Obsessive-Compulsive Disorder (OCD) is a disorder related to anxiety, and kids who have it struggle with obsessions, compulsions, or often both. Obsessions are unwanted and intrusive thoughts, images or impulses that make the child feel anxious or scared. The child will often attempt to ignore, suppress or neutralize the thoughts (by performing a compulsion). Compulsions are things kids are driven to do to get rid of the anxiety or distress. They may be repetitive behaviors or mental acts. The compulsions are time-consuming or cause significant distress or impairment.
It is like being bitten by a mosquito. It itches (distress) so the child scratches it to make it better. It feels better while scratching (compulsion), but as soon as the child stops scratching, the itching gets worse (distress). The scratching worked great for the child in the short-term, but made the long-term problem worse.
How to recognize it at school
You might notice that a child is scared of germs. They may be handwashing or using sanitizer in excess. They may avoid touching other children or items. They might be asking to go to the nurse often because they are afraid they are sick.
They might also be thinking they have to do something to prevent something bad from happening (e.g. they have to touch the doorway three times so their parent does not die in a car crash). It can be hard to know the mental part of this, but if teachers are seeing repetitive acts, it is a sign of OCD.
They may ask to check-in with their parents frequently. This may be coming from a need for reassurance that nothing bad has happened or that the parents will be picking them up. Or maybe they are frequently checking their backpack to make sure they did not lose something.
They might have a case of the “what if’s”. “What if there’s a fire alarm in the middle of the test?” “What if the water stops working?”
They might need to line up items or put things in particular spots without being able to explain why. They just know that it doesn’t feel right until they fix it. You may see children getting up to fix placement or put things the “right” way repeatedly throughout the day.
If you are noticing concerns, how do you bring it up to the parents?
Chances are, the parents are seeing some similar compulsive behaviors at home. There is also the chance that it is only happening at school. Scheduling a parent-teacher conference to mention the symptoms present at school is a very gentle way to alert parents to the issue. Be sure to mention how distressing the symptoms appear to be for the child and/or the level of impairment the symptoms are causing at school. Try not to use the term “OCD”. Rather, explain that you are seeing some concerning compulsive behaviors or intrusive thoughts that are impacting the child at school. Check with your school counselor for referrals to professionals who specialize in the evaluation and treatment of anxiety-related disorders.
How to assist in the treatment
If you have a student receiving treatment from a mental health professional for OCD and the symptoms are present in the school environment or with homework, you will need to be involved to some extent in the treatment. If the parent has not signed a release of information form allowing the therapist to communicate with you, ask the parent to complete one so you can speak directly with the therapist. You may be asked to complete some questionnaire assessments about the child. Completing those as openly and transparently as possible will be beneficial for the child’s treatment. At times, the therapist may ask you to reduce accommodating a symptom. For example, if the therapist and child are targeting the compulsion of erasing and rewriting, you may need to take the paper from the child after they have written their first draft answer.
However, if the child is not ready to tackle that particular compulsion just yet, they may need accommodations. For example, a child who compulsively erases and rewrites and is not ready to tackle this symptom in their treatment plan, may need extra time to complete tests and school work.
Frequent and open communication with the parents and treating professionals will ensure a quality team-approach to defeating the OCD.
- The International OCD Foundation is a great resource of information and research: https://iocdf.org/about-ocd/
- Students with OCD: A Handbook for School Personnel by Dr. Gail B. Adams (2011) https://www.amazon.com/Students-OCD-Handbook-School-Personnel/dp/0983436401
Tara Motzenbecker, LHMC, Registered Play Therapist, Licensed School Psychologist is organizing an in-depth teacher training on this topic. This training will be open to individual teachers and to schools. If you are interested and would like to be notified of scheduled trainings and further talks on this topic, please email info@ChildTherapySRQ.com.