As I was putting this packet together I began thinking what
would be best for my teachers and others to learn more about childhood OCD. I
wanted to incorporate as much information as I could to better help educators
define, notice, and deal with childhood OCD.
As I was doing some research I came across this amazing
web-site
http://www.ocdeducationstation.org/.
It is web site developed for educators and parents to give information about
OCD. I got most of my information that I put into this packet from this site
and learned a few things from it as I was making the packet. It makes me feel
good to know that childhood OCD is becoming more noticeable not just with researchers
but with doctors and educators.
Below is the packet (I could not upload it since it is a word document), but I will email you all the word document as well if you would like to print it off and use it (it is 11 pages long).
Dear
Teachers,
Please
take a few minutes and read through this information about OCD. This packet
will:
1. Explain what OCD is and why
it is important to know the difference between OCD and ADD.
2. Helpful tips to identify and
deal with OCD.
3. Resources to help you
further.
If
you have any questions please let me know. There will also be a post survey
about this information, so please take your time and read through it, you could
really make a difference with this information.
Shannon
Schulz
What is OCD?
OCD= Obsessive Compulsive Disorder
OCD is categorized within the mental health group as an anxiety
disorder. People with OCD express and have compulsive thoughts, worries, or
fears that result in exhaustive rituals that help keep these thoughts under
control.
Who Gets OCD
and Why?
Who-
One person in forty suffers from CCD. Symptoms
can appear anytime in ones life span, but most commonly show up in childhood.
The first symptoms that come about in childhood is repetitive touching, tapping,
or counting behaviors, or have obsessions with dirt or being dirty. OCD is not
biased; it affects people in every society, religion, race, and gender.
Why-
First and foremost, although there has been many theories
and research that has taken place, the reason of OCD is still not clear. It was
once thought that OCD came into play because of bad parenting and or toilet
training, but that is not the case. The most recent research and evidence say
that OCD is inherited. OCD has also been linked in children to different
environmental factors such as experiencing death, illness, and or divorce at an
early age.
So with that said, with the current
research and evidence OCD is a result to genetics and environmental aspects.
What OCD
Looks Like:
Like explained before OCD is a complex
condition with a variety of symptoms and types. A person with OCD has obsessive
thoughts that are followed up with compulsive actions. In other words, OCD
begins with irrational thoughts or doubts that can be soothed by certain
rituals such as hand washing, checking, and hoarding. Below is a list of
rituals expressed by people with OCD.
- The first
symptoms that come about in childhood is repetitive touching, tapping, or
counting behaviors, or have obsessions with dirt or being dirty.
- These
first symptoms are symptoms of many disorders, such as ADD and or autism.
· Compulsive hand washing -
this ritual is brought on by thoughts of being dirty or worrying about germs.
·
Child will ask to wash hands through out the day or
express anxiety if he or she cannot wash hands.
·
May shut down from all activities or “act out” if he or
she cannot correct this compulsion with hand washing.
· compulsive ordering and
symmetry obsessions- this ritual is brought on by thoughts of things not
"feeling right."
·
This is where many children are diagnosed with autism. The
need for order, structure, repeating things over and over, organizing.
·
May shut down from all activities or “act out” if he or
she cannot correct this compulsion.
· Hoarding- this ritual is
brought on by thoughts of "what if" what if I need it, or it has
sentimental value to it, which leads to what if get rid of the object I will
have to get rid of the memory.
·
Although seen more in adults, children also have this
symptom as well. Refusing to throw stuff away. Keeping things close at hand,
checking for items, messy desks or bags (not to be confused with the
“unorganized child.”
Common Symptoms of OCD at School
|
Obsessions
|
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 (students with OCD) 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)
|
|
Obsessions
|
Compulsions
|
Fears
that harm, illness, or death, will befall oneself or others; fear of causing
harm to oneself or others, including violent or aggressive obsessions (fear
of killing or injuring oneself or another person; molesting a child**)
**Note:
Individuals with OCD who have violent/aggressive thoughts neither have a
history of violence nor act upon these urges or ideas.
|
- “Checking”
behavior such as making sure doors and/or windows are locked
- Checking light
switches or turning them on and off repeatedly
- Reading a
paragraph over and over again to prevent harm from coming to a loved
one, pet, etc.
- Asking the
teacher for reassurance that the student (with OCD) is “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
- Unreasonable
avoidance of peers, teachers, for fear of causing them harm
|
|
Obsessions
|
Compulsions
|
|
Fears/feelings/urges related to 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
- 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
- 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.
|
|
Fears/feelings/urges related to discarding something (e.g.,
fears that something bad will happen or feelings of incompleteness if
something is thrown away); fears of contamination that prevent an individual
from touching an item; need to buy items in multiples of a particular number
(OCD-based 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
(e.g., buys in multiples of 3 because it's his magic number)
- Holding on to
what is “my” book, pencil, desk, chair, etc. and getting overly upset if
another student uses, borrows or touches their possessions
- Accumulating
items or objects in a particular area (e.g., locker) because they are
contaminated
|
|
Excessive fear of violating religious or moral rules
(scrupulosity)
|
- 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
- Avoiding
answering questions for fear of telling a lie
|
|
Fears/feelings/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, for example, by color or alphabetical order
- Avoiding a
particular room with square tiles (e.g., bathroom); seeing the tiles
would necessitate tracing each of the edges with the eyes
|
|
Fears/feelings/urges/images related to sexual content
|
- Seeking
reassurance that one is not gay or lesbian, despite being heterosexual
- Excessive praying
to atone for having inappropriate sexual thoughts or images
- Avoiding
magazines, books, DVDs, etc., for fear of seeing something
sexually-related
|
|
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
- Avoiding a school
locker to prevent checking the lock over and over again
|
|
Fears/feelings/urges related to having something "just
right," "just so" or "perfect"
|
- 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 one's name is 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 various
actions over and over for no apparent reason
- Avoiding a
hallway in which one must walk repeatedly until it feels "just
right"
|
The Role of School Personnel - Help for
Students Who Have OCD
Identifying OCD at School
The first step in
helping a student with OCD is to recognize the presence of potential OCD symptoms.
School personnel can’t expect that parents will necessarily alert them to their
child's problems. In fact, research has indicated that parents may not be the
first to realize that their child is experiencing difficulties with OCD. Also,
it is very unlikely that the students themselves will volunteer to discuss
their problems with school personnel. Because of the shame individuals with OCD
usually experience, they frequently keep their symptoms hidden, or secretive.
In fact, one researcher dubbed OCD the "Secretive Syndrome."
Unfortunately, even when a student has been diagnosed with OCD by a clinician,
parents and the student sometimes choose not to share this information -- or
others have recommended that they not share this information -- with teachers
and other educational staff. It is, in many cases, an alert teacher, school
psychologist, school nurse, social worker, counselor, paraprofessional,
administrator or other staff member who recognizes that a child is having
difficulties.
A number of different
scenarios may characterize the status of a student with OCD symptoms:
- The student has been diagnosed with the disorder, and the family has
already obtained professional treatment to help their child learn skills
to overcome the obsessions and compulsions. Moreover, the family has
discussed this issue with teachers and other pertinent school staff
members. This is the best scenario possible because the student has a
treatment plan in place, and school personnel and the family have forged a
working relationship to help the student manage the OCD.
- The student has been diagnosed with OCD and is receiving professional
help. However, the family has opted not to share information about OCD
with school personnel. It may be difficult to understand why parents would
choose such an option. There are a number of reasons, however, why they
may have reached this decision. First,
parents sometimes fear that, if they reveal their child's OCD, he or she
may be labeled or stigmatized. And although much progress has been made,
misconceptions and stigma surrounding mental illness still abound. Of note
is that, in some cases, it is the student who prefers that school
personnel not be told for fear that he or she will be singled out or
receive special treatment from the teacher. Second, some parents have
concerns that, if school personnel learn about the child's illness, they
will immediately try to persuade the family to put the child on medication
-- a decision many parents are hesitant to make. Third, parents sometimes fear
that the information they provide school personnel will not remain
confidential and privacy will be breached. Finally, many parents have been
counseled by clinicians, either directly, or indirectly via various
articles, publications, etc., that there is no real need to inform school
personnel about their child's OCD if it isn't interfering with school
performance and symptoms aren't present at school.
- The student and his or her family are struggling with confusing
symptoms and do not understand what is happening as OCD progresses.
- The student is hiding symptoms of OCD either at home or at school.
This means either parents or school personnel do not see the child or teen
struggling with the anxiety or discomfort associated with OCD, and may not
see any compulsive behavior. Academic performance may be affected -- but
it will be harder to uncover the fact that the student has OCD because the
teacher and the parents are dealing with two different sets of
observations about the student’s behavior. It is important to note that,
whenever parents inform school personnel about difficulties with OCD at
home, it is critical that educators take parents at their word.
- The student is hiding OCD symptoms both at home and at school.
- The student is experiencing a sudden onset of OCD symptoms, switching
from “normal” behavior to being overwhelmed with obsessions and
compulsions almost overnight. A sudden onset of OCD symptoms has usually
been reported in conjunction with a certain type of strep infection which
may trigger OCD in those children who have a genetic predisposition to the
disorder. This type of OCD, Pediatric Autoimmune Neuropsychiatric
Disorders Associated with Strep, or PANDAS, affects only a very small
percentage of children. Researchers continue to conduct studies to learn
more about this topic. Due to the sudden appearance of symptoms with
PANDAS, the student is most likely to get help quickly because both
parents and school personnel will see such a dramatic change in an
otherwise “normal” student.
In all of these
situations, school personnel need to know what behavior may signify OCD in
order to formulate a plan to help the student. When educators are knowledgeable
about OCD, they are in an excellent position to recognize symptoms early and
set a course of action to help. Without knowledge about OCD symptoms, educators
are ill-equipped to manage the student
or, in some cases, the classroom, when OCD is present.
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.
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.
The Importance of Effective Communication
with Parents
When a student is
observed to have symptoms that point to OCD, early intervention is essential.
Ignoring problems can give OCD more time to take a stronghold, making a child’s
or adolescent’s struggle with the disorder all the more difficult.
Enlisting the
help of parents is key. But how school personnel approach parents and discuss
their concerns is critical to gaining parental support and action.
Communication with parents requires preparation and careful dialogue.
Planning Ahead for Various Scenarios
When school
personnel speak with a student’s parents, it’s likely that they will encounter
one of the following scenarios:
- The parents are already aware of their child’s difficulties and have
taken steps to address them by having the student evaluated by a mental
health professional. The best scenario is that OCD has already been
diagnosed, and the student is undergoing treatment (e.g., Cognitive
Behavior Therapy) to learn to manage obsessions and compulsions.
- The parents have observed some behavior at home that is consistent
with the observations of school personnel. The parents may also provide
additional information about other behaviors of concern at home. Although
they are worried about these difficulties, no action has been taken. They
are open, however, to discussing the problem and formulating a plan to help
their child. They may or may not be highly stressed because of the child’s
difficulties, depending on the severity of the symptoms.
- The parents have observed some behavior at home that is unusual, but
they had no idea their child was having difficulties in school obvious
enough to cause school personnel to become concerned. They, too, are
worried about these difficulties and may be open to discussion and
suggestions offered by school personnel.
- The parents are accommodating the child’s behavior at home in some
way. They may be participating in OCD rituals (such as doing excessive
amounts of laundry for a child who has contamination fears), for example,
or allowing avoidance behaviors (e.g., they allow a child to use paper
plates for meals, because the family's usual dinnerware is
"contaminated"). The situation at home likely is very stressful,
and the parents may or may not be open to listening to information
provided by school personnel.
- The parents have not observed any behavior at home that might suggest
a problem, or are ignoring symptoms. They are defensive about their child
and may even resent “interference” by school personnel.
When school
personnel are prepared for any of these situations, communication with parents
will be enhanced. This is essential, because the way in which educators express
their concerns can make the difference between whether a child receives needed
help or is left to struggle -- with no relief -- with a potentially
debilitating mental disorder.
As described in
the Intervention section of this web site, learning about OCD
is the first step toward understanding the disorder and recognizing OCD
symptoms. If a teacher suspects OCD may be causing or contributing to a
student's learning, social, behavioral or emotional difficulties, it is
essential that school personnel observe the student and document specific
examples of behavior that point to OCD. Providing details about the child's
behavior will go a long way to facilitate communication with parents.
Dialogue with Parents
A face-to-face
meeting with parents is an excellent way to discuss the student's specific
difficulties. A phone conversation may be more convenient, but by talking with
parents in person -- especially the first time the student's problems are
brought up -- school personnel are in a better position to express their
concern and empathy during the discussion.
The purpose of a
conference with the parents is to establish a two-way information exchange.
Several general guidelines for talking with parents regarding potential OCD
symptoms may be helpful. First, it is extremely important to begin a
conversation by sharing positive feedback with parents about the student's
behavior and providing examples of other strengths exhibited by the child.
Parents need to hear "what's right" with their child. Moreover,
starting a conversation in this manner may result in the parents' being more
receptive to information about the child's difficulties.
Second, it is
important to provide parents details about a student's behavior. As noted
above, a discussion of specific examples of student behavior and objective
information are much more meaningful to parents than subjective impressions.
Stating that a child completes an average of one out of four assignments is far
preferable to saying that the child is lazy.
Third, parents
frequently experience great emotional pain and frustration as they grapple with
their child's difficulties. Therefore, it is important to approach parents with
an attitude of caring and concern. Blaming parents for a child's symptoms is
unwarranted and inappropriate. It is also extremely important to listen carefully
and empathically to parents as they describe what may be very sensitive
concerns. Whatever school personnel can do to reassure parents that everyone is
working to help the student (and not criticize or blame) will likely lead to
more productive conversations and greater cooperation.
Fourth, it is
vital that school personnel avoid using educational jargon and acronyms that
may confuse parents (e.g., IDEA, IEP, OHI). This language should be used only
if it has previously been explained to parents.
Fifth,
communication should reflect respect not only for parents and their child but
also for their culture. Parents may feel very uncomfortable discussing certain
issues because of cultural or social beliefs.
Finally, it is
always important that school personnel be familiar with local and state
regulatory constraints and privacy laws governing communication among parents,
school personnel, and the student.
Ongoing Communication with Students, Parents
and Mental Health Providers
When a student is
being treated for OCD, behavioral improvements usually are not immediate but
can occur within a few weeks. If the student is being treated by a cognitive
behavior therapist, he or she will be seeing the therapist at regular
intervals, and will be assigned “homework,” consisting of Exposure and Response
Prevention (ERP) exercises to do at home between therapy visits. If the
student's obsessions and compulsions are triggered by events, people, places,
or other situations in the school environment, the therapist may need to
conduct some of the ERP exercises at school. Some experts even suggest that, under
the careful supervision of a therapist, school personnel may be able to
carry out certain ERP tasks in the classroom (it is inappropriate for a
teacher, however well-intentioned, to take the lead in implementing ERP with a
student; unsuitable interventions could actually worsen a student's OCD
symptoms).
During treatment,
the student will be working hard to overcome his or her obsessive fears, doubts
and worries, but until these disturbing thoughts, impulses, and images are
conquered, they will be present and can still interfere with classroom work,
attention during class and homework assignments. Establishing rapport with the
student and letting him or her know that you are a “listening ear” and are
always willing to provide support will be especially important. It's important
to remember, however, that some students will be uncomfortable sharing their
OCD symptoms and experiences. Therefore, communication with the student may be
limited. However, teachers and other school personnel should have open and
frequent communication with parents to discuss the progress of the student and
identify particularly troublesome activities or situations.
It's important to
note that the success of interventions for children and adolescents with OCD
depends upon effective communication among all parties involved in
treatment: school professionals, parents, the student, outside professionals,
and any other individuals who are participating. Effective communication helps
with the creation of realistic and meaningful interventions for the student
with OCD. Moreover, good communication among all treatment partners throughout
the student's intervention is vital to determining the effectiveness of the
treatment program and making any necessary adjustments.
Individuals
taking part in the treatment plan must develop a practical system for
communicating with one another. Although information may be exchanged in
person, via telephone, or email, newer technologies such as texting have
greatly improved the ease of communication. Communication can occur as
frequently as necessary: biweekly, weekly, or even on a daily basis. A
parent-teacher log, in which parents and teachers share written
information/feedback about a student, for example, can be used each school day.
Families are
typically very eager to learn about any progress the student has made as a
result of treatment (e.g., Cognitive Behavior Therapy and/or medication,
school-based interventions). What appears to be an inconsequential gain to the
outside observer may, in fact, be monumental to the child and his or her
family: a student who has been unable to touch the classroom door knob without
first covering his or her hand with the end of a shirt sleeve or paper towel,
for example, is now able to touch the door knob without a covering. In these
instances, it is important for school personnel to communicate this information
to therapists, as appropriate, and parents. Considering the stress parents frequently
experience because of the negative impact of OCD on the family, some good
feedback can give parents a much-needed "boost." But it's also
essential that school staff members communicate directly with students,
commending them for their hard work and successes. School personnel should
always praise effort, too -- even in the absence of success. Positive feedback
can have a dramatic effect on a student's self-esteem.
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.
Managing OCD in the Classroom
In any classroom,
the teacher is the central figure who leads the class in learning, enlightens
with insight, maintains order, promotes good behavior and rewards good work.
The teacher also sets the mood of the classroom.
When a teacher
has a positive attitude, the students are also likely to be positive.
Conversely, a teacher's negative attitude can have an adverse impact on the
class. A teacher's approach is all the more important for students with OCD.
When a teacher supports and encourages these students, and tolerates no
ridicule or discrimination from other students, it can make a huge difference
in terms of how the student with OCD progresses.
One of the most
important things teachers must remember when faced with the challenge of
managing OCD in the classroom is that children and adolescents are very
impressionable. Peer pressure to fit in and to be part of a group of friends
can be extremely hard for the student who has OCD.
There are a
number of ways teachers can provide support. With some basic planning, a
teacher can make accommodations that help the student academically, socially,
behaviorally and emotionally. The following sections, beginning with Healthful
Support Strategies, will provide ideas and strategies for teachers and other
school personnel to work more successfully with and improve the school
functioning of the student who has what may be a very distressing disorder.
Roadblocks
There are a
number of school-related challenges that children with OCD face, but some of
these difficulties occur outside the classroom and are not easily monitored by
school personnel. Completing homework, for example, can pose serious problems
for students with OCD and their families. But teachers and other school staff
can still be effective in helping the student meet and overcome these
challenges.
Other potential
roadblocks include ‘high stakes” issues such as taking tests, doing independent
study assignments and completing long-term projects.
With
understanding and planning, a student can improve his or her approach to common
challenges related to:
- Studying effectively, including studying for tests
- Completing homework assignments
- Avoiding school
- Managing study and sleep time
- Test-taking at school
- Fears about homework or school in general
Understanding the Law as It Relates to
Students with OCD
School personnel
are likely to be familiar with the federal laws that protect a child’s right to
a free appropriate public education in the least restrictive environment:
- Section 504 of the Rehabilitation Act of 1973 (Section 504)
and
- The Individuals with Disabilities Education Improvement Act of 2004
(IDEA).
But when a
student has OCD, it’s not always clear how to ensure that the student receives
the best education. What’s important is that school personnel, the parents, the
therapist (when the student is receiving treatment) and the student, as
appropriate, are all working together to make sure that the student gets the
best education possible. Everyone should be on the same side -- the student’s
side.
The information
in several sections of the OCD Education Station web site provides background
on OCD, the effect of OCD on learning, social, behavioral and emotional
development, how to recognize OCD (or possible OCD) and how to communicate
effectively with parents. Additionally, best practices in intervention (including
accommodations and support strategies) are presented to give school personnel
practical suggestions that can help them manage OCD in the school setting.
The ideas and
specific tactics outlined help many educators, administrators and school staff
effectively work with students who have OCD, and today countless students
currently benefit from their use. But school personnel, parents, or both may
want or need to develop a more structured approach to managing a student who
has OCD to maximize his or her academic, social, behavioral and emotional
development. That’s when considering the laws pertaining to a student's civil
rights, the provision of special education and related services, and the
safeguarding of privacy is a good course of action.
Making the Best Choices for the Student Who
Has OCD
School personnel
can play a critical role in helping a student with OCD get the education he or
she needs in the least complicated manner. Schools do not have a uniform
approach to working with students who have OCD. The way a student with OCD is
treated -- and the education he or she receives -- depends on school
personnel’s knowledge about OCD and experience in working with students who
have the disorder. It can also depend on school personnel’s willingness to find
a way to help and, of course, individual school and school district policies.
Some students
with OCD need easy-to-implement accommodations (such as many of those detailed
on this web site) that can be put in place without additional cost or extra
time for existing personnel. Individual schools differ on their approaches to
making even simple accommodations but, in certain cases, students with OCD may
receive simple accommodations and supports without going through the more
formal processes associated with Section 504 and IDEA. It is important to note,
however, that many parents prefer having even simple accommodations documented
in writing under Section 504, rather than an informal verbal agreement with a
teacher or other school staff member. Circumstances change; the teacher with
whom a verbal agreement about accommodations was made, for example, may leave
the school. A plan developed under Section 504 (504 plan) documents, in
writing, decisions that have been made regarding a student's services.
Having a 504 plan
in place can also be important because accommodations and supports may be
needed during periods of heightened OCD symptoms (when symptoms wax) but not at
other times (when symptoms wane). Equally important, if a student is seeking
eligibility for accommodations for college entrance exams, during the college
years, or later in life, the presence of a history of prior formal recognition
of the disability is important documentation of the disability and need for
accommodations. By contrast, informal accommodations are less useful as
documentation later on. Moreover, Section 504 plans may contain important
procedures for managing learning, behavior or medical problems that sometimes
occur when a student has OCD. For example, procedures for managing a student
who has an OCD-related outburst or dispensing emergency medications may be
documented in a 504 plan.
The essential
purpose of Section 504 is to "level the playing field" for children
and adolescents with disabilities. In other words, Section 504 ensures that
reasonable accommodations and supports be provided to students with
disabilities so they can access educational opportunities and learn in a manner
similar to their peers. Importantly, support strategies may be needed only
temporarily, and should be discontinued as the student recovers from OCD and is
able to overcome his or her obsessions and compulsions.
In many cases,
Section 504 is the appropriate vehicle for providing students necessary
accommodations and supports. In other cases, special education and related
services under IDEA will be necessary for students with OCD who have more
serious needs. The most important objective is to meet the individual needs of
the student and provide the best opportunity for academic, social, behavioral
and emotional success. The information below outlines some of the differences
between Section 504 and IDEA.
Tools and Resources for School Personnel
In addition to
the information contained on the OCD Education Station web site there are other
resources we recommend for additional good information. We have reviewed the
books and web sites we feature to make your information search easier.
OCD Guides Provide Information You Can Use
Our OCD Guides
were developed to provide comprehensive, practical information about living
with OCD. They include information about symptoms, facts (and myths) about OCD,
related disorders and treatment options.
The guides provide current, accurate information in a detailed and readable
booklet format. Thousands of people have received the guides and their feedback
is that the information is not only helpful, but empowering.
Selected Web Sites for School Personnel
The web sites
listed in this section are ones we’ve found to be helpful for school personnel
seeking additional information about OCD. Included are web sites that focus on
OCD or related anxiety disorders, general mental health topics, laws that
pertain to OCD and OCD in college students. Some sites address ways to manage
OCD in the classroom.
After you have
visited these web sites, we encourage you to come back to the OCD Education
Station web site to find recommended books about these topics.
(We provide these links as a convenience, but OCD Chicago does not endorse
any publication or other web site.)
OCD at School
Teen Mental Health
Council of Parent Attorneys and
Advocates
Parents who are
looking to find a special education advocate for a child with disabilities may
look up referrals in the COPAA member directory.
Visit this site
Students with OCD - A Handbook for
School Personnel
National Association of School
Psychologists
Collection of
reproducible handouts for parents from their online book store, including
handouts on OCD and anxiety disorders. Select “Helping Children at Home and School
III”
Visit this site
School Psychiatry Program &
Madi Resource Center, Massachusetts General Hospital
What OCD looks
like in children and adolescents; Interventions at School
Visit this site
WorryWiseKids.Org
The Children's
Center for OCD and Anxiety provides this web site and a free e-newsletter for
parents and school teachers of children with excessive fears and anxieties.
Visit this site
SchoolBehavior.com
Contains
information to help educators learn about a number of neurological disorders
that may impair a student's functioning and occasionally create chaos in the classroom
Visit this site
Wrightslaw
Special education
law, education law, and advocacy for children with disabilities.
Visit this site
IEP4U
Lists over 4000
goals and objectives (IEP-ITP) each with changeable benchmarks.
Visit this site
Social Competence and the Child
with Learning Disabilities
Help a child
develop social skills through a social autopsy.
Visit this
site
Center for Effective Collaboration
and Practice
IDEA rights and
requirements; IEP introduction to functional behavioral assessment and behavior
intervention plans
Visit this site
KidSource’s Overview of ADA, IDEA,
and Section 504
Provides an
overview of three different laws that require govern services for students with
disabilities in the U.S.
Visit this site
Americans with Disabilities Act
(ADA)
Family Medical Leave Act (FMLA)
Social Security Benefits
Medicaid and Medicare
Section 504 of the Rehabilitation
Act of 1973
Parents & Children
OCDChicago.org
Up-to-date
information on OCD for individuals, parents, friends and family, college
students, school personnel, clergy and the media.
Visit this site
WorryWiseKids.Org
The Children's
Center for OCD and Anxiety provides this web site and a free e-newsletter for
parents and school teachers of children with excessive fears and anxieties.
Visit this site
International OCD Foundation
OCD in the
Classroom kit for presentation to school personnel; also The Touching Tree: A
Story of a Child With OCD – award-winning video about a young boy facing his
OCD and getting treatment for it. For information, email info@ocfoundation.org.
Visit this site
OCD in Kids
Keys to helping
children with OCD; homework and school recommendations
Visit this site
Kids Health
American Academy of Child and
Adolescent Psychiatry: Facts for Families
Awareness Foundation for OCD
“In the Shoes of
Christopher” – video tape about a middle school bully and a boy with OCD.
Visit this site
Columbia University's TeenScreen
Program
Builds
community-based partnerships to raise awareness of the problem of youth
depression and suicide risk, promote mental health screening, and implement
screening programs.
Visit this site
Yahoo Health Groups: The OCD and
Parenting List
Very active
online support group for parents of children with OCD. Advised by Dan Geller,
M.D., Gail B. Adams, Ed.D., and Tamar Chansky, Ph.D.
Visit
this site
Answers for Special Kids (A.S.K.)
Support and
education for families of children with special needs or learning differences
in the Chicago North Shore area
Visit this site
Resources:
Dufrene, B., & Hyman, B. (2008). Coping with ocd. Oakland: New
Harbinger
Publications,
Inc
