NASP Communiqué, Vol. 32, #7
Disorder: Information for
Parents and Educators
By Leslie Z. Paige, EdS, NCSP
Fort Hays State University
(OCD) is a type of anxiety disorder that causes unwanted, obsessive thoughts
and compulsive, repeated behaviors. The ritualistic behaviors associated
with OCD are an attempt to cope with the intrusive obsessive thoughts.
For example, a child with obsessive thoughts regarding disease or contamination
might frequently wash his or her hands. OCD symptoms range from mild to
severe, and can interfere with school or social functioning.
Approximately 2-3 % of adults
and children have OCD. Rates of OCD in children are approximately 1.9%.
Because individuals with OCD may try to hide the symptoms, this number
may be an underestimate. Symptoms in females usually begin in young adulthood,
and symptoms in males usually begin between the ages of 6 and 15. OCD occurs equally in both genders, and is present in all
ethnic groups. The earlier OCD is diagnosed and treated, the better the
The cause of OCD is unknown,
but research suggests it may be due to a problem with the way information
is processed in the brain. OCD appears to result from a biochemical imbalance
that causes the brain to send false messages of danger and prevents screening.� There
is also research suggesting that OCD may be a learned response to reduce
anxiety through compulsive behaviors, sometimes triggered by a stressful
event. Diagnosis of OCD is usually made by a mental health provider or
physician and is based upon the symptoms.
Characteristics of OCD
with OCD exhibit obsessive thinking and compulsive behaviors. They typically
report that they feel unable to control their thoughts and feel compelled
to perform the behaviors. Symptoms may worsen when the child is stressed,
ill, or sleep deprived.
Symptoms and Patterns of OCD
Obsessions. These are involuntary, recurring,
unwanted thoughts that cause feelings of anxiety or dread. Obsessions are
irrational and interfere with normal thinking. Common obsessions include
fears of contamination, disease, or causing harm, sexual images, doubting
(checking locks), thinking something must be done a certain number of times
or keeping items in certain positions to avoid harm, hoarding, and fears
associated with religion.
Compulsions. These are behaviors that are repeated to try to control the obsessions. These
behaviors reduce anxiety temporarily, but the urge to perform the compulsive
behavior becomes stronger over time. Other compulsive behaviors may be
added when the original compulsive behaviors become less effective in reducing
anxiety.� The vicious cycle of OCD is that more elaborate rituals are needed
to provide relief from the unwanted thoughts. Sometimes it is possible
to see the connection between the obsession and the compulsion, such as
fear of contamination and washing hands. However, sometimes there is no
logical link, such as needing to wear certain clothes to prevent a burglary.
Some children can delay performing the compulsive behavior, but this is
very difficult and they will nearly always engage in the compulsive behavior
later. Common compulsions include:
- Excessive washing and cleaning
- Checking (checking and rechecking locks, appliances)
- Redoing (opening and closing, erasing and rewriting)
- Hoarding (cannot throw things away)
- Praying (continuous and excessive)
- Symmetry (movements need to match, things have to look the same)
cannot be observed (such as counting rituals), but others can be easily
seen (such as hand washing).
Impact of OCD Symptoms
to ask when diagnosing OCD include:
time consuming are the behaviors?
is the degree of distress?
much do the obsessions or compulsions interfere with daily functioning?
people may feel anxious and check to see if they left the iron on, once
they determine that it is off they can go about their daily lives. Individuals
with OCD need to check, recheck, and check again, and this can involve
an hour or more. Cleaning household items with disinfectant as part of
housekeeping or during flu season is a good habit, but cleaning schoolbooks
daily with disinfectant and washing hands until they bleed may indicate
a result of the compulsions and obsessions, OCD can be very disruptive.
Depression, agitation, difficulty paying attention, feelings of shame,
stress, slow performance (owing to time-consuming rituals), and other problems
may be associated with poor academic performance and difficulties with
family and social relationships.
Early diagnosis is important. There is no cure,
but a combination of medication and cognitive-behavior therapy is considered
to be the most effective treatment.
Medication. There are medications
that are effective for treating OCD. Medication helps to decrease the feelings
of anxiety and the intensity of the symptoms, and allows the child to ignore
or turn down the volume of the obsessive thoughts.
Cognitive-behavior therapy. Children with OCD benefit from learning to cope
with the obsessive thoughts and reduce the compulsive behaviors. Many individuals
with OCD believe that they are going crazy and knowing what the disorder
is and the brain's role in tricking individuals into thinking that there
is danger or a threat can help to alleviate this fear. Therapy helps to
decrease the symptoms, provides explanations for the behaviors, and teaches
children strategies to deal with OCD.
Treatment strategies vary, depending upon the
age of the child and the severity of the symptoms. Sometimes the behavior
is limited by setting a time limit. For example the child is allowed to
pray for 10 minutes instead of 2 hours. Sometimes the child will be asked
to perform rituals in reverse order, or to engage in a different activity.
The mental health practitioner can help children find ways to keep OCD
from controlling their lives.
Support From Families
Living with a child with OCD can be very challenging.� OCD
can disrupt families. Simply telling the child to stop the behavior will
be ineffective. Some families may accidentally encourage the rituals; for
example, by helping the child turn lights on and off in a set pattern.
These reactions do not reduce the child's feeling of anxiety or danger.
Many parents report feeling fear, frustration, or anger when their child
engages in these disruptive rituals.
It is important for parents to participate in
therapy sessions to learn about OCD and how to help their child. Parents
can help by learning how to help their child follow their treatment plan
and to take the medication.� Support groups may also be beneficial for
Support From School
Identifying OCD. Children with OCD typically try hard to hide
their disorder, which makes diagnosis difficult. Teachers can help by becoming
educated about OCD. If they notice that there is a child who seems to engage
in time-consuming strange behaviors that are repetitive and interfere with
social or academic functioning, they should consult with their school psychologist
or school counselor. Some children with OCD exhibit behaviors commonly
associated with Attention Deficit Hyperactivity Disorder. For example,
children with OCD may appear inattentive because they are focused on their
obsessive thoughts. A lesson in math or spelling is less compelling than
the fear that the house may burn down or the belief that he or she is contaminated
with cancer or AIDS. They may become agitated because they want to engage
in a ritualistic behavior but want to comply with classroom rules to stay
Interventions. Good communication between
home and school is very important.�� Teachers can help work with the child
and the family to help alleviate symptoms by following through on treatment
plans that involve the school day. Plans for dealing with certain behaviors
that work at home may be helpful at school.
Information from the outside mental health provider
and/or school psychologist will be helpful in understanding and helping
the child in managing the OCD. The school nurse may need to administer
medication during the school day. The school psychologist will be able
to assist with educational and behavioral strategies to decrease anxiety,
reassure the child, and reinforce coping skills.
A well-structured classroom
with clear expectations, smooth transitions, and a calm climate is helpful
for most students, but particularly for the child with OCD. Be aware of
any teasing or problems with social relationships. Punishing or embarrassing
the child are ineffective and should be avoided because they may make the
behaviors worse. The symptoms will tend to worsen if the child is feeling
Teachers may need to know how the obsessive thoughts
or compulsive behaviors are interfering with academic or social behaviors.
For example, some children may need extra time to take a test because they
need to check and recheck their answers.� Children with contamination fears
may be unable to tolerate being touched.
Some children with OCD may qualify for special
education services if the disorder interferes with learning or behavior
to a significant degree.
symptoms of Obsessive-Compulsive Disorder can be extremely disruptive and
distressing. Children with OCD can be helped with a combination of medication
and cognitive-behavior therapy designed to reduce the intensity of the
obsessions and decrease the compulsive behaviors. It is important that
caregivers and educators learn about OCD and how to work together with
the child to manage the behaviors and implement the treatment plans.
T.E. (2000). Freeing your child from obsessive-compulsive
disorder. New York: Three Rivers Press. ISBN: 0812931173.
National Institute of Mental Health-www.nimh.nih.gov/publicat/ocd.cfm##ocd2
Z. Paige, EdS, NCSP, is the Grants Facilitator for the Docking Institute
of Public Affairs and the Graduate School at Ft. Hays State University
in Hays, KS. Previously she was a school psychologist for the Hays West
Central Kansas Education Cooperative and directed several federally funded
mental health projects, including RURAL: Safe Schools/Healthy Students
Initiative and the Hays Middle School Drug Prevention and School Safety
Coordinator Grant. She is currently the project director for the Hays
Emergency Action Response Team Crisis Preparedness Grant for the Hays Unified School District.
This handout will be published by NASP in spring 2004, in Helping Children at Home and School II:
Handouts for Families and Educators.