Healthful Support Strategies

OCD can have a negative effect on many aspects of school functioning.  Like other neurobiological disorders, OCD can cause a student to have extreme anxiety, and OCD symptoms can interfere with a student’s normal capabilities.  Some of the areas affected are learning, memory, problem solving, and focus.  Lacking the capacity to concentrate, understand what is read or understand problems, make deductions, devise strategies or remember, a student can experience serious difficulties with the learning process as a result of OCD.

General Classroom Support Strategies

Some effective strategies for supporting students with OCD include:

• Learning about OCD - School personnel should review this web site and take advantage of the additional resources listed in the Tools and Resources and OCD Guides sections.  A variety of information is available including the names of books, web sites, tapes, DVDs and other OCD-related material.  In the Chicago area, speakers may be requested from OCD Chicago for large groups.  In-person presentations with accompanying question-and-answer sessions for teachers and other school staff provide learning opportunities. School personnel can gain insight about the disorder, learn tips for better classroom management and learn strategies for helping students who have OCD.
• Bring awareness to the classroom - Conducting classroom discussions to educate peers about OCD, whenever appropriate, can be a positive step toward building understanding and tolerance.  Realize that, due to privacy concerns or the fear of the stigma of mental illness, some parents will not want their children to be identified as having OCD. Even if the parents don’t mind, a child may be very sensitive to this issue and not want to be singled out as having a problem.  If this is the situation, the discussion about OCD can be incorporated into the curriculum of health or biology class, for example.  In any case, great care must be taken to protect confidentiality. If the parents and student are willing to disclose the OCD, it’s possible that the student may want to take part in a presentation about OCD, depending on the student’s age, self-esteem and comfort with the subject matter. OCD, of course, is not the only disorder that could be included in mental health discussions. Most organizations that focus on a particular disorder have information available for classroom use.

Strategies for Managing the Student and the Situation

Some of the following strategies can help both the student who has OCD and the teacher who manages the classroom.

• Focus on self-esteem issues - Building or maintaining the self esteem of the student with OCD is an important strategy.   Students can sometimes be very cruel to one another and students with OCD may need some extra help realizing that they have value, talent and capabilities.  They need to hear that OCD is not who they are, but just something they happen to have, just as asthma and diabetes do not define who a student is but, rather, are conditions a young person may have. School personnel can look for the strengths a student who has OCD exhibits -- perhaps creativity, artistic capabilities or athletic prowess.  Educators should help them focus on their strengths, which can relieve some of the self-esteem issues that may arise from feeling “different.”
• Create a “safe” environment - A student who has OCD may get “stuck” trying to solve a problem or may falter and be unable to read aloud or present to the class.  He or she may do poorly on an in-class assignment or a test.  The student needs to know that the teacher will not become angry about these difficulties or lecture or punish the student for something over which he or she has no control. There are many reasons why a student may do poorly in school. But when it's known that the student has OCD (or it is strongly suspected), the patterns of problems may become more obvious and predictable.  It’s unrealistic to expect disciplinary action to change what the student is unable to change (and is already upset about).  In fact, punishment may actually create more stress for the already distressed student and therefore exacerbate OCD symptoms.
• Allow a “break” to defuse anxiety - Sometimes the pressure of the anxiety, worry, doubt, and urges associated with OCD builds to a point where students feel as if they could explode.  If an outburst happens in the classroom, it has the potential to be very disruptive. Students can sometimes avoid an outburst when they experience mounting stress by taking a kind of “time out” to relieve the pressure. Keep in mind that this is not the traditional time out in which a student is asked to leave the classroom or go to a designated area as a result of inappropriate behavior.  When a child has OCD, he or she may be allowed to leave a situation in order to calm down, or regroup.
  
  Some teachers have reported good success with allowing students to leave the classroom for a few minutes before things get out of control, or before they cannot control their emotions.  Surprisingly, this privilege is not generally abused by the student who has OCD –- he or she realizes it is a coping strategy.  The child may just need to stand outside the classroom or walk down the hallway and back to feel better.  Sometimes the office of a staff member (such as the school nurse or counselor) can be designated as a “safe” place where the student can go for a few minutes or talk with the staff member for a short time.  To avoid classroom disruption, a small card can be developed with wording such as “GO” or “BREAK” on it.  The student can lay the card on his or her desk and quietly leave the room without disturbing the class (it may help these students if they sit near the classroom door).
  
  Another idea is to have the teacher and student develop a private signal (e.g., a hand signal such as raising the hand with a closed fist) that the student can use to indicate he or she needs to leave the room.  A time limit should be established in advance for breaks, and, should a student be found to be using this privilege inappropriately, normal disciplinary measures should be implemented. Of note is that this is not a good strategy for a student who experiences contamination fears and wishes to go to the bathroom repeatedly to carry out washing rituals.
• Watch for side effects of medication - Some problems students experience may be caused by a reaction to medication.  While Cognitive Behavior Therapy (CBT) is frequently the first line of treatment for OCD, it’s possible that the student may also be taking medication.  And in some cases, a student may be taking medication only.  Any side effects -- even those that are minor and hardly noticeable -- should be documented.  If side effects are frequent, unusual, or severe, however, parents should be contacted immediately.  Some of the more serious side effects are listed here, but more information about reactions to medication can be found in books listed in the Tools and Resources section of this web site.
  
  Watch for:
  
  • Tremors, difficulty speaking, slurring of speech
  • Extreme restlessness or motor activity
  • Extreme jumpiness
  • Slowed thought processes
  • Rigid muscles or uncontrollable spasms; any seizures
  • Excessive sleepiness
  • Extreme stomach upset
  • Contortions of muscles or the face
  • Unusual or extreme eye movements
  • Any evidence of suicidal thoughts or behaviors
  
  If parents share information about OCD medication with school personnel (and, hopefully, whenever a child is on medication, school personnel will be alerted), it’s appropriate to ask them to provide a list of possible side effects so teachers and other staff members can know what to watch for.  And school personnel should always share any behavioral changes with parents, so parents have a complete picture of their child’s behavior while he or she is in school.
• Try to recognize tough spots for the student and respond appropriately. Teachers can improve the student's chances for success by recognizing the particular difficulty a student may be experiencing and responding in a constructive way. For example, many children who have OCD are paying attention to the OCD worries instead of the teacher during class. Before explaining an assignment, the teacher may need to grab the attention of the class by announcing that directions are about to be given. A change in one's tone of voice or modulating one's speech may also help to break through the OCD thoughts. A child who has OCD may be better able to understand the instructions with these simple strategies. The good news is that these techniques may be very beneficial for other students in the class, as well -- not just the student with OCD.
• Be positive and reward even small successes - Because students may be anxious or uncomfortable about their OCD, it’s important to help them see that even small gains or achievements matter. Therefore, it's essential that school personnel watch for and praise small improvements. The student who previously was unable to touch a door knob without using a paper towel, for example, should be commended when he has touched the door knob with his hand. Moreover, a student should be praised for making an effort to fight the OCD -- even if it is unsuccessful.                 
• Create ways to reduce stress for the student with OCD - Showing respect for the student who has OCD may seem obvious but, when a child or teen presents teachers and other school personnel with challenging behaviors, it can be easy to forget that the student has little or no control over the OCD behavior.  When school personnel create a positive relationship with the student, the student is more likely to believe that he or she has allies and will trust that teachers and other school staff are motivated to try to help. School staff who respond to the student with OCD in a positive manner also serve as excellent role models for the other students.
• A “buddy” system - With this system, the teacher designates (or the student who has OCD selects) a fellow classmate to share notes taken during class to help with studying. This plan must ensure that the student selected to act as a "buddy" is willing to participate and has the time to do so. Moreover, participation should not affect the buddy's ability to complete assignments or study for tests. The buddy system can help the student who has OCD access information missed either because the OCD interrupted concentration or the student was unable to take notes due to excessive slowness or writing compulsions.  Having a buddy to work with on homework assignments can help the student who has OCD focus on studying, and concentrate on the most important points for the assignment or for an upcoming test. A buddy system can also be helpful during recess, breaks or cafeteria time. The benefits of this practice include helping to reduce anxiety and relieve the isolation and loneliness students who have OCD often feel, improving the acedemic performance of the student with OCD (and possibly, the student who is helping), and increasing empathy among students without disabilities.
• Seating accommodations - Seating students who have OCD closer to the door can make it less awkward for them to make an exit if they need to leave the room to relieve an anxiety build-up. It may also be helpful to seat students who have OCD close to the teacher, so that the teacher can get their attention when they start to lose focus and help them stay on track with the lesson or discussion. Teachers must recognize that it’s not realistic to expect a student with OCD just to set aside their worries, obsessive thoughts and rituals in school.  Because OCD is a neurobiological disorder, students frequently are unable to suspend disturbing thoughts, fears and compulsions on command.  It is important for school personnel to be patient.
• Create different expectations - Some students who have OCD will not be able to finish an in-class assignment or a homework assignment in what is considered to be a “normal” length of time. The teacher can reduce the amount of work required of the student, and can also set limits on the amount of time the student has to spend on homework.  The teacher should be sensitive to the student’s feelings and refrain from giving negative feedback if he or she has not completed the assigned work.

There are many tips for working directly with students who have OCD in the book Teaching the Tiger, by Marilyn P. Dornbush, Ph.D. and Sheryl K. Pruitt, M.Ed.  This book includes many classroom modifications teachers can make to improve the day-to-day academic and social success of students who have OCD.

Academic and Social Strategies

In addition to the general classroom support strategies and techniques for managing the student and situations described above, there are other specific strategies for helping students who have OCD succeed academically and socially.  This OCD Education Station web site includes separate sections for academic and social support strategies.  Follow the links below to access those sections.

Learn more about academic support strategies

Learn more about social development support strategies

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