OCD Facts: OCD at School
OCD at School - A Primer for Educators
Obsessive Compulsive Disorder (OCD), which can be a debilitating disorder, affects approximately one in 100 children. That means that close to one million children in the U.S. currently have this illness.
Consider these educator scenarios:
- You have (or have had) a child or adolescent with OCD in your classroom, so you already know that many students with OCD need help, because you're aware of the symptoms associated with this disorder, and you’ve seen the debilitating effect it has on their grades and self-esteem.
- (Note: Because some compulsions/rituals are mental, they cannot always be observed...)
- A child in your class has OCD but, because he or she is hiding the symptoms, you haven’t been able to recognize that OCD is behind the problems the child is experiencing.
- Parents or guardians have contacted you to inform you that their child needs special accommodations because the child has been diagnosed with OCD. Now you have to quickly learn what to do.
- You haven’t seen OCD at school yet, but you know someone who has the disorder, or you’ve learned that a friend or family member has a child who has been diagnosed with OCD.
- You are barely aware that a disorder called OCD exists.
In any of these situations, learning about OCD is an important step toward being prepared to cope with the symptoms and effects of this disorder when it enters your life. OCD may invade the classroom and, when it does, it quickly changes the way teachers and other school personnel should respond.
If you haven’t yet had to cope with OCD in your classroom or school, chances are you will (and probably more than once) during your career. Understanding this heartbreaking disorder provides you an opportunity to play a crucial role in the development of a young person who may desperately be in need of your help.
What is OCD?
OCD is a disorder that has a neurobiological basis. This brain illness affects how children (and adults) think. It is characterized by obsessions and compulsions that take up a considerable amount of time (more than 1 hour a day). Obsessions and compulsions create distress in the lives of individuals to the point that they interfere with daily functioning, schoolwork, and/or relationships.
Obsessions are involuntary intrusive thoughts, images or impulses that can cause unbearable worry, fear or discomfort. To cope with the obsessions, the person who has OCD has to perform mental or physical acts called compulsions.
Compulsions are repetitive rituals that make individuals with OCD feel better when they perform them, but the relief is only temporary. In some cases, compulsions are preceded not by anxiety, but rather by what are referred to as "sensory phenomena." Visual, auditory, or tactile sensations may trigger a need for something to look, sound, or feel "just right," or perfect." Upon seeing a paper on a desk that isn't symmetrical, for example, a student may have to arrange and rearrange the paper until it looks "just right." In some cases, external triggers are absent, but the individual has an inner feeling and/or perception of discomfort that causes him or her to repeat a behavior until the feeling is relieved. In other words, when a person has an inner sense of something not being "just right" or "complete," a behavior needs to be repeated until it feels "just right" or "complete." In yet other situations, repeating behavior is preceded neither by obsessions, sensations, or feelings, but rather by a need or urge. Research has indicated that sensory phenomena are more frequent among individuals with OCD and co-occurring Tourette Syndrome than among those with OCD only.
Currently, there is no cure for OCD; it is a chronic condition. However, much like children with asthma, allergies or diabetes learn how to manage their conditions, children with OCD can learn how to manage their obsessions and compulsions with the right treatment -- an important component of which may be educational support.
OCD is not something children or adolescents choose to have. When OCD is untreated, young people frequently do not have any control over how it affects them or how they react to it, much as children with untreated asthma cannot control an asthma attack. OCD is not a behavioral choice. Although children sometimes are able to suppress or hide their symptoms at school or substitute mental rituals for overt rituals (e.g., mentally repeating a specific number pattern may take the place of hand washing), suppressing symptoms may come at a great cost. In school, these students may work diligently and expend an enormous amount of energy -- even to the point of becoming extremely fatigued -- just to "keep it together;" so much so that school personnel may be surprised to learn that they have OCD. Moreover, once they arrive home after school, they sometimes engage in a frenzy of ritualizing, even having to "make up" rituals that weren't performed at school.
OCD appears about equally in boys and girls. While the disorder often appears in adolescence or early adult years, the onset of OCD frequently occurs during childhood. Although uncommon, it has been diagnosed as early as two years of age. Mental health professionals report that, when symptoms begin in childhood, they may appear earlier in boys than in girls. While the onset of OCD in boys is often seen between 5 and 8 years of age, girls are somewhat more likely to develop OCD in adolescence. However, the prevalence tends to equalize during adolescence. Onset also frequently occurs during college years.
Learn more about what OCD is.
Learn to Recognize OCD Symptoms
Children sometimes describe their obsessions as “bad thoughts” or fears or worries -- and sometimes they have a very hard time putting into words just what is bothering them. In some cases, children with OCD experience symptoms in one setting but not in another -- for example, symptoms appear at home, but not at school. As previously indicated, some children and teens become very good at suppressing or hiding their symptoms, because they fear punishment or ridicule at home or at school. In yet other cases of OCD, a child or teen is unable to ignore obsessions or resist the compulsions that “undo” the bad thoughts and make them feel better temporarily.
Learn more about the varied symptoms of OCD in children and teens.
What Causes OCD?
It is not known exactly what causes OCD. There is some evidence that heredity plays a role. Parents often blame themselves, or wonder what they did “wrong” to cause this heartbreaking problem. Sometimes family members, neighbors or friends reinforce this concern. But parenting is not to blame.
Learn more about what causes OCD and some of the myths surrounding OCD.
How Prevalent is OCD in Children and Adults?
Millions of people around the world have OCD. In the U.S., current estimates suggest that at any given point in time, one in 40 adults and one in 100 children lives with this potentially debilitating disorder.
Learn more about the prevalence of OCD and who is affected.
How Is OCD Diagnosed?
No laboratory test can identify OCD, but a mental health professional who is knowledgeable about this disorder can conduct an evaluation to determine whether a child or adolescent has OCD.
Learn more about OCD diagnosis.
What Other Conditions Might Co-Exist with A Student’s OCD?
A number of conditions frequently co-exist with OCD, including depression, anxiety disorders (e.g., separation anxiety disorder, social anxiety disorder), depression, bipolar disorder, AD/HD, autism and Tourette Syndrome. Other disorders that share many similarities with OCD may also occur with OCD, including Body Dysmorphic Disorder, Trichotillomania (hair-pulling) Disorder, Excoriation (skin-picking) Disorder, Hoarding Disorder, and other body-focused repetitive behaviors such as nail biting, lip biting and cheek chewing. Many students with OCD have one, two or even more co-existing disorders. Educators need to be aware of the possibility of co-existing conditions in order to be able to cope with the student's special needs in class.
Learn more about other disorders and conditions that may occur with OCD.
What Treatments Are Effective for OCD?
The good news is that effective treatment for OCD is available. Cognitive Behavior Therapy (CBT) a scientifically-supported treatment, is considered by many experts to the first line of treatment for OCD in children and adolescents. It is recommended by nationally-recognized institutions such as the National Institutes of Mental Health, the Mayo Clinic, Harvard Medical School and the American Academy of Child and Adolescent Psychiatry. Clinical studies have also indicated that a number of medications may be helpful in treating young people with OCD.
Learn more about Cognitive Behavior Therapy and medication.
Treatment Challenges and Resistance
Underdiagnosis and misdiagnosis of OCD can present challenges to appropriately identifying and treating OCD. In a small number of cases, treatment may be ineffective, and sometimes young people resist treatment.
Learn more about underdiagnosis and misdiagnosis of OCD, why treatment can fail and why some children and teens resist the very treatment that can make them better.
Tremendous (and often rapid) improvement can be seen in children and adolescents when they make a commitment to treatment. Significant improvement can occur within a relatively short period of time. However, it can sometimes be financially challenging for parents to cope with the expense of OCD treatment. If parents confide in school personnel their concerns about being unable to afford treatment, there are several resources that can be shared with them to help them get the treatment the child needs. Being informed about affordability options can help educators help the child and his or her future development.
OCD at School - Recognizing OCD and How It Affects Student Performance
While OCD sometimes occurs both at home and at school, OCD can manifest differently in one place than it does in the other. A child who performs compulsive rituals at home may be symptom-free (or seem to be symptom-free) in school.
As an example, a child may have an intense fear of someone breaking into his or her family’s home and harming someone in the family. The child may insist upon repeatedly checking that the doors and windows are locked at bedtime, or ask the parents to check the locks over and over again. But at school the child may not show evidence of this obsessive compulsive behavior.
This can make it hard for educators to recognize potential cases of OCD. It may also set the stage for conflict between parents and educators. Parents and other family members may be drained by the child's OCD symptoms at home, while school personnel are seeing no problems at school. It may even be difficult for school professionals to believe or understand the difficulties that are occurring at home. It is important to take parents at their word when they describe their experiences at home and offer as much support as possible.
The reverse may also occur: the child may experience symptoms at school but they are not observed at home. If the parents don’t see symptoms at home, school personnel may have a more difficult time approaching parents about a child or teen’s observed behaviors in the school setting.
In some cases, children and adolescents experience obsessions and carry out rituals at school, but the obsessions cannot be observed and the rituals may be hidden or disguised. For example, a child may ask the teacher for permission to make repeated trips to go to the bathroom, where he or she is actually engaging in washing rituals (washing hands over and over). It’s not always easy to recognize the purpose of those trips to the bathroom. As previously noted, children may also work very hard to suppress rituals at school, but at great cost (e.g., fatigue, interference with concentration on school work).
To learn more about ways to recognize OCD in the classroom and its effect on academic performance and social skills, go to the Recognizing OCD at School section of this web site.
The Role of School Personnel in OCD Treatment and Recovery
Educators can play a crucial role in helping a student who is struggling with OCD to experience success. From initial observations that something is wrong with a child or teen’s behavior, through providing support as the student struggles to control his or her obsessions and compulsions, a teacher can significantly influence a student’s progress.
The Role of School Personnel section of this web site offers more information about how to make a positive impact on the life of a student with OCD -- academically socially, behaviorally and emotionally.
Go to the Role of School Personnel section.