Recognizing OCD at School: OCD Symptoms at School

What Does OCD Look Like at School?

A child or adolescent may come to your school or classroom at the beginning of the school year with a diagnosis of OCD or the disorder may develop during the school year.  Whenever the student is seen as beginning to falter -- either academically or socially -- educators need to take steps to intervene. A proactive approach to helping a student who has OCD can make an impressive difference in the student’s ability to cope with the disorder.  And this can positively impact the student’s academic performance and interpersonal capabilities.

The first step is being aware of what behaviors can signal OCD.  Because OCD includes a wide variety of symptoms in children and adolescents -- and because OCD symptoms are not always obvious -- it is important to become knowledgeable about the information in this section on typical OCD symptoms as seen in schools.  Keep in mind, however, that OCD symptoms are notorious for:

  • Being confusingly with symptoms of other mental illnesses, including AD/HD and anxiety disorders other than OCD.
  • Being confused with “acting out” behavior or misbehaving that is not associated with a neurobiological disorder.
  • Changing in nature or scope -- “morphing” from one set of obsessions and compulsions to another, with differing behaviors.
  • Waxing and waning -- worsening and then almost seeming to almost disappear, often for no obvious reason, then repeating the cycle.

First, review some of the common symptoms of OCD in children and adolescents in school, as reported by school personnel, parents and mental health professionals. (The student stories are for illustrative purposes only, and do not portray actual students.)

Common Symptoms of OCD at School

OCD Obsession Observable Behavior (Compulsions)
Fears of germs or contamination
  • Repeatedly washing hands, using anti-bacterial wipes or hand-sanitizer
  • “Protecting” what is perceived as “clean” space -- personal desk or locker, other personal property
  • Avoiding touching “dirty” surfaces that others may have touched, including any common-area objects such as doorknobs or desks, shared supplies, lab equipment, computer keyboards, paints, paste, soap, cafeteria trays, etc.
  • Avoiding contact play or sports -- either because of a fear of catching a disease or fear of contaminating another student
  • Avoiding the use of school washrooms
  • Seeking reassurance that they or others are not “sick” or “dirty”
  • Refusing to share items or supplies with others
  • Refusing to eat in the cafeteria
  • Avoiding certain products or surfaces because they may contain “poison” (substances used in chemistry, lab tables)

Jason

Jason, a second grader, did not want to take part in classroom projects where he needed to share supplies with other students.  He would become very upset if another child touched his paints in art class or asked to borrow anything of his, such as a book or a pencil.  Jason had a tantrum when a classmate who had a cold threw a used tissue on his desk.  No one realized Jason had OCD until many months had passed.  All that time, Jason’s anxiety about contamination escalated to the point that he was experiencing severe distress.  He’s now doing better -- Jason’s teacher and his parents compared notes and realized that there was a problem.  Jason was evaluated by a psychologist and is now is undergoing Cognitive Behavior Therapy and learning to manage his fears about germs.

OCD Obsession Observable Behavior (Compulsions)
Fears of harm, illness, or death, to oneself or others; fear of causing harm to others
  • “Checking” behavior such as  making sure doors and/or windows are locked
  • Checking light switches or turning them on and off repeatedly
  • Asking the teacher to reassure them that they are “safe”
  • Avoiding leaving a “safe” zone (such as a classroom); avoiding going into certain "unsafe" zones (for example, for lunch or recess areas)
  • Avoiding open spaces, such as a gymnasium

Emily

Emily always seemed to fear the worst and her concern was upsetting to some of the other children in her fourth grade class. She was overly afraid that someone would come into the classroom and hurt her, the teacher or the class. At first, it seemed to be a reaction to school violence reported in the news. But it didn’t go away. And she became worried that the electrical outlets would catch fire, or glass in the windows would break in a storm and glass fragments would scatter and cut her. At a parent-teacher conference, Emily’s parents shared that Emily had recently been diagnosed with OCD and had begun treatment with a cognitive behavior therapist who specializes in working with children who have disorders like OCD. By sharing the information, Emily’s teacher is empowered to take an active role in the classroom to help Emily manage her OCD at school.

OCD Obsession Observable Behavior (Compulsions)
Preoccupation with numbers, e.g., "good" numbers, "bad" numbers, "magical" numbers    
  • “Counting” behavior such as counting, touching or saying words a certain number of times (believing there is a magical significance to certain numbers and, for example, using those numbers to “magically” keep harm from coming to another); counting the number of steps between locations, and having to start over if interrupted
  • Avoiding using certain numbers that are “unlucky” or “not safe;” only using numbers that are “safe” or “lucky”. When avoiding certain numbers, math problems may be answered improperly, pages may not be read if the information is on an unlucky page number, certain page numbers may be avoided or pages may be numbered out of sequence to avoid an unlucky number. In general, assignments may be incomplete.
  • Touching objects a certain number of times; not being able to move on unless this touching has been accomplished
  • Reading words or pages a certain number of times, causing delays in completing assignments
  • Going back and forth through doorways a certain number of times before it’s OK to enter the room
Fears/urges related to losing something valuable or a need to collect items
(hoarding)
  • Saving useless items -- scraps of paper, candy wrappers, bottle caps, broken items; being unable to part with things that are not needed any more
  • Holding on to items for fear that they might be needed sometime in the future, such as books, toys, food, school papers; wanting multiples of the same item “just in case”
  • Holding on to what is “my” book, pencil, desk, chair, etc. and getting overly upset if another student uses, borrows or touches their possessions
  • Picking up objects on the playground or sidewalk such as stones, pieces of string, empty can
Scrupulosity; excessive fear of violating religious or moral rules
  • Apologizing or confessing that something was (or is thought to have been) wrong, such as breaking rules, including religious, classroom or school rules
  • Constantly seeking reassurance that a task has been completed right or perfectly; seeking affirmation that a mistake was not made
  • Saying prayers a certain number of times; excessive praying to atone for being “bad;” repeatedly confessing perceived “sins” or bad behavior
  • Repetitive praying, confessing to neutralize or “undo” bad thoughts, intrusive sexual thoughts, or visions of acting badly including cursing or blaspheming in school or church
Fears/urges related to symmetry or order
  • Constantly “evening up” items or groups of items, such as books on a shelf or items on a desk; aligning edges to be “just right” or “even”
  • Rearranging items to be in a certain order, such as by color or in alphabetical order.
Preoccupation with sexual thoughts, urges, images
  • Seeking reassurance that one is not gay or lesbian, despite being heterosexual
  • Excessive praying to atone for having inappropriate sexual thoughts or images
Excessive doubting/dread of uncertainty
  • Constantly rechecking to see if everything that should be in a backpack or book bag is actually there
  • Asking to leave the classroom to recheck a locker or its contents
Fears/urges related to having something "just right" or "just so"
  • Getting up and sitting down repeatedly at a desk, until the "just right" feeling has been achieved
  • Repeatedly revising the way letters, words, numbers, or their names are written to make them look "just right;" getting "stuck" writing the same letter or word over and over again
  • Repeatedly filling in circles on answer sheets; getting "stuck" on one or two questions because too much time is spent carefully filling in the circles, erasing, refilling until it looks 'just right" or "perfect"
  • Erasing words and rewriting over and over -- sometimes until holes are rubbed in the paper
  • Extreme slowness with activities or school work -- making sure that everything looks "just right" or is done "just right," possibly in a certain order or pattern
  • Repeating some actions over and over for no apparent reason

Antwon

A pattern began to emerge with Antwon -- always being the last to turn in his class composition and spending an inordinate amount of time rewriting his words and sentences. It worsened over time. Something was apparently dreadfully wrong when he could not finish the standardized test in eighth grade; in fact, he barely started it and was almost paralyzed with anxiety over filling in the circles properly, completing only a few of the questions in the first section. Antwon’s teacher asked him to talk with the school counselor, and afterwards Antwon agreed that school personnel should contact his parents to see how to help him. Antwon underwent Cognitive Behavior Therapy and is much better now. Good communication with the student and with the parents is essential if a student is to be helped.

Paul

Paul had to count his steps everywhere he went, and he had to go in and out of the door to the classroom a certain number of times before he could enter the room. His classmates were not very kind about this and he became the subject of teasing, which turned into ridicule. In high school, eccentricities are not well-tolerated and his embarrassment was painful to watch. The school counselor was able to talk frankly with him and his parents and shortly before the end of the term he began appropriate therapy (with medication to relieve some of his anxiety). His prognosis is good, and he’s now planning to go to college next fall.

Kate

Kate was an honors student at an all-girls parochial school. Her grades plummeted in her junior year and she isolated herself from her usual group of friends. School personnel noticed repeated absences at required church services, but Kate could be found praying alone in the library during breaks. She had also started wearing a lot of religious jewelry. She confided to the school nurse that she was sure she was condemned to hell for her intrusive sexual thoughts, including some that horrified her concerning God. She thought the only way to make up for it was to pray constantly. But she feared she would blurt out something inappropriate in church, so that was why she was skipping services. Her parents had no idea this was happening. Kate was evaluated by a mental health professional and she has been undergoing treatment and also was prescribed medication. Now Kate is back with her friends and is attending church services most of the time. By getting the help she needed, Kate learned how to gain control over her symptoms and it’s very likely she will go on to a normal and happy life.

In addition to the OCD symptoms described in this section, OCD symptoms can appear in the school setting in ways that are not obviously or immediately tied or related to OCD.  Informed school personnel often are the first to notice a behavior change that indicates something is wrong with a student, but it may be hard to know what the cause is.  The more information about OCD that you have, the more likely it is you will recognize the not-so-obvious symptoms of OCD when they present themselves.

Learn more about the-not-so-obvious symptoms of OCD in school.

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