Obsessive-compulsive behaviors can occur in a wide range of psychiatric and developmental disorders. This article was written by a behavior specialist who works at a day program for individuals with severe Intellectual Disabilities (ID). She shares how she helped one of her clients reduces his compulsive behaviors.
When I entered the human services field, I met quite a few individuals diagnosed with Intellectual Disabilities who also had an OCD diagnosis. When I witnessed their symptoms, I thought of friends I have with OCD who manage their OCD successfully through learningf about their OCD, seeing a therapist, utilizing cognitive behavioral therapy, and having a close support system of family and friends. I wondered whether similar approaches might work for compulsions of individuals with an Intellectual Disability.
One individual, I’ll call him Aaron, attends my day program and exhibits significant compulsive behavior on a daily basis. Aaron’s compulsive behaviors include pacing, moving furniture around, hand/elbow/head tapping, loud vocalizations, and buying numerous sodas from the vending machine. If his compulsive behavior is interrupted, he becomes aggressive and violent. I first met Aaron when I was called to help with one of his aggressive outbursts. He was yelling loudly, attempting to hit and kick his peers, pacing around in circles, and punching himself in the head.
Aaron is non-verbal, does not use sign language or picture icons, and communicates primarily through movement. While maintaining a safe distance, I raised my hands in the air to communicate my question gesturally. He began pointing repeatedly down the hallway. One of my co-workers said, “He wants a soda.” After confirming this fit within his food and drink guidelines, I turned my attention to him and said, “Let’s go to the vending machine.”
I walked with him down the hallway and observed the tension in his body decrease as he ceased his attempts to be aggressive. He bought a soda, and we sat down. He took 30 minutes to drink the soda, tapping the table and his own elbows numerous times as well as rearranging the position of his chair over and over again.
When Aaron was finished with his soda, he joined a group of peers playing ball for about ten minutes before becoming agitated again and gesturing to the vending machine. I was faced with a dilemma — how many sodas do I let him buy? On the one hand, I would be enabling his OCD behavior. On the other hand, if I didn’t allow him to buy the sodas, he could hurt one of his peers and since he is an adult with no medical restriction governing his fluid or soda intake, purchasing it is his right. I opted to spend the rest of the day with him and observe his behavior.
After that day I had many questions. Primarily, how could I help?
I had seen that Aaron’s aggression stemmed from anxiety and I felt this had to be addressed to ensure everyone’s safety. I read his file to learn more about him, and discovered that he was already taking medication to treat his OCD and saw a psychiatrist every 6 months with his mother. I decided to call his mother to gain more information.
During our conversation, I described to Aaron’s mother what I had observed in the day program and she told me that was typical behavior for her son. We worked out a better system of getting information about Aaron’s behavior to his psychiatrist and she shared helpful information about things Aaron enjoyed, such as sorting colored blocks.
With this new information, I met with my co-workers and we created a schedule for Aaron to keep him busy with things he liked doing. The schedule would help him to know what to expect from his day. We included group activities, two opportunities to buy a soda, sorting, puzzle time, and taking out the trash. We agreed to work as a team to consistently make those tasks a part of his daily routine.
Once we implemented this schedule, we saw a decrease in Aaron’s aggressive behavior. I believe this is because he was occupied doing things he enjoyed and had less opportunity to focus on his compulsive behavior. He still has some compulsive behaviors, but we do not interrupt these behaviors as they are not harmful to anyone and do not recur as often.
Although I can’t verbally communicate with Aaron about his thoughts, feelings, or obsessive thoughts, I have gotten to know him well. I believe that his OCD symptoms have improved since we implemented treatment options to reduce his anxiety and boredom and increase his participation in pleasant activities. I am grateful for the experience of working with and learning from Aaron and I hope that with the support of his psychiatrist, his mother, and the day program his improvement will continue.