When School Intervention is Needed - Helping a Student Who May Have OCD

Identifying a Problem Exists

The first step in obtaining necessary interventions is identifying that there is a problem.  Teachers and other school personnel, especially those who have been practicing for some time, are typically very familiar with behavior that falls within the range of normal child development.  As a result, they're good at picking up on students who are struggling academically, socially, behaviorally, or emotionally.  And even though it's not always easy to know what is causing the problem, warning bells go off when education professionals observe that:

• A student who has previously been doing well in school and has appeared to be acting “normally” in interpersonal situations begins to have difficulties.
• A student who is of normal intelligence begins to struggle unduly with assignments that ordinarily would have been easy to understand and complete -- ones that are completed readily by his or her peers.
• A student is overly tired and is repeatedly late for school or has not completed homework.
• A student whose school attendance has been good begins to avoid school.
• A student begins to seem distracted or disinterested in class and continues this behavior even when it is brought to his or her attention by the teacher.
• A student begins having trouble concentrating in class, is not paying attention to the teacher or class presentations, cannot concentrate on an in-class assignment or test, or is too tired to stay awake in class.
• A student begins asking to go to the bathroom frequently.
• A student begins asking over and over for reassurance that he or she understands the work, that homework is correct, that performance on a test was good, etc.
• A student begins asking the teacher to repeat a question or comment over and over again.

These are just some of the ways a student may exhibit chronic symptoms that are suggestive of an underlying problem.  Identifying changes in student behavior that raise concern gives teachers and other school personnel a framework within which to begin helping the student.  If it appears that a student is exhibiting behaviors that are consistent with symptoms of OCD, an intervention may be in order.  School personnel would need to assess the nature of the student’s problem and develop a plan to help the student manage symptoms at school.

Reviewing the symptoms of OCD in children and adolescents is a good beginning if educators suspect a student is developing problems academically, socially, behaviorally or emotionally.  To review symptoms of OCD, go to the Recognizing OCD at School section of this web site.

Gathering Information and Developing the Case for School Intervention

A teacher may be the person who observes difficulties that could be symptomatic of OCD.  When this occurs, it’s important for the teacher to document the problems to build a case for helping the student.  It’s likely that classmates or other staff members also have noticed unusual behavior and, when this is brought to the attention of the teacher, it should be noted in writing as well. 

Documentation should be detailed as to the type of behavior observed.  It's also important to be objective about observations.  For example, it is much better to write, "The student is walking around his desk," rather than "The student is disrupting the classroom."  It is also important to record what the student is doing rather than what he or she is not doing (e.g., "The student is erasing and re-erasing the words on his paper," rather than "The student isn't completing his worksheet").

Specifics regarding the time and situation or setting in which the behavior occurred, and any event/s that occurred directly before the behavior (antecedents) or after the behavior (consequences) should also be recorded.  This information may be helpful in determining potential patterns related to triggers for a behavior (e.g., every time the teacher asks a student to sit on the floor, he cries) or what follows it (e.g., each time the student cries, the teacher verbally reprimands him for not sitting on the floor).  In addition, any social impact the behavior has on peers, others in the room, or the classroom climate should be recorded (e.g., peers laugh when teacher repeats her directive).  Finally, any adaptations or interventions that have been tried with the student should also be documented.

Specificity regarding student observations cannot be overemphasized.  For example, documenting that a student's math homework assignments have been missing for the last 5 days and that the student has stated each day that his or her homework wasn't "good enough to turn in" (which could be an indication of needing to have something done "just right") are concrete observations that can be shared with parents. Merely stating that the student "isn't getting his work done" doesn't help parents understand the bigger picture -- the student's concern over homework being "good enough to turn in" -- which may indicate that a problem is developing.

When the teacher has observed behavior that is consistent with symptoms of OCD, it will be important to gather additional information.  One of the first strategies may be to contact parents.  Parents or other family members may provide important information such as their perspectives of the student’s behavior and changes in the student’s life that might be affecting school functioning. 

Communication with Parents

When talking with parents, school personnel cannot indicate that they think their child has a particular mental health diagnosis.  It’s appropriate to explain the behaviors that have been observed and compare notes with the parents about whether any behavior at home might be consistent with what is observed at school.  But only a qualified mental health professional can make an actual diagnosis.

Learn more about communicating effectively with parents.

Enlisting Help from Other School Personnel

It may also be beneficial for teachers to discuss their concerns with the school psychologist, social worker, counselor, school nurse, or other pertinent school professionals.  Today's schools frequently have an array of professionals with expertise in many areas, and they can be effective allies in evaluating a student's behavior.  It may be very helpful for the teacher to share his or her observations and concerns with one or more of these staff members, who may then conduct additional observations of the student in class or in social settings (such as the cafeteria, between classes, in sports activities or other activities) to validate the teacher's observations.  These professionals may also ask parents, other school staff who work with the student, or the student to complete questionnaires, checklists, rating scales, etc., to gather additional information.  When school personnel agree that a student is having difficulties, and the observations are documented and consolidated, it will make explaining the observations to the student’s parents more effective.

School personnel who interact with the student can also help by identifying a student’s strengths.  Focusing on positives, such as the student’s abilities in certain areas (creativity, language skills, artistic ability, gymnastics, etc.) helps to reinforce that the child has capabilities and value -- and that the OCD-related problem is just a part of the whole student, not the focal point.  Emphasizing a student's strengths can not only help a student with self-esteem issues related to OCD but can also help parents keep a more positive perspective.

Evaluation

The best thing for a student who is having continuing difficulties that may be related to OCD is to have an outside evaluation by a physician or mental health therapist.  Because of differences in state laws and school liability issues, however, teachers should never make a direct, formal school recommendation to parents to get a medical evaluation for their child.

It may be helpful for school personnel to suggest to parents that they have seen other students (taking care never to reveal the names of other children, for confidentiality purposes) who have exhibited symptoms similar to those exhibited by their child.  If parents ask for the school’s ideas for mental health providers, school personnel may provide names and contact information of therapists in the area.  It is extremely important that staff provide information about therapists 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.  OCD Chicago can refer parents to therapists who have experience working with children who have OCD.  Parents can also find a list of therapists on the International OCD Foundation web site at www.ocfoundation.org or at the web site for the Anxiety Disorders Association of America at www.adaa.org.

School personnel may also suggest that the parents consult their child's doctor and discuss the school staff's observations.  These observations may be put in writing and shared with the health professional who, in turn, could direct the parents to various services, as appropriate.

Next Steps in Helping the Student Who Has OCD

Once a student is diagnosed with OCD, educators and other school personnel know what they are dealing with and can begin to formulate plans to help the student function in school.  In cases in which there is no formal diagnosis of OCD but the student is experiencing chronic, serious, school-related difficulties, however, school personnel will still need to take action.  A common way to begin the process of helping the student is to bring the problem to the attention of the school’s pre-referral or intervention assistance team.  (If the school does not have an intervention assistance team, the general education teacher may enlist the help of the special education teacher or other school personnel to review the situation.)

Response to intervention (RTI), which has been widely used for students’ academic concerns, is increasingly being used for students who exhibit emotional and behavioral difficulties.  With a three-tier RTI model, the time currently spent evaluating students with OCD to determine whether they qualify for special education and related services (as required by the Individuals with Disabilities Act of 2004 -- the law governing special education services in the United States) might be used more effectively to implement evaluation procedures to identify successful services and interventions for these students.                  

In an RTI program for students with OCD or who may potentially have OCD, a possible first-tier level of services might include universal screening for emotional and behavioral disorders as well as prevention techniques such as (1) teaching all students strategies for coping with anxiety and (2) creating a positive and calm classroom environment.  At the second tier, students with OCD whose symptoms interfere with learning and/or behavior could be brought to the attention of a school psychologist.  The psychologist might conduct further assessment and collaborate with families and professionals outside the school to implement various interventions (e.g., cognitive behavioral therapy, medication).  Although clinicians would play the major role in implementing these interventions, school personnel play a critical role in supporting and monitoring the effects of these interventions.  For students with substantial needs, third-tier services may include individualized, resource-intensive, and comprehensive interventions.  An evaluation might also be conducted to determine whether the student qualifies for special education services.

Learn more about managing OCD in the Classroom.

Learn about the law as it pertains to OCD.

Back to the Role of School Personnel

Back to Recognizing OCD at School

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