OCD Facts: Diagnosing OCD
Diagnosing OCD in Children and Adolescents
If you are a classroom teacher and have reason to believe that one of your students may have OCD, it would be wise to discuss your concerns with the school psychologist, social worker, school nurse, counselor, or other team member who has expertise in this area. School personnel are not in a position to make a diagnosis of OCD; that is the responsibility of a trained clinician. However, a teacher may conduct a conversation with parents something along the lines of the following:
“I remember working with a child like (insert name of child suspected to have OCD here) once. This other child (do not state the name of the other child, for confidentially purposes) was similar in that (insert information about child’s similar behaviors). One thing that this child’s family tried that they found to be helpful was (insert information here about different people with whom they might consider consulting). If you would like more information about that, I’d be happy to provide some suggestions for places to go or experts to talk with about this.”
This avoids labeling and making official school recommendations.
You may also want to provide parents with information or literature about OCD. One especially good resource is a booklet designed for parents of children and adolescents with OCD produced by OCD Chicago. You can download a copy from this web site by clicking here.
Another resource is a collection of reproducible handouts that may be distributed to parents (and others, as appropriate). These handouts, “Helping Children at Home and School II,” may be purchased from the online bookstore of the National Association of School Psychologists. Included in this set are handouts on OCD and anxiety disorders in children. You can find their web site and other good resources for information about OCD in the Tools and Resources section of this web site.
How Mental Health Professionals Diagnose OCD
When a mental health professional evaluates a child with OCD, the exact approach used will vary, depending upon the clinician consulted. A full evaluation by a psychologist or psychiatrist includes many components. A thorough psychiatric, developmental, and medical history ideally should be performed to make an accurate diagnosis of OCD as well as any other disorders that may co-exist with OCD. It is common for a child or teen to have OCD and another disorder, including non-OCD anxiety disorders, depression, repetitive body or facial tics, or attention-deficit/hyperactivity disorder. Care also must be taken to distinguish OCD behavior from behavior that may be a preference, habit, normal development, or simply "eccentric."
Clinicians frequently use diagnostic interviews such as the Anxiety Disorders Interview Schedule for DSM-IV (child and parent version) or the Schedule for Affective Disorders and Schizophrenia for School-Age Children (present and lifetime version) to assist in making a diagnosis of OCD and determining the presence of other disorders. A complete physical exam may also be included as part of the evaluation.
Once a diagnosis of OCD has been made, it is important to establish how much distress and impairment the child or adolescent is experiencing as a result of the OCD. The most frequently-used tool for this purpose is the Yale-Brown Obsessive Compulsive Scale. There are two versions -- one for adults (Y-BOCS) and once for children (CY-BOCS). The therapist administers the CY-BOCS to both the parents and the child to try to pinpoint which OCD symptoms (i.e., obsessions and compulsions) are present and the severity of these symptoms.
A thorough mental health evaluation also includes a review of records, both medical records (such as immunizations and physical exams) and school records (such as grades and test scores). Information regarding how a child is functioning in the school setting should also be included. Because young people spend such a large part of their day in school, teachers and other school personnel are an extremely important resource in this regard. Educators frequently feel overwhelmed by the amount of paperwork that is involved in working with students. But if you are asked to complete a rating scale or other questionnaire for a child who is undergoing an evaluation, please take the time to do it. Your input is extremely valuable.