Category: Social Work in the City

By: Kasha Martin and Natalie Bunner, LCSW-BACS

Remember Alyssa*? She was our case study in Part 1 of this series who struggled with obsessional thoughts around school which led to compulsive behaviors. She has Obsessive Compulsive Disorder, or OCD. Due to the school-related stressors she experienced, Alyssa began to exhibit compulsive behaviors which included hair pulling, or trichotillomania. Today, we will explore the reality of the “C” in OCD – compulsions – what triggers them and how they may present. But, before we do, let’s have a side bar….

Trichotillomania…What is That??

Perhaps you have heard of trichotillomania before; in fact, you may have even heard of it in the context of OCD. Many people assume that it is simply a symptom of OCD. It is important to note that while hair pulling can be a compulsive behavior associated with OCD, it is not always related to OCD. Trichotillomania is a stand-alone diagnosis where the compulsion to pull one’s hair or skin is the primary expression of the disorder. Meanwhile, the compulsions seen in OCD are usually related to obsessional thinking and can included many actions one may take to assuage them.

Compulsions: Triggers and Presentation

Compulsions are repetitive actions that people with OCD have in response to an obsession. Compulsions can be physical or mental. They are rarely rational or logical in action; they are performed out of an overwhelming need to react to the anxiety induced by obsessional thoughts. We know that obsessive thinking is usually the primary trigger for compulsive behaviors. As a quick recap, the focus of obsessive thoughts may be:

• A fear of being contaminated by germs, viruses, body fluids, or chemicals
• Fear of losing control of your body, thoughts or behavior with ruminations about how our lack of control could hurt others, accidentally or on purpose
• Undesired sexual thoughts, acute or chronic, that may include thoughts, or images that are disturbing
• Moral obsessions, particularly fear of not being “holy” or ethical enough
• Preoccupation with order, design and having things occur in very specific ways

Compulsive behaviors are usually chronic and intrusive. Once the mental connection is made between the thought and action, it is extremely difficult to dissuade the behavior. Compulsive behaviors might include:

• Washing hands excessively or excessively cleaning objects to eliminate perceived contamination
• Checking things repeatedly for reassurance
• Excessive religiosity or zealotry
• Chronic counting, tapping or use of certain colors to ward off anxiety
• Rigidly following routines regardless of their effectiveness
• Hoarding behaviors from fear of loss

Ways to Manage OCD Compulsions

Now that we have identified signs and symptoms of OCD, what can we do to manage them? First, be willing to learn. With education, parents can help their children understand themselves better and build confidence in their ability to cope with OCD-related challenges. Next, use your resources. Consider what your child will need to effectively manage their symptoms and connect with those who can help you and your child. Their pediatrician, therapist, psychiatrist, school counselor are just a few people who can help you get the assistance you need to help. Remember, with the right interventions, your child can live a productive and fulfilling life. There is HOPE!

*Alyssa is a fictional character created to convey a person with OCD.

Edison

I thought I didn’t want to be a mother. I loved working with children and did so with passion and energy. But, I wasn’t sure if I would be a good mother. And then you were born. I can’t even remember life before you. My love for humanity expanded in a way I cannot explain when you were born.

You are a gem. One of a kind. My little Spartan. My wild, wonderful, and wacky Edison. You see the world from such a unique perspective and help me gain understanding and insight into what it’s like to be a kid in today’s world.

Your superpower is Hyperlexia and, although do not understand it, makes you one of the most interesting, most intelligent people I know. You can read at a second grade level and you already know your multiplication facts for your four ones, fives and tens.

You are smitten by little babies and you fiercely protect your brother, even from me sometimes. ?

I can’t explain how much I love you. I just do.

Happy birthday.

Happy birthday to you.

“Can’t you sit still for ONE MINUTE!”

“You’ll never learn this if you don’t focus!”

“What is wrong with you?!”

“Will you just pay attention for ONCE?!”

Can you envision the impact of those statements on one’s childhood? Ingesting the embedded message that you are worthless, simply because you struggled with symptoms of ADHD? Actor Bex Taylor-Klaus has. Yet, with time, they identified the benefits of being neurodivergent and how to optimize ADHD in many areas of their life.

You have a unique way of looking at things.

Wow! That was very creative/innovative/original!”

“Let’s take this process, one step at a time, so you can understand it.”

“I notice the effort you are making to follow instructions. Keep it up!”

Knowing how negative messages can deeply impact how we see ourselves, intentionally learning about ADHD may aid us in becoming a positive, powerful voice for those who live with it. Knowledge is power. Our willingness to learn can empower others to go on and do amazing things!

Learn more about ADHD: Attention Deficit Disorder Association (ADDA)

Imagine being tall, gangly with big ears and poor impulse control. Imagine being the kid that caused so many disruptions in class that teachers became weary at the sight of you. Imagine struggling with all of your might to get through one school day without getting in trouble. Then, imagine someone introducing you to something that challenges you, strengths you and aligns you with greatness. Imagine being Michael Phelps.

ADHD could have defined him and, for some, it has. However, Michael had someone in his corner that we all need: a champion and, in his case, a rock-star Mom. Below, Debbie Phelps explores how she determined to focus on what made Michael unique instead of trying to fit him to a socially normative box:

We all need an advocate, children most of all. Children with ADHD need us to speak up and speak out for them; they need to know that they hold value at their most fidgety and least focused. When we truly see those with ADHD as human beings with burgeoning potential, we can contribute to their ultimate success.

October is ADHD Awareness Month. American society has been conditioned to view Attention Deficit Hyperactivity Disorder as just that, being out of order. However, this series will highlight the amazing qualities of ADHD that have propelled actors, athletes, and incredibly successful world changers into greatness.

ADHD is a Superpower

You don’t believe me? Let’s ask Simone Biles, the GOAT of gymnastics!

The Takeaway

Biles made a powerful point: “If you make them think of [ADHD] as a problem, then they will think they have a problem…if they think of it as a superpower, then that’s kind of cool.” When we understand that there are benefits to having ADHD (and, YES, there are benefits!) and explore them with our kids (and adults), they may feel confident enough to hone their skills into powerful abilities. Take the time to nurture the greatness in your child!

Learn More about ADHD: ADDitude

“He’s such a quiet kid…”

Walking into the gym, I found him surrounded by four 5th-grade girls. He looked angry yet resigned, fending them off half-heartedly as they taunted him, slapped at him, tried to steal his glasses from his face. Again. This was clearly a bullying incident. Immediately, the behavior was disrupted, the girl gang was disbanded and the Behavioral Specialist intervened. Sidebar: bullying should not be tolerated in any setting. What made this incident more challenging was that, while the environment was loud and chaotic with kids laughing and shouting around him, he did not make a sound. He just sat on the bleachers, watching me. I knew why he hadn’t tried to defend himself with words or report his bullies to teachers. It was because he couldn’t.

He has selective mutism.

Selective Mutism – What is that?

According to the Selective Mutism, Anxiety and Related Disorder Treatment Center, “Selective Mutism (SM) is a complex childhood anxiety disorder characterized by a child’s inability to speak and communicate effectively in select social settings, such as school. These children are able to speak and communicate in settings where they are comfortable, secure, and relaxed.” Due to debilitating fear and anxiety, children with SM feel incapable of articulating their thoughts and feelings. Thus, they experience extensive bouts of silence. The internal and external pressure to express with words further entrenches the inability to talk. So, I knew that this conversation would be unique. In order to release his thoughts and feelings with me, he had to see me as an ally. He had to feel like I was truly listening to what he had to say, even though he would not speak a word. Above all, he needed to feel safe and be heard.

Encouraging Communication with Someone with SM

When he entered my office, I produced a colorful array of dry erase markers and let him choose a color. Pulling chairs up to my writing board, I briefly explained that I wanted to talk to him about the incident that happened earlier. I pulled a marker from batch and wrote, “What happened?” He stood at the board and pondered. Sitting next to him, calm and assuring, I allowed him the space to process the question. He began to write his account of the event on the board. I did not read his answers aloud as we ventured into his thoughts and feelings; he had already expressed them so repeating them was not necessary. At times, I could hear a slight humming, as if he was testing his voice, but I did not call attention to it. We processed the incident and how it impacted him, in writing. My last question was, “What can I do to help you?” He thought about it for almost a minute. He then responded, “Let me come to your office when I can’t handle it.” That statement expressed two important things: one, he was willing to attempt communication with me because I met him at his level of ability. Two, he had found a place on campus where he felt safe.

October is Selective Mutism Awareness Month. If you are interested in learning more about SM, check out the following sites:

• https://selectivemutismcenter.org/
• https://www.asha.org/public/speech/disorders/Selective-Mutism/
• https://www.selectivemutism.org/
• https://childmind.org/guide/teachers-guide-to-selective-mutism/

Here is one of the things that remain constant in Social Work: the work is plentiful and those who can do it effectively are few. Perhaps that is what makes the work so compelling; those of us who do social work well are tenacious and are willing to go above and beyond to help our fellow human. The primary principle of Social Work is to service the need of others. Even when resources are significantly limited.

Finding resources in Lafayette, LA that aren’t already tapped out for this fiscal year is a monumental challenge. Community non-profits are stretched thin and philanthropy is currently in ebb as companies save their charity dollars for the holiday season. Food banks and churches battle the “feast to famine” phenomenon that impacts their ability to serve their communities consistently. Good intentions clash with dwindling resources and social workers are left to attempt to bridge the two to provide desperately needed services.

I’ve needed all weekend to process this past week. And, man, what an experience it has been! School fights, DCFS calls, helping a displaced family found temporary housing, working with the truancy team to stem the flow of absenteeism. It was a lot. What made the week more exhausting was that, at times, it felt like I was going it alone. There are elements of the work that can be done by other professionals. And I work with an amazing group of them; teamwork truly makes the Dream work! But, compassion fatigue is definitely real. (We will certainly revisit this topic later!) When I receive a report from a teacher that one of their students came to school with bodily injuries, the expectation is that I, the social worker, will investigate. Although teachers are mandated reporters, the understanding is that, if the child reports that her injuries were made by a caregiver that I, the social worker, will file a report with the Department of Child and Family Services. During those instances, the work can feel daunting and overwhelming.

Look, we know we signed up for this; we’re not having a pity party around here. We social workers just need a minute to remember that, just as we can be effective in providing resources in a state that is known for its resource deficits, using our personal lifelines are just as important. As social workers, we need to identify and utilize the people, programs and community connections to regain and maintain a professional and personal surplus.

When we slow down long enough to think it through, we realize that we are not doing this incredible work alone. We have our people and they are legit. We can do this.

Have you ever been to Detroit? If you haven’t, you’re not alone. When planning family trips, Detroit is probably not one of your top three favorite destinations. When most people think of the city, these words may come to mind: gritty, impoverished, dangerous, abandoned. And, during my first experience there, I would have agreed with you.

Several years ago, I was invited to Detroit to provide training to youth workers from all over the city. For several weeks, we moved throughout the city, connecting with some of the most amazing, resilient and committed youth advocates. Over time, I grew to love this hardy city and its people. My initial reservations about Detroit were indelibly affected as I witnessed the effort youth were making to change their lives with every bit of resources made available to them. Story after story described kids making extraordinary efforts to finish high school, get out of gangs, go to college while being caregivers, find viable employment. They attacked obstacles and goals with the same ferocity and persevered, defying the odds.

This year, Detroit is giving the world a glimpse into the hearts of their youth through the Detroit Youth Choir featured on America’s Got Talent. This group melds two of my most cherished life sources, working with youth and making music! I am once again awe-inspired by the bold joy the students expressed through song; they are clearly in pursuit of greatness! This is the city I know! To be a Detroiter is to be resilient, courageous and strong. I want to be a Detroiter!

Watching their performance tonight, I find myself reflecting on the universal challenge we all face: working in the dark. We have all been there, toiling relentlessly at a goal when no one else is paying attention. Shedding blood, sweat and tears over something that mattered deeply to you but, seemingly, no one else cared about. Are we committed to diving into the deep over and again to see our dreams come to fruition? Will we yield to the planning and preparing that comes with accepting the challenge? Achievement doesn’t happen overnight; it will require unerring focus and a relentless work ethic that most people will not see. But I wonder how fulfilling life would be for us all if we committed to living a purposeful, abundant life?

Watch this clip and ask yourself, “Am I a Detroiter?”