The Not-So-Obvious Symptoms of OCD in School
When a student is barraged by obsessive fears, doubts and urges, he or she may perform rituals or compulsions to try to neutralize or “undo” these thoughts or feelings in order to feel better. But sometimes it’s not clear that a student’s behavior is connected to OCD. A student who has OCD may not perform actions repeatedly in the classroom, so no rituals are observed. Or a student may be completing rituals mentally or covertly. It may be hard to recognize that OCD is causing learning difficulties, interpersonal problems with other students or the great distress and anxiety the student who has OCD may be experiencing.
For example, young people who begin having unauthorized absences from gym class may be demonstrating a fear of germs or of being contaminated by sweat or the gym floor. They might also be afraid of contaminating others. Or they may be afraid of hurting themselves when participating in exercises or sports -- or of hurting someone else because they have aggressive thoughts (aggressive thoughts usually horrify the individual with OCD, and people who suffer from these thoughts neither have a history of violence nor act upon their ideas or urges).
While school personnel may not know or understand the root cause of the behavior, they can detect patterns of behavior that aren't “normal” for a child or teen who was previously acting fine. So whether the behavior indicates OCD -- or some other developing problem -- understanding typical “warning signs” such as those listed below is the first step toward helping a student get needed support. Most OCD behavior doesn’t make sense when observed, and it often doesn’t make sense to the student who does it either. But students with OCD act the way they do because they feel compelled to do so.
The following symptoms are presented as a guide and were compiled from reports of educators, social workers, school nurses, counselors, parents and publications.
Some ‘Hidden” Indicators of OCD in School
- Very rough, red, dry and/or cracked skin on hands, arms or face. This may result from repeated washing. The student may be spending lunchtime, breaks or bathroom visits continually washing his or her hands. This behavior may be going on at home, too, with multiple showers and washing.
- Repeatedly asking to go to the school bathroom. Students may frequently ask to use the bathroom under the guise of voiding when, in fact, they are actually carrying out washing or cleaning rituals.
- Spending a long time in the school bathroom. The student may stay in the bathroom for extended periods of time each visit. Again, he or she may be carrying out hand washing or other washing rituals.
- Avoiding certain public places. The student may avoid places such as the lunchroom or gym that are likely to trigger OCD symptoms. He or she may repeatedly ask to be excused from sports activities or have unexcused absences from gym class.
- Dropping out of sports, clubs, team activities (or unexplained absences from such activities). If the student was previously an active participant or seemed to enjoy the activity but then “lost interest,” it may be that some aspect of the activity is triggering OCD symptoms.
- "Misbehaving" when put into a group activity or class project. Young people with OCD may get very upset when others are standing or sitting “too close” to them, when others touch them or their materials, or sometimes for no apparent reason. In certain cases, the student may become so upset that he or she acts out because of panic. This outburst or tantrum-like behavior may even stop the ongoing class activity.
- Not being able to “switch gears.” Some students with OCD have extreme difficulty moving onto a new project or task. They may delay turning in work or labor over a single task. Or they may seem to be “stuck” on a single question or problem and are unable to skip it and go on to the next one.
- Writing a number, letter or word (or name) over and over again.
- Taking much too long to write a simple sentence or paragraph, or tracing over a word, letter or number multiple times. Students may erase words, letters or numbers and write them over again and again because they don't think their writing looks "just right," or they feel the need to make it look better or perfect.
- Turning in class assignments, quizzes, homework or exams with multiple erasures and paper rubbed through to the point that there are holes in it.
- Staying home from school to work on an assignment that should not take a lot of time to complete.
- Not turning in homework assignments, or consistently turning them in late. If questioned, a student may say it needed more work or wasn’t done well enough to turn in on time.
- Being drowsy or falling asleep in class. This is common if a student stays up late at night studying or working on a homework assignment, laboring over it, reading it repeatedly or checking it multiple times. In addition, research indicates that many young people with OCD experience one or more sleep-related difficulties such as being overtired, having nightmares, a need to sleep next to someone in the family, and having trouble sleeping.
- Being late for school frequently -- often accompanied by fatigue.
- Exhibiting what seems to be a lack of concentration in class; appearing to be daydreaming, looking out the window or not being able to follow the teacher. The student may also seem to be noncompliant, or worse yet -- "lazy."
- Repeatedly asking the same question or asking the teacher to repeat a question multiple times. Students may ask for more clarification about the question (to make sure they understood the question exactly or perfectly, or until it sounds "just right").
- Seeking reassurance that they understood the question or that their answer is correct.
- Seeking reassurance that their homework assignment or class assignment was correct, done well or correctly, or was “perfect.” Students may exhibit great anxiety or concern over whether they get a high test score or are praised for good work.
- Being unable to make a decision or choose an answer (they may be overwhelmed by trying to make the “right” choice, or overcome with fear of making the “wrong” choice).
- If interrupted when reading, writing or reciting, having to start over at the beginning rather than being able to pick up where they left off before the interruption. Frustration or mounting anxiety at being unable to complete a ritual may lead to an outburst or tantrum.
- Avoiding a certain number -- for example, if students believe that “5” is an unlucky number, they may refuse to be seated in a group with 4 other students, or will do just about anything to avoid being in a group of 5, including leaving the room without permission or starting an argument in an attempt to have the group disbanded. When counting off in a group, they might avoid being number 5 by trading places with another student, or refusing to say the word “five.” They may not want to wear a team jersey with the number 5 on it, or might try to get out of playing on the sports team in the fifth game of the season. They may even fake illness to avoid coming to school on the fifth day of each month. When eating, they may avoid chewing food 5 times, or taking 5 sips of a beverage. Conversely, if 5 is a “lucky” number, they may feel compelled to chew every bite of food 5 times and take 5 sips of a beverage every time anyone else would take 1 sip.
- Fidgeting with clothing, adjusting and readjusting sleeves, waistbands, buttons or snaps, socks, shoes, shoelaces (tying and untying), complaining of skin irritation or clothing labels bothering them, taking off a piece of clothing that is bothering them or “doesn’t feel right.” Velcro can be a particular problem for some students with OCD because rows of fabric on both straps must align to fasten tightly. These students can get "stuck" trying to align the Velcro "just so," and may become extremely anxious and upset when simply trying to fasten a shoe strap.
OCD is an unpredictable disorder. When considering the cause of a student’s behavioral issues, it’s important to remember that many behaviors seen in children with OCD are also seen in children with a number of other mental disorders. It's also important to keep in mind that even "normal" children and adolescents can try the patience of teachers and school administrators with their antics or obstinate and unpredictable behavior.
The Many Disguises of OCD at School
The following examples are not representative of actual students, but illustrate behavior that can be puzzling and require intervention -- before the student spirals so far downward that it will be even more difficult to recover.
When Davey started getting to class later and later in the morning, his 10th grade teacher at first thought Davey might be staying up late at night because of outside activities. When questioned, he admitted he was having difficulty reading his assignments and writing the reports required. Because he was so afraid of missing an important point, or misunderstanding what he read, he was taking hours to read a single chapter of the textbook, and even longer just to write a simple report. He was exhausted from getting only a couple of hours of sleep, simply from doing routine homework. Davey agreed something was wrong and (surprisingly) agreed to involve the school counselor and his parents in finding a solution. After an evaluation by a psychologist, Davey began Cognitive Behavior Therapy and is on his way to overcoming his OCD.
Javier could not have been slower tying his shoelaces. The loops had to be exactly the same size before he could walk, and if he was interrupted when tying a lace, it could take him a long time to recreate his “perfect” loop. Other troubling behaviors became apparent with Javier, too. He concentrated too long on printing letters of the alphabet -- copying one letter over and over again until he was satisfied that it was perfect. He also was not willing to stop his tedious printing when told it was time to do something else, resulting in tears and tantrums. First grade is such an important time for learning essential skills, and he was never going to learn them unless the mystery of his focus on “doing it RIGHT” could be solved. Javier’s parents were wonderful when told of the situation. They took him immediately to their pediatrician, who referred them to a child psychologist. It’s been only two months since Javier's OCD was diagnosed, but he is doing much better with appropriate treatment.
Sheryl was very slow. No one believed she was mentally challenged but she was maddeningly slow to write so much as her name at the top of a test, let alone answer the questions. What should have taken her ten minutes would take her an hour, if her teachers had allowed it. As it was, she was rapidly failing in her classes because she could not keep up. She could not read a page in the time others could read a chapter. When her parents were contacted, they were defensive -- Sheryl was fine at home, they insisted. When her grades dropped from “A” and “B” level to the “D” and “F” level in just two quarters, Sheryl’s parents took her to a psychologist for an evaluation. Now that Sheryl is learning to manage her OCD, she is getting back on track and is much happier.
Everyone was confused by Kenisha’s academic ups and downs. She could read at an above-average level and her standardized test scores were good. When she started having a lot of trouble with math, it was the inconsistency that was so puzzling. Some problems were a breeze for her, and others would contain errors using the same formulas as the problems she correctly answered. She also would not read certain pages of text within a chapter, so she was having difficulty understanding some of the important facts in History and English. She finally answered some questions posed by school personnel -- she “had” to avoid the number “8” because it was a “bad” number that would bring harm to her parents if she used it. Even if she knew the correct math answer contained an 8, she could not write it, so she substituted another number. She could not read any page that was numbered 8 or contained an 8. And she had to skip the entire chapter if it was numbered 8. There were times when she could not read the eighth word in a paragraph; yes -- she counted the words before reading the paragraph so she could skip the eighth one. Kenisha was struggling with fears that she would kill her parents if she went anywhere near an 8. Fortunately, the school counselor knew about OCD and was able to recognize that Kenisha was experiencing symptoms of what appeared to be OCD. Now Kenisha is doing special homework assignments that her cognitive behavior therapist gives her, and is improving. At Kenisha’s school it is now mandatory that all staff learn about OCD so they are prepared to assist the next time a student with OCD needs help.
Mike felt as if he would explode if he didn’t get to wash his hands several times each hour. This was very disruptive because he kept asking to go to the bathroom right in the middle of his teacher’s explanation of a project and at times when he should have been listening or writing. When he was in second grade, he was a model student. Now in the third grade, his behavior was problematic and no one understood what was going on. His teacher sent home a note describing Mike’s behavior and indicating her concern that Mike might be suffering from a physical condition (e.g., bladder condition). He wasn’t. It took a while, but it was finally determined that Mike was standing at the bathroom sink and washing his hands over and over again; he didn’t need to use the bathroom at all. With this information, Mike’s parents were able to find a doctor to evaluate him, and he is now undergoing treatment to learn to manage his OCD and eliminate his hand washing rituals.
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