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. Although school personnel can provide assistance to their students in countless ways, they are not in a position to make a diagnosis of OCD; that is the responsibility of a trained clinician. And due to school liability issues, school personnel typically are unable to make a direct, formal recommendation to parents to seek a medical evaluation for their child. When a teacher or another school staff member has to approach parents about the possibility of their child having OCD, he or she may conduct a conversation with them something along the lines of the following:
“I remember working with another student like (insert the name of the child whose parents you are speaking with). This other student (do not state the name of the other child, for confidentially purposes) was similar to your child in that (insert information about other student’s similar behaviors). One thing that this student’s family tried that they found to be helpful was (insert information here about different people with whom they might consider consulting).”
School personnel may also suggest that the parents consult their child's physician and discuss the school staff's observations. These observations may be put in writing and shared with the child's doctor, who, in turn, could direct the parents to various services, as appropriate. Whenever information regarding mental health providers is shared with parents, it is imperative that school personnel provide names and contact information of therapists in the area who have experience treating children with OCD. Not all mental health professionals are familiar with how to diagnose and treat OCD in children and adolescents appropriately. Names of such health care providers are available by contacting us, and through the web sites of the International OCD Foundation and the Anxiety Disorders Association of America.
By following these recommendations for speaking with parents, school personnel avoid 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 III,” 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. To make an accurate diagnosis of OCD as well as any other disorders that may co-exist with OCD, a thorough psychiatric, developmental, and medical history ideally should be performed. It is the rule, rather than the exception, for a child or teen to have OCD and another disorder, including non-OCD anxiety disorders (such as separation anxiety), depression, repetitive body or facial tics, and/or attention-deficit/hyperactivity disorder. Care must also 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 one 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 when asked to complete a rating scale or other questionnaire for a child who is undergoing an evaluation, it is critical that school personnel take the time to do it. Their input is extremely valuable.