HOARDING

6/13/22

What I love about this profession is the myriad of issues that can arise and still challenge me in new ways.  Because I was in the classroom for most of my career there were scenarios that parents had to deal with outside of school that didn’t cross my path. But now that I am dealing directly in homes or virtually with moms and dads like yourself, I am being presented with your daily challenges and some of them are obviously upsetting for you as you learn your child and wonder what to do when these situations arise. 

Hoarding, according to the American Psychiatric Association when referring to hoarding disorder is explained as, People with hoarding disorder have persistent difficulty getting rid of or parting with possessions due to a perceived need to save the items. Attempts to part with possessions create considerable distress and lead to decisions to save them. The resulting clutter disrupts the ability to use living spaces 

In the first example I’d like to share, a parent has been trying to manage her child’s hoarding of clothes and toys and his need to take everything out of the closet and drawers and cover the bed leaving only a small space for his body.   We have spoken about labeling the drawers and closet with pictures of the articles inside so that her child knows where things are in hopes of reducing anxiety over their whereabouts.  And by having the spaces identified, when the clothes and toys are out, he will know where they go if it’s possible to get him to put things away.  The thinking for this is if it is known that everything goes in the same place it will also reduce the anxiety of disorder.  

A possible problem arising from this approach is that this solution is not satisfying the need to be surrounded by everything he owns that he must see and possibly even need to feel.  

Another suggestion was to try and set a time limit for allowing his things to be out and adorning his bed.  This way it is understood that there is a beginning and an end point.  Built into this would be a reward system that recognizes cooperation in successfully putting away everything at the designated time in it’s designated place.  

This could include earning a small reward at the moment the desired behavior occurs or by accumulating tokens over an agreed upon time interval, for example every two days which can then be widened to every several days, and so on, as the behavior begins to improve, leading to a more meaningful reward.  For example, if you decide that you will collect tokens after two days of successfully following the behavior plan, then your child can get ice cream or something comparable.  This can gradually expand to every 4 days and then expand again.  You will know when to increase the time between rewards when you see the behaviors change.

Here as well, you can begin with allowing the clothes to be out for 12 hours and then reduce the time frame after a week and then again as you witness the hoarding diminish.  

The goal again, as always, is to have the desired behavior without needing to reward with tangible sources, but that takes time, consistency and patience. 

And know that this is no magic pill and depending upon the severity of the behavior there may exist other underlying dysfunction that may then require the intervention of a psychiatrist.  And there is nothing wrong with that.  It’s just where your child is.  It’s ok:)

From Autism Speaks, according to psychologist Micah Mazurek, of the University of Missouri’s Thompson Center for Autism and Neurodevelopmental Disorders : Generally, professional help is needed when hoarding becomes so extreme that it interferes with a person’s daily functioning. If you sense that this is the case with your son, I strongly recommend working with a psychologist or other behavioral health professional with expertise in treating compulsive behaviors including hoarding.

This treatment could include medication or cognitive behavioral therapy which can help with the anxiety by helping the individual, “ learn to discard unnecessary items with less distress—diminishing their exaggerated perceived need or desire to save these possessions. They also learn to improve skills such as organization, decision-making, and relaxation;” according to the American Psychiatric Association.

During the time working with this case I proposed the idea of attempting to recycle old clothes that the mom wanted to get rid of which were being hoarded, by donating them.  The idea would be that the mom would select something of her own and bring her child to a donation facility and hand in the article of clothing to see how clothes are reused and modeling that it is ok to let go.  

My idea was to donate “clothes” plural.  The mom came up with the idea of one article at a time, which is brilliant, and we decided on her proposal of taking an article of clothing each; one from Mom, one from her child and one from sibling, and each day driving to donate the piece.  Afterwards there will be a reward, which again, you can decide what is realistic and financially practical for you.  This can be a choice of rewards that you decide on and offer to your child.  

Some reasons for the hoarding can be associated with anxiety and depression, the inability to make a decision on what to keep and relinquish or the stress of not knowing how to organize one’s space.  These can paralyze your child and cause them to act out when you suddenly step in and try to get rid of things you know to be either junk or old or even dangerous.  

Well planned strategy with a clear explanation of the cleaning and relinquishing process is critical to children and adults who possess an inability to live without things being a certain way.   Including social stories is a great way to show a process and reduce stress.  Modeling the behavior you want to see can be helpful.  Have your child help you clean your room.  Showing videos of cleaning up a bedroom or going to a donation center to see where clothes go can expand experience and understanding and possibly help to reduce the anxiety of “losing” an object when knowing it has a place and is not “gone.” 

It’s not easy to know what might trigger the hoarding behavior but by paying close attention to your child you may notice that something is happening to cause heightened stress, anxiety and depression leading to your child turning inward and needing to secure their environment. 

From the National Library of Medicine in an article on Hoarding in Youth with Autism Spectrum Disorders and Anxiety in May of 2016; hoarding severity was associated with increased internalizing and anxiety/depressive symptoms, externalizing behavior, and attention problems. Discarding items was associated with internalizing and anxious/depressive symptoms…Hoarding decreased following cognitive-behavioral therapy.

Hoarding is different from obsessions. From Clutterhoardingcleanup.com; obsession are Recurrent and persistent thoughts, urges, or images that are experienced, at some time during a disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress. These thoughts attempt to be neutralized by performing a compulsion.

• Hoarding is the Persistent difficulty discarding or parting with possessions, regardless of their actual value.
• This difficulty is due to a perceived need to save the items and to distress associated with discarding them.

From MentalHealth.org;  individuals with hoarding disorder often describe their acquisition behavior as a compulsion, experienced as strong urges. They feel driven to acquire the desired items and experience significant anxiety if they do not. A difference between OCD and hoarding disorder is that in hoarding disorder the compulsive acquisition of items results in a “pleasurable” feeling. This is not the case for compulsions in OCD.

In another example of hoarding behavior, I have a client who has a room filled with paper bags spilling over.  The bags are sponging up the space making it difficult to move around in the room and are a source of distress for the mom.  The child likes to play “school” in the room and recently the mother discovered that the bags are acting as “backpacks” for the “students” the child is pretending to teach.  These bags will not be parted with and any conversation of such causes resistance that could lead to a tantrum.  

Knowing the reasons for things is a tremendous help. Whereas with the first example, we don’t necessarily know the cause of the hoarding.  We have some ideas but because the child is, for the most part, non verbal when expressing the whys of her behavior, the second child is verbal and may be able to say or hint at what is triggering the hoarding.  

With this new information I suggested that hooks be installed in the bedroom and cheap, synch bags take the place of the paper bags.  Acknowledging that not everything can fit, the hope is that when the bags are presented as more realistic examples of “school bags,” the child will appreciate that and accept it’s capacity limitations.  I will follow up on how this goes and let you know. 

As with attempting to harness behaviors of all kinds it is important to pay attention to your environment and make needed changes that may be causing sensory disruptions in your child leading to anxiety that may domino into different forms of obsessions and compulsions. Structuring your home is also so important in creating a safe and predictable space affecting stress reduction in your child. Structuring activities is helpful at redirecting consuming compulsions.  And from the National Autistic Society, Set boundaries: If you need to, set clear, consistent limits – for example, ration an object, the time a person should spend talking about a subject, or the places where they can carry out a particular behaviour. Behavioural change is most likely to be successful and the person less likely to be distressed if you start small and go slowly. Increase time restrictions and introduce other limits gradually. 

I see the toll taken on the nerves of parents regarding hoarding.  I want you to be comforted knowing that this behavior is common and that there is a reason for it.  Also, that there are solutions.  If you can give yourself time to observe antecedent behaviors you will have a jump on how to intervene best.  If you find that the behaviors persist or get worse, don’t be afraid to ask for help.  It is out there.  You don’t have to reinvent the wheel and, most importantly, you have a right to it.  If there is anything you feel I can help you with, feel free to reach out.  

Peace and Keep Rising!