Understanding & Identifying OCD in the Classroom

Today’s blog post comes to us from one of our Family-Endorsed Providers, Carla Kenney, LMHC. She writes on the importance of both educators and family members noticing the possible signs of OCD in children. Thank you, Carla, for sharing your expertise with us at rtor.org. —Veronique Hoebeke, Associate Editor

Children say and do unusual things on occasion, or even quite often, but how do we know that it isn’t just a quirky behavior or something more serious? How do we know if a child is struggling? If you are a teacher or school personnel, how would you know that those unusual behaviors you observe in your student may be something more, something that needs to be explored and possibly addressed?

Scenario:

Jonny is a 10-year-old boy attending the 5th grade. His academic performance is below average. He arrives tardy to school on most days and his parents report that he is “slow moving” and “not a morning person.” Jonny’s teachers notice that he asks the same questions over and over about his assignments as if he didn’t understand and he spends a lot of time on his classwork. Sometimes his teachers see him erasing things repeatedly and starting over. He is often the last student to finish his work and he is falling behind academically. The other kids in class notice these behaviors too and sometimes make fun of him by calling him “slow poke.” This makes Jonny more anxious and he gets more stuck on his school assignments. In addition, Jonny asks to use the bathroom multiple times each day. His visits to the bathroom are lengthy and when he leaves the bathroom his hands and wrists are visibly wet and red. The teacher is also noticing she is replenishing the soap and paper towels more frequently than usual in her classroom.

The above scenario describes a child struggling with Obsessive Compulsive Disorder (OCD) in the classroom environment. Many of these behaviors could be observed by onlookers as part of this child’s character or disposition rather than something more serious, which could lead to an untreated illness that worsens and becomes more debilitating over time.

Understanding OCD

Before we can identify how OCD can manifest in the classroom we first need to understand it. According to statistics at least 1 in 100 children are diagnosed with OCD. This means that roughly about 8-10 kids in an average sized elementary school struggle with this illness. Research indicates that OCD is one of the most common psychiatric illnesses affecting children and adolescents.

OCD is an anxiety disorder that consists of obsessions and compulsions. Obsessions are unwanted thoughts, images, and urges that cause prominent distress. Compulsions are behaviors that are performed to help decrease the distress that the obsession has caused. Compulsions can be visible behaviors but they can also be mental acts that are not seen by others. These obsessions and compulsions are excessive and cause significant distress to the child and will often lead to avoidance behaviors. OCD is not pleasant and often a person who has OCD describes the illness as torturous and disabling.

Teachers and other school personnel spend a lot of time with children – often they see things that may go unnoticed at home therefore, it is important that they are aware of the many kinds of OCD symptoms. Sometimes OCD symptoms may mimic other illnesses.

How OCD Manifests Itself

While everyone experiences fears once in a while it is important to remember that these fears, worries and behaviors are excessive and cause significant and debilitating distress. Below are common obsessions and compulsions.

Common Obsessions

Contamination Obsessions: fear of dirt, germs, diseases, bodily wastes, sticky substances, chemicals, animals, insects and environmental contamination

Ordering Obsessions: need for symmetry, exactness, order, and perfectionism

Religious Obsessions & Morality Obsessions: fear of having bad thoughts and being punished for them, not following rules of religion or family values, losing control and doing bad things against religion, values, or society

Health Obsessions: fear about having a bad illness despite medical exams finding no evidence of an illness or having worries about being responsible for the well being of others

Aggressive Obsessions: fear of losing control and harming self or others

Sexual Obsessions: fear of losing control and acting out sexually, sexually harming others and thoughts about being homosexual, heterosexual, bisexual or other

Other kinds of obsessions

The need to know, seek out, confess, remember information that is useless
Fear of saying something wrong, not saying it a certain way, leaving out details
Worrying about losing things, making errors, forgetting information
Fear of saying certain words because something bad might happen
Fear of certain numbers, colors, objects, places

Common Compulsions

Cleaning and Washing Compulsions: hand washing, showering, bathing, teeth brushing, grooming, dressing, cleaning of house, space and objects

Checking Compulsions: checking to make sure no harm was done to self or others, that nothing terrible happened, that no mistakes were made

Repeating, Counting, and Ordering Compulsions: rereading, rewriting, repeating certain behaviors, doing things a certain number of times, counting items, counting while doing activities, arranging things a certain way

Health Compulsions: checking of the body to look for illness or injury, seeking out nurses, doctors and other medical professionals reassurance that everything is ok, seeking out medical tests, spending excessive amounts of time on the internet looking up medical information

Other kinds of compulsions

Mental rituals such as praying, counting, saying certain phrases
Excessive need to seek out reassurance from others
Excessive confessing about behaviors that are trivial
The need to touch, tap, rub items or people
Eating in a ritualistic way

As you can see, OCD symptoms can vary greatly. Not only can a person have multiple symptoms but symptoms can wax and wane over time in intensity as well as change altogether. For example, someone can have excessive worries about fears of getting sick and perform multiple washing compulsions and then these symptoms can lighten and a new obsession and set of new compulsions take center stage. These behaviors are often labeled as ”odd” and much too often, a child will be misdiagnosed. As a result, they may end up getting ineffective treatment that only make their symptoms worse.

How OCD Is Missed

OCD symptoms can go unnoticed for several reasons. Teachers are not clinicians and have not had in-depth training on mental health illnesses and how they can present in the school environment. Also, many clinicians are not fully aware of the various faces of OCD and these “odd” behaviors are often dismissed as a phase the child may be going through. Children may also have trouble articulating what they are feeling or thinking or simply may lack self-awareness. Other children may be insightful about their thoughts and behaviors but choose to conceal their symptoms to ensure better social acceptance.

Some common manifestations of OCD in the classroom

Tardiness and/or absences from school
Disruptive behavior, meltdowns, tantrums and rage-like episodes
Asking questions repeatedly or having difficulty with completing work
Seeking reassurance
Rereading, rewriting, excessive erasing or throwing paper out
Inability to complete work, procrastination
Frequent trips to use the bathroom or nurse
Avoidance of certain places, people, situations, objects
Red, raw, and chapped looking hands and arms
Adjusting desk, contents of desk, locker or backpack, other items in the classroom
Repeatedly doing things (by number or by a “just right” feeling)
Difficulty transitioning from tasks, including entering or exiting rooms
Wearing the same clothing
Eating rituals

It is important that these behaviors be addressed as they can interfere with learning and affect a child’s ability to concentrate, think and process information.

How OCD Affects the Student

Attention can be limited because the student is focused on their obsessions. This can be very exhausting for the child and can affect sleep. These behaviors in school can also take a heavy toll on social interactions with peers and may result in bullying by other students and isolation. Both can lead to depression.

Any teacher or school personnel who have concerns about a student having OCD should communicate it to the appropriate person and continue to monitor and document behaviors. In most cases the person to report these observations to are school psychologists, therapists/clinicians, adjustment counselors, or guidance counselors. Usually these professionals have in-depth training about mental illness and can investigate more by talking with the child, the child’s teachers, and his or her parents. If a diagnosis of OCD is likely, then a referral to a treatment provider who specializes in the treatment of OCD should be made. It is important that if there is a diagnosis of OCD then communication between the outside treatment provider and school personnel should take place to help determine the best actions to help the student while in the school environment.

Teachers and school personnel who are educated about OCD can play an important role in the identification of this often-debilitating illness. Early detection is possible and can lead to effective treatment before symptoms worsen. This can help the child avoid years of unnecessary suffering. Understanding OCD and other related disorders can provide support that is crucial for a child’s ability to function successfully in the classroom.

There are many online resources about OCD. The International OCD Foundation has specific information for educators and school personnel to provide guidance and support. In addition, there are a few books that are also very helpful. Please visit iocdf.org for a list of books that are recommended.

Carla Kenney, LMHC

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