Why Real Exposure Requires Unreasonable Courage

In 2015, the International OCD Foundation hosted its annual conference in Boston, bringing together clinicians, researchers, families, and individuals living with obsessive–compulsive disorder. What makes this event unique is the combination of academic learning and lived experience. The honesty, vulnerability, and clarity offered by both groups can be transformative.

Why Certainty Becomes the Compulsion

Obsessive–compulsive disorder (OCD) often changes shape across a person’s lifespan. A child who once feared contamination may grow into an adult whose obsessions target something entirely different. The theme may shift from germs, to morality, to perfectionism, to relationships. The form changes, but the mechanism stays the same: doubt becomes danger.

Not all forms of ADHD are easy to spot.

Some children are clearly impulsive, physically restless, or constantly moving from one thing to the next. But others—especially those with inattentive presentation ADHD—may not stand out in the same way. These students often go unnoticed because they are quiet, cooperative, and not disruptive in class.

But while everything may look calm on the outside, their minds are somewhere else entirely.

Strong communication skills are more than just finding the right words—they’re about knowing how much to say, when to say it, and how it will be received by others. For many children, this kind of social awareness does not come naturally and must be explicitly taught.

One of the most persistent challenges in supporting individuals with ADHD involves helping them initiate, tolerate, and sustain effort during non-preferred or laborious tasks. The barrier is rarely a lack of understanding or intention. It is often the mental fatigue, low internal reward, and delayed reinforcement that make certain activities feel disproportionately draining.

A diagnosis of ADHD may provide a broad label, but it rarely captures the complexity of the condition. ADHD is not simply about being hyperactive or easily distracted. The diagnostic criteria include approximately fifteen symptoms of inattention and fifteen symptoms of hyperactivity and impulsivity, each of which presents differently depending on the individual.

Enrollment for the 2024–25 school year is now full, with approximately 100 children and teens participating across a range of carefully structured social skills groups. These groups are trusted by families, educators, and mental health professionals for providing meaningful support to children and adolescents navigating social challenges.

Teaching students with ADHD can feel like tending to a tree whose roots are growing invisibly underground. Progress may not always be immediate or obvious. At times, it may seem like nothing is working...

Jonathan Grayson’s Freedom from OCD remains one of the most meaningful resources I have encountered in the treatment of obsessive-compulsive disorder. In my clinical work with children, adolescents, and their families, Grayson’s explanations consistently help individuals understand intrusive thoughts in a way that reduces shame and opens the door to skill development.

In many complex cases, psychoeducational assessments do not fully address questions related to autism spectrum disorder (ASD). While these assessments offer valuable insights into a child’s cognitive and academic profile, they may not always capture the subtle social-communication patterns or developmental history needed for a confident ASD determination.

When we think about progress—especially in children—it is easy to look for quick results. A child begins therapy, joins a social skills group, or starts working on emotional regulation, and we hope to see visible change right away.