How Does OCD Affect Children In The Classroom?

Obsessive Compulsive Disorder (OCD) is an anxiety disorder consisting of obsessions and compulsions, and it is one of the most common psychiatric illnesses affecting children and adolescents, with at least one out of 100 children receiving a diagnosis. The obsessions sufferers experience are unwanted thoughts, images, and urges that cause significant distress, while the compulsions are behaviors that are performed to help decrease the distress that the obsession has caused.  Compulsions can be visible/observable behaviors or mental acts that are not seen by others.

“Those who suffer with OCD have excessive obsessions and compulsions that cause significant distress to the child and can affect their school performance, social success, and home life,” explains Jill Fodstad, Ph.D., HSPP, BCBA-D, clinical psychology at Riley Hospital for Children at Indiana University Health. “For someone with OCD, these compulsions and obsessions are not pleasant, and they often want to stop them but may have an inability to do so on their own. OCD is not something can be turned on and off like a light switch. For most people who are living with OCD and are not actively receiving evidence-based care, they are unable to control their thoughts, urges, and impulses.”

In a school setting, OCD symptoms may go unnoticed, especially depending the obsession, and as some are not entirely obvious to the naked eye. As teachers do not have in-depth training on mental health illnesses, many may dismiss these odd behaviors as a phase, or it could be misdiagnosed as something else, leading to ineffective treatment that often makes symptoms worse.  Some common ways OCD may manifest in the classroom include:

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

“OCD can cause poor school performance as children may find it difficult to concentrate on school work due to the amount of attention focused on their obsessions and compulsions,” notes Dr. Fodstad. “Essentially, the child spends so much time focusing on their obsessions or performing their compulsions that their attention to academic tasks is limited.  This time spent on their OCD symptoms is also very exhausting for the child and can affect their sleep.  These behaviors can take a heavy toll on a child’s social environment with peers and can result in bullying by others – especially if their behavior is viewed as socially inappropriate or odd, and social isolation.”  

Often, parents are the first to notice symptoms. Dr. Fodstad urges parents to seek help from a mental health professional immediately for an accurate diagnosis and a proper treatment plan – a child will not simply outgrow OCD on their own. Parents should always notify school personnel so they are aware of the situation and can put supports in place.

“If school personnel are not alerted that there might be an issue, then difficulties the child may be experiencing due to OCD may be regarded as the child being ‘naughty’ or something else outside of what is actually going on,” Dr. Fodstad cautions. 

There is hope for children who suffer from OCD, especially when caught early. Research has shown that the best therapeutic outcomes typically involve a combination of medication and cognitive-behavioral therapy (CBT), which teaches children they are in charge, not OCD.  Through CBT, they will face their fears slowly, in small steps, without giving in to the rituals.  It is recommended that therapy be tried before medication, but those that have shown the best outcomes are serotonin reuptake inhibitors (SSRI’s). However, it does take time to see a change in your child’s symptoms – results may take up to 10 – 12 weeks for both therapy and medication. 

If OCD symptoms upset your child and interfere with his or her everyday life, talk to your child’s pediatrician or seek an evaluation with a qualified mental health professional such as a psychologist, psychiatrist or social worker. With proper therapy and a supportive environment at home and school, a child with OCD can achieve academic success. 

OCD: Common Causes and Treatments

Causes:

While we still do not know the exact cause or causes of OCD, research has provided various theories:

• Differences in the brain – dysfunction in the ability for the front part of the brain to communicate to deeper structures of the brain
• Environmental influences – social support, exposure to trauma or abuse, significant life changes, substance abuse, living conditions/home life, general health and wellness
• Genetics – multiple closely-related family members who have OCD symptoms could play a role, but this is not a guarantee that the child will develop OCD

Treatments:

It is recommended to try therapy prior to medication, and it should be noted that there is no one “best medicine” for treatment as the medicines affect each person differently.

• Cognitive Behavioral Therapy (CBT) - teaches children with OCD that they can learn they are in charge, not OCD.  They face their fears slowly in small steps, learning that their fears do not come true. Children learn to get used to the scary feeling, just like they might get used to cold water in the swimming pool. 
• Medicines that have shown the best outcomes are serotonin reuptake inhibitors (SSRI’s), which target the brain structures that use serotonin.