Oh! Your daughter has severe problem you immediately go to a diagnostic center and get an MRI, CT scan and a few blood test get done. Till the report comes,” I am prescribing some medicines so your daughter would start going to school again” said the psychiatrist. He prescribed 9 tablets in a day and he assumed that the features of OCD (Obsessive Compulsive Disorder) are present but it will be confirmed after the diagnostic report, there is no need of worrying.

Rehana, 9 year old girl, stopped attending her school for 22 days. Before that, almost for 2 months she used to cry a lot in the school. She had a belief that if she left her parents then they would die, meet with serious accident, get injured etc. if she parted with them. Whenever this thought popped up in her mind, she created a scene in the classroom, the whole class got disturbed; teachers were not able to manage her. As soon as she would start crying they would send her to the school counselor.

The counselor was trying to counsel her. She told her that if would cry like this then she might get thrown out of the school.  This would ruin her future, neither will anybody (parents, family & friends) love her nor will any school give her admission.  After many sessions she took Rehana to the principal’s office, the principal told her either to take a transfer certificate or he would keep her in the hostel.  Now, along with Rehana her parents became anxious. Their entire life got disturbed; if they wanted to send their child to the school then one of them would have to accompany her for the whole day. Her father’s business, mother’s household chores, siblings… entire routine was disturbed.

Then the parents took her to another renowned senior counselor. She showed sympathy towards them and met with the child very warmly. After talking to Rehana, she told to the parents that your child is suffering with acidity. Just because of acidity she vomits every morning. (Rehana had started vomiting as soon mother got her ready for school.) The counselor gave them a diet schedule and asked the parents that she made her (Rehana) understand now she will attend her school.

However, Rehana was not ready to go to school at all. She still thought of the possibility of her parents’ death or an accident as soon as she went to school. Since it apparently was nothing major, only acidity, her parents beat her to make her go to school.

Anxious parents took her to a psychiatrist and he wrote 9 tablets per day along with a long list of diagnosis to make sure that the child is showing the features of OCD. Then the parents decided to take another (4^th) opinion, so they took her to a pediatrician.

The pediatrician referred the child to me. Since her final exams were approaching, the patents were even more worried. So it was a challenge for me to counsel the parents and the child together. I indirectly observed her behavior for 1 hour.  When she was at my clinic, she did not allow her parents to go away from her sight.

This was the first day. I told to the parents to not pressurize her or even themselves for the final examination. I consulted  a psychiatrist to get an opinion regarding medication. He recommended working solely through therapy initially and putting on medications only if required.

On the 2^nd day, I took Rehana’s session; we worked on identifying the thoughts- helpful thoughts, and unhelpful thoughts through game.  I used a doll for this exercise. Rehana enjoyed this exercise and could identify the dysfunctional thoughts. After that I did cost-benefit analysis. Meanwhile, I sent her parents to nearby market. The purpose behind this was exposure.   Rehana made posters for her drawing room.

She promised me that she would go to school for 2 hours only and her father will drop her by car. She refused to go there by school bus.  We both agreed upon this. On the 2nd day again at the time of school she started feeling like vomiting and stomach pain and started crying. She did not go to school.

In the evening she came for therapy session, again we worked on thoughts through different games (not like a formal therapy session). We played blind fold and did imagery exercise through blind fold to deal with her thoughts that ‘My friends will laugh at me if I go to school’.  Finally, we both prepared very colorful thought monitoring sheet.

The third day, finally she went to the school by school bus. She was there for the whole day. Though she noticed that the thoughts were coming in her mind but the frequency and duration were reduced. She filled her sheet by her own. Gradually, the child started attending the school happily. She wrote her exams without any medications. I have done six sessions with her.

Working with this child, some questions popped in my mind, is there any need of labeling (OCD) the child at this tender age?  Is there any need of MRI, CT Scan & blood tests for the diagnosis of OCD? If the child’s problem would have been understood properly by the school counselor then so much pain may have been avoided. Physiological symptoms due to anxiety are very common. If this could have been understood by the senior counselor then probably the child would not have been beaten by her parents.