In the beginning of treatment (and upon the modification of critical accommodations), parents will often reach out to our center with the concern: “we are doing everything right, why are they getting worse?” While there are many reasons why, behaviorally, OCD clicks into high gear, the simplest explanation for these early days of tumult is a behavioral concept known as the 'extinction burst'. Extinction Burst is a behavioral response often misinterpreted and mishandled, yet it's pivotal in solidifying positive changes in our kids.

Behavioral modification, rooted in the most basic psychology observed even in rats, comes from a balance between stimuli and responses. Parents are reinforcing desirable behaviors and extinguishing those that are less-than-ideal.

Imagine you're encouraging your child to sleep alone. Moments of when they are able to be alone in their bedroom are praised—a sticker chart, perhaps, or a promise of a reward the next day—making the association between the words and the positive feelings of parental approval. Undesirable behaviors, like wandering out of the bedroom to ask for reassurance, are met with a neutral reaction, signaling their ineffectiveness. Selective reinforcement is consistently applied and behavioral modification is well underway.

Behold, The Burst

Here's where things get messy. Although it is counterintuitive, a child's undesired behavior may seemingly intensify in response to the extinction process. This is not an indicator that you've charted the wrong course. This surge, known as the 'extinction burst,' is a sharp increase in the behavior you're attempting to extinguish before it eventually abates.

The child might come out of their room even more than usual, with an entirely new angle to their worries. They might send their parents a barrage of harassing texts at bedtime rather than turn off their phones and accept that their parents will not be rescuing them from this particular discomfort. 

Why does this happen? Well, imagine flipping on a light switch and, to your surprise, the room grows brighter before plunging into darkness. The brain scrambles to understand why the previous 'sure-thing,' a response with a history of positive reinforcement, no longer yields results. Previously, getting parents to climb into bed with them and tell them they were safe, was like flipping a light switch. The child cognitively struggles to understand and accept that the light switch no longer functions as they believe it should. The increase in the undesired behavior is the brain's frustrated, last-ditch effort to secure the reward of parental accommodation.

Parents often misunderstand the extinction burst and interpret it as a sign of the failure of their approach.

They may unwittingly 'switch on the lights' by responding to the burst with inadvertent reinforcement, such as increased attention (remember even negative attention is attention) or the allowance of the undesired activity. And thus, a surge becomes a sustained storm, teaching both parent and child that a tantrum, a protest, or any unwanted behavior is a potent tool.

The extinction burst feels intimidating and dramatic to parents at the moment, but it truly isn’t a long term phenomenon. As long as we don’t reinforce problematic behavior, the extinction burst is just the last hurrah of an old, but familiar, neural pathway. It's a natural part of the relearning process, signaling that the old behaviors are losing effectiveness. It's in this moment that a parent's patience and resolve become their greatest assets.

Picture the extinction burst like a storm passing over; it’s formidable, but time-limited. Weathering the emotions, both yours and your child’s, is crucial. Stay consistent in your new behavioral patterns and maintain a steady reaction to undesired behaviors. Remember, in the face of the storm, your silence, your neutrality, is your strength.

By not reinforcing the burst, you communicate that the old tactic no longer holds sway. This paves the way for the eventual cessation of the unwanted behavior. And when the storm finally subsides, you’ll find a calm where a reliance on the favorable behaviors begins to settle in.

When your child is having an extinction burst, I want you to picture a lab mouse furiously pushing a level that previously had given it food. Eventually the mouse (and your child) will give up on this level. This behavioral phenomenon is a natural reaction to change. Turn on your scientific brain and do not refill that food well. 

Every time we encounter and successfully handle the extinction burst, we are teaching our children resilience.

They learn that change, even the kind that involves giving up something comfortable, can be manageable. And in those moments, when with grit and grace you ride out the surge, you model adaptability, problem-solving, and the enduring strength of love.

The extinction burst, in its peculiar way, is a stepping stone to a more harmonious parent-child relationship. It reaffirms that behavioral change is not about quick fixes or smooth sailing. It's about the journey, the partnership between parent and child. Throughout OCD treatment, we must all exhibit tremendous patience and perseverance.