain emotion that's coming up or, you know, some sort of internal thing, rightattempting to get away from it or avoid it or run away. And the tenet of that is that, you know,if that's not in line with your values to be moving away from that all the time, which I think, youknow, for a number of situations, that's probably the case, then we let our values guide usinstead. And so instead of avoiding, we do things like we foster curiosity, and we get better athaving those feelings when they do come up, or we get better at having those internalexperiences, if if it's could be a thought to write or a sensation, or whatever it is. But continuingto let things that are important to us guide us, instead of it just being this perpetual runningaway from internal things.

41:13 And these therapies happen in a school setting. 41:16 They can, yeah, I've actually gone into schools themselves, because as you can imagine, right, Imean, things don't necessarily they're not just relegated to one context. Oftentimes, occasionally they are, sometimes OCD can get real specific. But oftentimes, it's bleeding over into all kinds of settings. And part of the reason I've gone into schools, because it's showing upin school, another part of the reason is that sometimes that's the best place to find the kiddo.Right? I can track them. And, and the other nice thing about when I do go into schools is that Iget to see all of these other people who are on this kids team, you know, like I get to,sometimes, you know, it's not even on purpose, right? I'm like in the office, and, you know, thekid comes in, and they're, like, introduce you to so. But it's actually really great, because itbecause OCD because it is, you know, sort of, by definition, impacting major areas of life,there's a good chance it's going to be impacting school, it's gonna be impacting grades, even if,even if the flavor or the theme has nothing to do with, you know, academics, it very well couldbe because if you imagine like, World War Three is going on in your mind, you tuning into thismath lesson is probably not high up on the list. So I think it can be really important, and thatway I can, you know, meet with teachers and provide them with resources and provide them with, you know, education. The other thing is, is that I think, once we, you know, in thesesituations where we can have this really awesome for team based approach is that we can beconsistent across the board. And that is so, so nice, because one of the, you know, these theserelationships that the kid has, with these adults, they're, they're not insignificant, and they're,but, you know, I think we can use that to actually help the kid, right? So like, for example, if thekid is really, you know, for examples really doesn't believe that they can do this thing, right?They can't face this scary thing. They can't whatever. We're, the adults in their lives having sortof a common refrain that they're using, it actually is, it's somewhat comforting, right? That like,you know, we we believe in, you know, you got this right, and we kind of do that, because whathappens is that if there's this unequal thing, right, maybe there's, there's one person in thekid's life who is, you know, just, and again, I just say this as a parent who has totally done this,right. But like, just isn't willing, you know, and just doesn't want to see the kid struggling in thatmoment, right? Even if it's a moment of growth. I mean, I did this the other night, my kiddothrew a tantrum because I wouldn't give her a full walnut even though she's, you know, 21months old and can't swallow like full solids, right? And, and she threw a tantrum and I was like,Okay, I fully know what I'm doing. But I gave it right, you know, I get it, I get it, and nobody's gonna be perfect. But I can be helpful to have these sort of go to responses so that you guys allknow you're on the same page so that there is not one of these things where I'm And maybethere's a, you know, one individual that the kids like, oh, well, it's fine. I know, I can go to so and so and exactly all the reassurance I need, you know. And that's that's not to say that the kids trying to be manipulative, right. I mean, that's, that's, that's OCD talking, that's crazy talking. But, but it will get creative, right if given the opportunity. That's. So that's one of the things that can be really useful about doing it. And whether the therapy is taking place insidethe school, or it's just sort of a general team approach, you know, with an outpatient personand the, you know, sort of school team, it can be so, so helpful to have everybody on board.

45:48 I am a huge proponent of collaboration, I feel like with the students that we support,collaboration has to take place that communication has to take place. Can you Anna, give mean example of an instance or an opportunity you have found where you've seen, you're like,Man, this collaboration, this team is phenomenal. Like what has used? What is something thatyou have seen that it's really worked successfully, that maybe others could take as a nuggetand implement with their team? 46:20 Yeah. Oh, I love that question. I'm trying to think of one specific example. I think that the best relationships that I've had with school team members have been the ones that are. And I like, I love the word collaboration right there. Because it's a two way street, everybody who's there isworking in the kids best interest, but everybody who's there also has a specific skill set and aspecific, you know, thing to bring to the table. And one of the things that I've had situationswhere, like, the, you know, the teacher is essentially like, you know, our eyes and ears, right,and in the classroom and stuff. And we'll we'll sort of, you know, occasionally we'll throw up aflag, right? And be like, hey, whoo, hi, over here, we had a total meltdown and reading. And, and, you know, what can we do here? And we'll problem solve it. But you know, I think that thebest the best situations have been when, because the teacher, right? I mean, the teacher isgoing to be the expert on educating the kid, right? And it's going to know, like, here's what they need to know, right. And this is this, there's some of the best ways to get this across. But it also is really awesome, when we can, you know, come together and just, you know, mesh all of ourknowledge. With the kids best interest in mind, I think the biggest thing is, like, if we have ateam approach, right, you know, we might have sort of an ongoing, you know, sort of Teamemail, or we may have occasional check ins, right. Each semester might have like a check inand be like, hey, our so and so doing right, but even in between those times, the ones thathave been really great have been when the all the team members feel like they can come andflag something, and it may be something like on my edge, right, I hear that. Okay, so and so islike, really still keeps telling me that they like have no idea what's happening in math. And that, you know, yes, there's OCD, but they actually maybe need some, like additional assistance, orwhatever. And I can flag that. But similarly, there's, uh, you know, the teachers or the guidancecounselors, or, you know, whoever or these go to people can send a quick email and be like,hey, just a heads up, right, like this is going on. And sometimes that means we set up aseparate time to talk about it, sometimes it means it's just something that's worth me knowingabout. So that when the kiddo comes into my office, you know, like, not that kids are always,you know, trying to try to skirt talking about difficult things, but sometimes, we all do. So, I think that that's, those have been some of the most helpful things. But yeah, like I said, the bigthings are, you know, team based approach, having a consistent response t o this so that weknow how we respond when for example, if we're it well, in the OCD, anxiety worldaccommodations, actually isn't always a positive word right? It It really isn't always a goodthing. Because right, if we're talking about the OCD cycle, it can feed into things. And so there might be situations where we have to adjust. And we have to say, okay, that accommodations that's adaptive, and that's helpful. And we want that kid to be able to do that themselves someday, and like, that's great. There might be other ones where we're like, you know, this is a great accommodation. And for this specific time, right, we don't want this to, you know, the kidhas other bigger fish to fry, right, and we don't need this negatively impacting, you know, therest of their school year or something. But we are going to gradually work to cut back thoseaccommodations, right, you know, and so, yeah, they could all might, for now get a little bitextra time on on tests. But once we get to the point where we're willing to do ready to doexposures, we may purposefully go in, you know, to a test, you know, and it may be somethingthat that may be a situation where, you know, I would be present there, right, or something likethat, with a test, and we're going to, you know, like immediate, we're gonna cut it off, right,we're gonna see what happens, we're going to have that feeling. And it's going to be hard, butwe're going to do it, and we're going to work through it so that we can get better at having thatfeeling. So it's, it's, it can be like, it's somewhat individualized, but it's, um, but I think that, youknow, communication, team based approach tends to be the best way to go.

51:33 But I love how you, you brought up a lot of points here in terms of pointing out that OCD andanxiety has a cycle, right. So if you think about just from my special education lens, andsupporting students that have learning needs and differences, you have accommodations andgoals, through that IEP cycle, or a 504. But my, I think the important point, and correct me ifI'm wrong, Hannah with always communication is important, right. But I think with a student that's presenting with OCD and anxiety, during that cycle, to really make sure that we'recommunicating, because you will set up say, a 504, or an IEP for that student, but they may ormay not always need what's written out in that document. So I think educating the team firstand foremost, as you as, as the professional that really has this training, educating the teamthat supporting that student, and having those conversations of, yes, we're going to use theseaccommodations now. But we know that sometimes we're not going to need them, but we're not going to take them away because of the cycle. And so really kind of making sure that we'reeducating and being consistent with that collaboration and communication to truly ensure thatwe're supporting that child's needs, wherever they are in their journey. Right, right.

52:59 Absolutely. Yeah, I think that's, that's the big thing is that the the accommodations and whatthey look like, at one point in the treatment process may look or at least the implementation ofit, right may look drastically different from when we first start, you know, and we're just tryingto mitigate, you know, kind of put the fire out and make sure that, that there's not these thesemajor long term, you know, effects and that the kid is to the best of their abilities, able to just,you know, kind of keep keep up enough, right. But as things go on, and we get better, and we you know, keep you know, progressing. My hope is is that with, at least with the stuff that'sdirectly related to OCD, that we would be able to kind of, you know, challenge, right, the andcontinue to challenge and maybe slightly alter, you know, the, the goals, right, and say, Okay,well, I know that, you know, we know, you can handle this feeling for five minutes. Let's try for10 minutes, right, let's see what happens if we double it, you know, or something like that. So, I think there's always room for growth. But the really awesome thing about about OCD treatmentis that it's, it's pretty first of all, it's pretty concrete. It's pretty practical. It's very practical, but it's also super empowering. And I think once that ball gets rolling, right, I mean, it's, it's so niceto see, you know, I'll be I haven't have worked with like a kid for, you know, like, a few monthsor something. And I'll come up with something like, how would you feel about you know, thisthing and I'm thinking right that this is going to be a big thing. They're like, Oh, I got that. Yeah, I did that yesterday. Right. You're like. And so it's so empowering. And it really is so nice to see that confidence return. And it's that confidence in that like, Oh, they're 100% sure that they'renever ever going to when we're talking about contamination, OCD like that they're never evergoing to get sick again, right? Like, that's not necessarily the goal, the confidence is inthemselves, you know, and their ability to have that feeling to maybe feel a little uncertain attimes and a little like, Yeah, but to continue to let their values guide them and what they're,you know, when they're at school, right, hopefully, the values they they want to, you know, besort of a good student. Yeah. 55:48 So kind of as we wind down, I feel like, We just scratched the surface of this conversation, I feellike there's just so much more that we could go into depth about, can you share someresources that parents or professionals could tap into to kind of either educate themselves or tomake their life easier if they're supporting a student with OCD, or anxiety or a combinationthereof? 56:22 Yeah, yeah, there are some really great resources in there, they're actually sort of beingconstantly added to, I think the big resource that comes to mind, and this is the resource thatoften you can kind of link to other resources with is the International OCD Foundation, or theiocdf, as you will hear it called, they provide a lot of sort of public education. They also have regional affiliates. So they'll have like, there's OCD Mid Atlantic, where they might have more local events, and might sort of keep people apprised of, of, you know, more local things going on. The International OCD Foundation, also, a few years ago, launched something calledanxiety in the classroom, which is a great resource for parents, for teachers, for schoolpersonnel, you know, kind of give some of that really solid, you know, psychoeducation, on onwhat this could look like, what accommodations might look like, what treatment might look like,and what you might expect, you know, if you have a kiddo that's going through that, so thoseare two really, really solid wins, there are so many, so many books that I could tell you about,right, or it's so many other good things. But those are really good places to start.

57:52 What did I not know enough about to ask that I should have asked? I'm 58:00 like, yes, a lot of really good questions. But I think probably, if I was to think about one of the big barriers to kiddos getting help. I think it would be that there is navigating finding the rightperson, the right therapist, can be difficult. It's it's, it doesn't seem particularly straightforward.Partly because there are so many of those letters we talked about floating around and it'sconfusing. But also because, you know, when we talk about CBT CBT is such a big umbrella.Right? There's so many different ways to apply CBT. And some of them are, you know, superhelpful, you know, for OCD, and some of them actually, like we've recently found out like,maybe aren't so helpful, right, like, you know, kind of get us a little bit more in the weeds, withOCD. So there are like slight alterations and unless you're working with somebody who, youknow, is working with, I don't know, maybe like 50% or more of their caseload, right, beingOCD, and they have specialized training in this, they may not know that there are those slightalterations. And so I would say, you know, finding somebody who specializes in this, who reallyfeels like they know, what they're, you know, knows their stuff, right? is really important. And one of the best places to find that is through iocdf They have a resource directory, you can goonline, you know, I don't know that it's necessarily quote unquote foolproof, right, but Butanybody who's special, that's it. That's a broad scheme. But, but most people who specialize in OCD are going to be members of iocdf. They're going to have their play just listed, you know, their their practice listed on there. And so that's a good place to start. The other resource for parents, and this is a really cool program for parents to look into is space, which is actually it'sa space training, it's, there are more and more providers that are being trained in this. And it's actually a parent based approach. So works really well especially have a busy kiddo thatdoesn't have a lot of after school time, because I got to, you know, spoiler alert, a lot oftherapists are also not available. So it's really such a cool program, because it focuses onwalking parents through how they can support their kids, and it actually has some really robust,awesome research behind it that is showing it to be just as effective as working individuallywith the child. So that's really nice. And it also I think, hits on some major, sort of like pain points for parents. So sorry, go ahead and interrupt. 1:01:12 No, no, no, I think this is fantastic. And it's called Space SP, AC SP, AC E. Yes, yes. So there, you may find providers who do individual, not individual, but they do, likework individually with parents. There also are groups that are starting up. In fact, I'm hoping to start up a group myself to work with with parents. So there may be either of those options, butit's nice, because I know families are busy, it is hard to get kids from point A to point B andthey've got a lot of stuff going on. And a lot of times, that can be a big barrier for kids, right?They're like, Oh, no, no, no, no, no, no, I am not missing. Tuesday, soccer practice, right, you know, to go talk to this lady? I don't think so. So it can be nice, right? Because a lot of a lot ofparents nowadays, not all, but a lot of parents have a little more flexibility with their jobs, theymight be able to during lunch hour or pop on with somebody to work through this stuff. Instead of it, you know, being something where they've got to navigate rush hour with their kid.

1:02:24 Right. Right. So if you had one billboard, or a tip for parents, what would it be? And why? Final question? 1:02:35 Oh, okay. Wow, Billboard question. Um hmm. I feel like the thing that's coming to mind i it is, I guess, helpful for the parents that I work for. But I think also I really love if I were to get a tattoo, I don't have to get a tattoo. I think it would be sort of the like, this, too shall pass, you know, type. Oh, I've heard a couple of different words. But But I think and the reason I say thatis because you know, what we want to, I think instill in our, our kids is that hard feelings andhard situations and hard thoughts come up. But But 1:03:32 yeah, typically, right. 1:03:33 I mean, at some point, I tell people, I'm like, you can't actually be anxious forever, you will passout at some point. If that's reassuring, but But you know, it will at some point, I think, I thinkkeeping in mind that whatever situation you're in that it's it's temporary, is so incrediblyhelpful. And even if the situation itself like will continue the way you're feeling about it is likely temporary. I mean, Feelings come and go thoughts come and go. So I think that's so important, because I think it also helps with that feeling. That hopeless feeling that people get, yeah. 1:04:16 Yeah. Oh my goodness, how can people find you so how can they how do you prefer to becontacted? How can they find you?

1:04:24 Yeah, yeah. So the best way to find me right now is through my website. So my website is OCD dash dc.com And I think I sent that to you. So hopefully, we can put that in the notes. But um, the we have there's like a online contact form. You can also reach out there's, we have a phone number and that sort of thing. You know, if you're more of a phone person, typically the webresponses get a little bit of a faster response just because it's faster to you know, follow up onthose, you know, set aside a certain amount of time in case the conversation goes on but, butthey can feel that out. And, you know, with anybody coming in, I, before we even meet for ourfirst official session, we have a, I do sort of a 20 minute phone consultation with them. So, so typically that is kind of the process, people will reach out. If they want to move forward, we'llset up, uh, you know, or feel like it's would be a good fit, then we'll set up a 20 minute phoneconsultation, and we can talk about what's been going on and you know, how I might be able tohelp. And and if I'm not the right source, you know, where to find the right resource. And then additionally, I just, I just started got, you know, on on Facebook, right, I mean, it's pretty, it'spretty bare bones right now, folks, but but I'm sure would appreciate the following. 1:05:55 And we'll put all of that in the show notes as well. And I am very grateful for this discussion andyour willingness to share your story and your experience and providing information andguidance to folks that are either supporting students that have OCD and anxiety or have a childin their home with OCD and anxiety. So I'm very grateful for your time today. Yeah, 1:06:23 yeah. Thank you so much. It was it was really a pleasure. And yeah, I'm really enjoyed it. 1:06:29 You bet. All right, bye for now. Bye bye. Obsession, compulsion anxiety school aged students,what is OCD and how can we support our students? Welcome to the special ed strategistspodcast where we strategize all things, special education. If you are a new parent to special education or a seasoned parent sitting at the IEP table. We are having a conversation todaywith Hannah Breckenridge talking about all things OCD. I am your host Wendy Taylor. I am a mom and a special educator I have sat on both sides of the IEP table as a parent and aprofessional. Over the last 25 plus years, I have made it my passion and mission to helpparents and professionals bridge learning gaps, access special education services and buildkick butt IEPs. If you want more tips, so show us some love on social at learning essentials. And if you are new to our podcast, give the special ed strategists a like and a follow. Let's get ready to strategize. Welcome to the show. Thank you again for listening to this incredibly personaldiscussion and insight from Hannah for helping us. Let's try that again. Thank you again forlistening to this personal discussion and insight that Hannah gave to us today, as she helpsshine light on OCD and how to support our students. My three special ed strategy takeawaysfrom Hannah and this podcast included higher rates of incidence of OCD occur around nine to 12. late teens, early adults and tend to and tend to spike during moments of intense stress. communication, education and collaboration are key to supporting our students that areexperiencing OCD and anxiety and modeling the behavior and talking through a narrative ofwhat is happening and getting curious help our students, our children move towards positive outcomes. Thank you again for strategizing with us and spending your precious time listening.If you love what you hear, give us a like and a follow at learning essentials, and the special edstrategist podcast. Looking for free tips. Head over to learning essentials edu.com and you candownload free tips to prepare for an IEP meeting plus bonus questions to ask. I am your host Wendy Taylor. If you need more special education support visit learning essentials where weprovide an individualized and systematic approach to supporting students with various learningneeds and differences through academic coaching and educational therapy. Brain camp is our executive function support model. If you are a parent looking for IEP support, we've got you covered through IEP coaching