A Teacher’s Guide to OCD
Students with OCD face certain challenges inside the classroom that may be mitigated by teachers acting as allies. Unfortunately, this can be easier said than done, partly because of the excessive amounts of misinformation surrounding the disorder.
The greatest gift teachers can give their students is to educate themselves about OCD as much as possible.
The following is a good place to start:
Step 1: Know What OCD Is
Perhaps the best way to approach OCD is to erase the proverbial chalkboard of everything you think you know and start with a clean slate. OCD, despite popular misconception, is not simply a handwashing disease or a disease centered on organization. Instead, it’s a neurobiological disorder that manifests in all sorts of ways.
True to its name, Obsessive Compulsive Disorder involves pathological doubt marked by obsessions (intrusive thoughts that scare the sufferer) and compulsions (rituals the sufferer engages in as a way to reduce anxiety). For example, a child suffering from OCD might experience thoughts that they’ve made a mistake on an exam and will fail a class as a result. To regulate this anxiety, they may compulsively erase their answers, redoing them again and again until they feel right or perfect.
While this provides some relief, the reprieve is consistently short-lived because OCD, as a rule, is never ever satisfied. The obsessive thought, feeling, or image always returns, causing the sufferer to engage in their rituals again (which is why the compulsive behaviors are repetitive). Each time the sufferer engages in their ritual, they lock their OCD in further, worsening the disorder and teaching themselves that their intrusive thoughts are legitimate. Still, they continue to ritualize because the anxiety caused by their obsessions is so intense that they can’t help but seek relief.
Children with OCD, like adults with OCD, might not buy into their intrusive thoughts all the way. But the disease pesters them with questions of “What if?” until the sufferer performs their compulsion as a way to reassure themselves that nothing bad will happen. OCD demands 100% certainty; even 99% is not enough to sate it.
Interestingly, intrusive thoughts are not limited to those with OCD; they’re present in the general population as well. The difference between those with OCD and those without it is that OCD sufferers take these intrusive thoughts seriously, fear they say something about who they are deep down, and give them meaning. People without OCD, on the other hand, are able to disregard the thoughts as meaningless (and they are meaningless).
The ultimate goal of treatment is to help people with OCD behave like people without: OCD sufferers are encouraged to ignore their thoughts and label them as insignificant. This eliminates the thought’s power and potency in the process.
Step 2: Know What OCD Isn’t
OCD isn’t a common disorder and, on the whole, only about 1 in 100 children are diagnosed. However, some argue that OCD is underdiagnosed in kids and that the number of those impacted is higher.
OCD affects people from all races, social classes, and parts of the world. Many speculate that it’s been around since humans first roamed the earth though it was misunderstood for centuries and centuries.
In men and women, it shows up equally but boys are more likely to experience early onset, showing symptoms in childhood. Some people may experience no symptoms at all until they reach adulthood.
Despite popular belief, people with OCD (whether kids or adults) are not anal-retentive or rigid and they don’t insist upon having their way (though people with Obsessive Compulsive Personality Disorder (which is different from OCD) may exhibit these traits). Even so, if an OCD sufferer is in the middle of performing a compulsion, they may come across as inflexible. This isn’t because they want their way; instead, it’s because they’re trying to reduce their anxiety. If they’re interrupted while doing so, they’ll likely need to start over again. Some rituals are very time-consuming and sure to cause frustration for a child who needs to begin anew.
OCD is not a disorder uniformly marked by cleanliness, neatness, or a fear of germs. While it can certainly manifest in this manner and result in compulsive episodes of scrubbing or handwashing (as the sufferer attempts to relieve fears of contamination), only about a third of people with OCD are preoccupied with germs (defined as Contamination OCD). Other sufferers have subtypes of OCD that present differently. In fact, many people with OCD don’t care about germs whatsoever. They may even be full-on slobs.
Overall, some of the most common “flavors” of OCD in children include:
- Just Right OCD where kids feel they need to do things perfectly or in a way that feels just right (often, they might not be able to conceptualize what “just right” actually means)
- Checking OCD where kids may be preoccupied with safety (they may make sure doors are locked or that their shoes are tied, fearing a traumatic injury if they trip and fall)
- Contamination OCD where kids fear germs and wash compulsively or avoid touching things like doorknobs
- Harm OCD where kids fear harming others either directly (such as dropping an infant they’re holding) or through magical thinking (i.e., they may fear that thinking of an unlucky number will cause their parent to get in a car accident)
- Scrupulosity OCD where kids may have bad thoughts about God or fear that they don’t love God
- Hoarding OCD where kids may hoard items for fear that something bad will happen if they don’t or because they believe it’s possible that they’ll need a useless item again someday
Step 3: Understand Why OCD Happens
The exact cause of OCD is unknown though doctors believe it’s a combination among brain abnormalities, problems with communication inside the brain, a hyperactive amygdala (the threat center of the brain), low serotonin, and genetics.
Some kids may experience flare ups or sporadic disease after an episode of strep throat or a related illness. This is called PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) and can cause OCD-like symptoms or those that represent Tourette’s Syndrome. PANDAS may be responsible for up to 25% of cases of OCD in children.
Most everyone with OCD tends to possess several dysfunctional beliefs, including:
- An extreme need for certainty
- Thought-action fusion (sometimes called “magical thinking”): This is the idea that thinking about something is the same as doing it or the idea that thinking of something can cause it to happen
- Hyper-responsibility: OCD sufferers tend to believe they are responsible for things they can’t control or things that are well outside the realm of reasonable duty
- Overestimation of threats: The brain of an OCD sufferer either overestimates minor, insignificant threats or manufacturers threats, alerting the sufferer to one that doesn’t exist
- Perfectionism: Not everyone with perfectionism has OCD, but most people with OCD have some sort of perfectionism
- A desire to control thoughts: Because OCD thoughts are so terrifying, the sufferer desires control over them, which ultimately worsens the thoughts along the way
Importantly, OCD is an egodystonic disease, using the sufferer’s values against them and torturing the sufferer with thoughts that are opposite of their true desires. For instance, a child who fears that they’ll stab their mother with a pair of scissors loves their mother and wants nothing more than to not stab her. That’s why OCD latches onto this area and torments the sufferer so. OCD obsessions are not fantasies, desires, or subconscious wishes; they’re based on fear, 100% of the time.
It’s also important to know that people with OCD never do the thing they’re afraid of. For example, a child with OCD may be afraid that they’ll stick out their leg and trip their teacher as she walks by but they never do it. They never engage in the behavior related to their intrusive thought; they only fear they will.
OCD sufferers do, however, engage in compulsive behaviors to reassure themselves that their fears won’t come true. For example, if a child is afraid of tripping their teacher, they may get up and walk away whenever their teacher approaches them or they may tie their own shoes together to prevent their leg from jutting out.
Step 4: Know the Signs of OCD
OCD is not always obvious, especially when children suffer from Pure O and their compulsions are purely mental (such as silently praying or thinking “good” thoughts to cancel out the “bad” ones). Most of the time, people with OCD have compulsions that are both mental and physical.
As such, there are specific signs that signify the disorder. These include:
- Behavioral changes that occur during two specific stages of life: Pre-adolescence (8-12 years) or late adolescence (19-21 years)
- Behavioral changes that appear suddenly (literally overnight) after the child had strep throat or a similar illness
- A child who disappears for long periods of time, either without offering an explanation or offering one that doesn’t seem legitimate
- A child who prefers to spend a large portion of time alone
- A child who takes considerable time performing a simple task (such as putting on snow boots, writing their name, or using the restroom)
- A child who is consistently late for school or tardy when returning to class after lunch or recess
- A child who engages in the same task over and over again even when it looks like it was done correctly the first time (this may include redoing a math problem, rewriting a sentence, or zipping up a jacket repeatedly)
- A child who asks others for repeated assurance in regard to whether or not they did something correctly, whether or not they offended or hurt someone, or whether or not something is safe
- A child who questions their own decisions or actions (a student with OCD may turn in a paper and then repeatedly ask for it back, believing it’s not “perfect” yet)
- A child who sleeps during class or shows changes in appetite
- A child who grows emotional if minor tasks aren’t done a certain way (for instance, a child with OCD may become upset if the lunchboxes aren’t stacked in an orderly manner – this isn’t because the child prefers organization but rather because they fear something bad will happen unless the boxes are stacked in a way that feels right)
- A child who avoids certain things (such as using the restroom, eating cafeteria food, or climbing on the playground)
- A child who exhibits mood swings or irritability
- A child who engages in behaviors that appear to make no sense to onlookers but seem as though they make sense to the child
Some of the above is not unique to OCD. For instance, a child can experience irritability or sleepiness for all kinds of reasons and a child may avoid climbing on a playground because they’re afraid of heights. But when the child demonstrates several of the above, especially symptoms around repetitive behavior and reassurance-seeking, OCD must be considered.
Step 5: Support OCD and Giftedness
Children with OCD are often categorized as gifted. This is due to the overlap between symptoms of OCD and symptoms of giftedness. This overlap is so common that some gifted children are mistakenly believed to have OCD.
OCD can be linked to extremely high levels of creativity, attention to detail, and imagination and children who have it may demonstrate enhanced aptitude around creative writing, art, or storytelling. Anxious children, on the whole, are often believed to show higher levels of intelligence.
Some children with OCD do indeed qualify as gifted while others do not. But regardless of their giftedness, the OCD must be addressed. Putting a child with OCD in the Gifted and Talented Program and doing nothing to address the underlying anxieties will not help their mental wellbeing.
Step 6: Remember that Ritualistic Behavior is a Compulsion, Not a Disruption
Children with OCD may come across as disruptive if their compulsions interfere with class. But it’s vital to keep in mind that their behaviors are driven by anxiety and fear rather than a desire to act out or get attention. Many children even go to great lengths to hide their compulsions because of the shame they possess about their disorder or the fear they have in regard to their peers labeling them “weird”.
Teachers must keep the above in mind and never punish a child with OCD for their repetitive behaviors; they should be especially careful not to draw attention to a child by calling them out in front of others or amplifying the embarrassment they already feel.
It’s equally important that the child isn’t shamed for the content of their obsessions. For instance, a child with Scrupulosity OCD who fears they don’t love God should never be made to feel bad for that fear. They should also not be told that God forgives them because forgiveness implies that they’re doing something wrong. Rather, obsessions should be regarded as nonsense and children should be encouraged to ignore them as much as possible.
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Step 7: Be Aware of the Secondary Problems that Exist in Kids with OCD
Many children with OCD have other mental or physical illnesses as well. Tourette Syndrome, for example, is present in about 15% of children with OCD. Depression and social anxiety may occur too. Yet even in the absence of a co-occurring disorder, students with OCD face additional challenges.
Some of these include:
- Low self-esteem
- Social ostracization
- Problems with relationships
- Feelings of sadness
- Fears that they’re crazy
- Additional academic challenges (kids may not be able to complete assignments in a timely manner because of their rituals)
- An enhanced fear of public speaking, presenting, or reading out loud
To ease these challenges, teachers can take the following steps:
- Encourage empathy among all students
- Celebrate differences among people and the different talents and struggles that make us unique
- Practice acceptance and compassion
- Implement a routine (a routine can ease OCD symptoms by telling children what to expect)
- Adopt meditation, yoga, or mindfulness practices inside the classroom
- Reduce stress whenever possible (stress will worsen OCD symptoms)
- Allow for reasonable accommodations but be careful not to enable (more on this below)
- Sit the student near your desk (only do this if it’s helpful and be careful not to do it if it makes the child feel singled out)
Step 8: Know How to Sidestep Enablement
One of the trickiest parts of helping a child with OCD is avoiding enablement. But enabling the sufferer only enables the disease. In the classroom setting, enablement may happen when teachers unknowingly engage in helping students with compulsions.
The reason compulsions impact the disorder so dramatically is because they validate the disorder, telling the child, “Your intrusive thoughts are real and meaningful. You should listen to them.” Children with OCD need to be told the opposite. The only way to treat OCD is to stop the compulsions – once a child can do that, the OCD goes away.
This is way more difficult than it sounds as the compulsions provide relief from the intense anxiety. Thus, stopping them causes extraordinary stress. And that’s often why teachers, parents, and friends want to help, enabling the child in an effort to reduce discomfort.
This enablement offers a temporary reprieve but with long-term damage. The anxiety returns eventually – sometimes nearly immediately – and the urge to engage in a compulsion returns. That’s why OCD appears in cycles and why breaking the cycle is the only key to healing.
It can be hard to know whether you’re offering a child enablement or support as the two sometimes feel like a blurred line. Yet teachers can err on the side of caution by avoiding the following:
- Giving reassurance: If the child is asking for reassurance in the context of their OCD, refrain from giving it to them.
- Extreme classroom changes: Some changes in the classroom may be reasonable and helpful but sidestep anything extreme as it’s more likely to be enabling.
- Helping the child engage in avoidance: For example, a child with Contamination OCD may avoid touching doorknobs and ask you to open doors for them. Doing this enables the disease by reinforcing the idea that doorknobs are dangerous.
- Denying that there is a problem: This fails to address the disorder, assuring it will strengthen.
Step 9: Celebrate Small Victories
OCD, even when a child receives proper treatment, is not a disease that disappears quickly. On the contrary, OCD is a lifelong disorder that ebbs and flows in severity but never truly goes away. Even those whose OCD is well-controlled must be vigilant regarding flare ups.
Keep this in mind and do what you can to prevent children from becoming discouraged. One way to do this is by celebrating the small victories, no matter how tiny.
For example, a child with OCD may continue to ask for reassurance but if they ask for it four times a week when they used to ask for it six times a week, that’s progress worthy of celebration.
Step 10: Work with Parents and Therapists
As a teacher, there is only so much you can do for a child with OCD. Even if you follow all the above steps, parents and therapists play important roles. Work with moms, dads, school psychologists, and OCD specialists to help any way you’re able. Someone suffering from OCD can never have too many people on their side.
Step 11: Continue Your Education
Anyone who wants to help someone with OCD must understand it first. This article is a good start but the science surrounding the disorder is constantly evolving and new treatments are always on the horizon. Keeping up-to-date keeps you as effective as possible.
Just make a point to go to valid websites as there’s lots of misinformation circulating around the internet (playing a role in the many misconceptions).