Topic: Obsessive-Compulsive Disorder
Researched and written by:   Jesse J. Jarman
                                                I attest that the following report is a product of my own original work.

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Obsessive-Compulsive Disorder in Children:  The Classroom, the Disorder, and the Issues                 Obsessive-Compulsive Disorder (OCD) is classified as a behavioral disorder by the Diagnostic and Statistical Manual-IV-Revised (DSM-IV-R).  OCD is characterized by obsession (unwanted repetitive thoughts) and compulsions (ritualistic or stereotyped behaviors (Thomsen, 1998).  This article looks at OCD in terms of the disorder and its defining characteristics.  The article also gives information to those who think their children may be suffering from the disorder.  It can be helpful for professionals and clinicians alike who need to know some of the warning signs of OCD if they are not familiar with symptoms of the disorder already.  Throughout the text, one will gain knowledge about the disorder and how the disorder is manifested within a school system and also common characteristics that can be seen across the population.  Another section in the text is dedicated to researched treatments that have been proven to be successful for treating OCD and have great maintenance with the disorder.   OCD is a disorder that can be treated and maintained with intervention in all aspects of the child’s life whether that’s school, home, or even in peer interactions.      Overview of Obsessive-Compulsive Disorder               To first get an idea of what Obsessive-Compulsive Disorder (OCD) is it must be defined.  OCD can either be described as either recurrent or unwanted thoughts (the obsessions part) or ritualistic patterns of behavior (compulsions) (Child Development Institute, 2004).  The obsessions tend to be recurrent and are repetitive thoughts, impulses, and even images and are typically unwanted.  The compulsions, on the other hand, are characteristic of the individual and seemingly have a purpose to them and can seem ritualistic or stereotyped in some way (Thomsen, 1998).   Some other attributes to OCD are that it is getting in the way of the individuals life and is causing some sort of distress to the individual.  Most children tend to fit on the compulsion end of the continuum meaning that their behavior takes the form of excessive hand washing and shower taking behavior (Thomsen, 1998).  Another commonality that is seen across children suffering from OCD is checking behavior which entails making sure the door is locked and if stove or iron has been turned off (Thomsen, 1998).  Now keep in mind that some of these acts appear to be normal to many of us but the frequency of the behaviors is to the extent that it causing the child impairments in many areas.  The compulsions can be so bad that they may literally wash themselves to much or to hard that they begin to bleed.  Some children can also have a particular obsessive thought that goes along with the compulsion.  If a child feels the need to check the stove they may think that if they don’t the family will be burned alive and the child becomes consumed by this unwanted persistent thought.  Other common compulsions include fixing and arranging objects, pattern rituals, and even counting (Thomsen, 1998).  Some common obsessions that can be seen across the samples are thoughts of disease, sex, death, religion, and thoughts of terrible things happening to them or other things and people found within the child’s environment (Thomsen, 1998).  Taking all this into consideration it still is a grueling process to identify the symptoms of OCD in children.  Many different types of professionals may not be able to catch some of these toll tale warning signs.  These would be professional of dentistry, pediatrics, and even dermatologist (Grados & Riddle, 1999).  Therefore it is of the utmost importance to catch this debilitating disease early and even to get an accurate diagnosis of the disorder to help achieve quality treatment.   Statistics on Affected Population               OCD can be found across the population whether those individuals are old or young.  For children and adolescents, depending on the research, OCD can be seen in approximately 2-3% of our nation’s young (< 18) population (Grados & Riddle, 1999).      This is not a large number yet it is a substantial amount of children and adolescents suffering the affects of full blown OCD (this figure does not take into account children with obsessive-compulsive tendencies).  The typical age of onset for females is 20-29 and in males it’s been seen as low as six and there have even been cases of children as young as two have exhibited symptoms (Purcell, 1999).  OCD tends to span across the life cycle meaning that it is progressive and can occur over the course of an individual’s whole life (Eagle, Swearer, & Hope, 2000)               The sex ratio for OCD is that that is an equal likelihood that it can occur in male and females but the data shows that there is a better chance of seeing it in males.  This could be for a number of reasons like just being noticed more in the classroom, home, or by a clinician or maybe the disorder in males is exhibited by more extreme forms of OCD (Thomsen, 1999).  OCD is equally likely to occur in males and females it may just be that the boys are easier at being targeted for certain symptoms as opposed to girls.              In the United States there is a potentially high number of children and adolescents affected by OCD in the population.    Characteristics of OCD               Obsessive-compulsive disorder can have many manifestations that are classified under its umbrella.  The two main distinction of OCD are compulsions (physical) and obsessions (mental).  Compulsions can be characterized as repetitive ritualistic behaviors (i.e. hand washing) and obsessions are repetitive thoughts, images, or impulses (i.e. thinking terrible things will happen) (Turnbull, Turnbull, Shank, & Smith, 2004).              OCD can appear to look like other disorders and also OCD is frequently comorbid (more than one disorder) with other disorders.  For instance, in the classroom setting it can seem as though a child is exhibiting ADHD because of the excessive getting up to wash hands or they have persisting thoughts that race in their minds (Scholzman, 2002).  The disorder is most commonly mistaken for ADHD but really is found to be the least comorbid disorder associated with OCD (Schlozman, 2002).  Even so there are still a variety of other disorders that are commonly comorbidly diagnosed with OCD and these range from specific phobias to eating disorders (Grados & Riddle, 1999).  OCD can be complicated on its own and can become increasingly complex to treat with the addition of other disorders. Some common diseases that are diagnosed with OCD are specific phobias (i.e. germs), generalized anxiety disorder (GAD), tic disorder, and even serious eating disorders (i.e. anorexia) (Grados & Riddle, 1999).  One other potential comorbid diagnosis is depression and when ever there is depression that is competing with another disorder it brings the element of suicidal ideation into play (Thomsen, 1999).  Therefore, all of these disorders can be exhibited simultaneously and increase the complexities of the disorder.  OCD then becomes a hard disorder to pinpoint when other disorders are diagnosed along with it.  This especially will become a problem when addressing proper treatment techniques.              Some characteristics of the disorder can be seen in the school setting that might make it easier to pick up, here are a few: 1.      using shirt or other apparatus to cover hands when opening/closing doors 2.      excessive bathroom request 3.      checking behaviors (doors, windows, or outlets an even to answers on a test) 4.      repetitive movements (leaving class, getting up and down) 5.      arranging items on desk 6.      avoiding contact with class supplies (glue or paint) 7.      rereading and scratching out answers on assignments (being a perfectionist) (Adams & Burke, 1999)                            Classroom Issues and Other Considerations               Obsessive-compulsive children are faced with many different factors upon entering social institutions such as a school setting.  OCD can appear in many ways within the classroom and even may not be detectable because of secretive behavior.  Some of these behaviors may be exhibited as coming to school late because of compulsive rituals, have trouble testing due to the illness, and also possibly slipping into a depressive state or have a comorbid diagnosis of depression (Purcell, 1999).             Within in the school setting there is a need for cohesion among members of the individualized education plan (IEP).  Some of these people include administrators, teachers of the student, parents, and even the child if they are old enough to understand the meeting.  One of the most important members of the team, when a behavioral or psychological disorder is present, is a school psychologist.  The psychologist determines if the child in fact suffers from a particular disorder and aids in assessment and also how to help the child (Adams, Waas, March, & Smith, 1994).  Several techniques can be used to asses the children while in the classroom.  The most common are observation of the child, rating scales, checklist, and even a direct interview with the child (Adams, et al., 1994).  To qualify for special education “services under I.D.E.A. [the child is characterized] as seriously emotionally disturbed if OCD-related symptoms adversely affect the child’s educational performance and characterized by one of the following: 1.      an inability to learn 2.      an inability to build or maintain satisfactory interpersonal relationships 3.      inappropriate types of behavior or feelings under normal circumstances 4.      a general pervasive mood of unhappiness or depression 5.      [or] tendency to develop physical symptoms or fears associated with personal or school problems              (cited in Adams, et al., 1994, p.284).”  For a child to receive service under the I.D.E.A. law they must fit the above criteria.  This means that even if a child has OCD but does not fit the school criteria they will not be eligible for service.  This is important to know because this is another aspect to consider when looking for proper treatment and even making it affordable.  Everyone should know that under I.D.E.A. every child has the right to a free and appropriate education no matter what is needed (Turnbull, et al., 2004).              Communication across the members of the IEP team is also important because students assume different levels of impairment form their disorders.  There are also students that are able to hide there disorder when out in public or in school and the result is that it all comes out when in the home setting.  This puts added strain on the family unit and this is why communication is necessary (Adams & Burke, 1999).   Ways teachers can help the strain put on parents would be to facilitate the child’s disorder by letting them wash there hands a few times or even talking to the parents and student about some of the child’s symptoms to alleviate some of the anxiety that coincides with OCD (Schlozman, 2002). Communication between the parents, child and, officials at the school are important so that the child is helped in all aspects of their disorder instead of treating individual situations or environmental circumstances where the OCD tendencies are seen.  It is also important that teachers try to believe parents even though they themselves do not see the behaviors (Adams & Burke, 1999).  Therefore, it is mainly up to all of the members of the team.  There should be a sense of comradery among parents and school officials any way even if a formal IEP team is enacted.  This will help to understand the child’s well-being better and even if they are not suffering from a disorder they will be able to rely on many people for support and guidance.               When looking at issues in the classroom it is important to remember communication is key.  This means from parents to the child to the school officials.  There are many different characteristics that can be used to assess the child’s behavior in terms of the disorder.  A school psychologist can be a useful person in finding out how severe or if the child does have a particular disorder, particularly OCD.  Many factors play a role in the outcome of a disorder therefore cooperation is an imperative tool and the most essential component for increasing the chances of pinpointing and treating such a debilitating disorder.   Treatment of OCD:  In the Classroom and Beyond   Several avenues can be taken to achieve successful treatment and maintenance of OCD.   Over the years there have been a lot of treatments researched and there have been some valuable findings.  This is good news for those who are suffering from the disorder and to those who are seeking information about OCD.  Treatment can take various forms but some of the better ones are education on the disorder, psychotherapies, medication, and school based treatments (Grados & Riddle, 1999).             The first step to treatment is definitely getting oneself educated about OCD.  Reading this paper, checking websites, or even talking with psychologist are all ways that a person can gain some insight into what OCD is, some potential treatments, and even some of the leading theories of why it occurs at all (Grados & Riddle, 1999).  Education is a very important step and it should be the first of many steps that will help the child on the road to treatment and maintenance.             The role of the family in therapy is another great step in the right direction.  It is important for any person suffering from a particular disorder to have involvement from the whole family unit.  It is even possible that without support from the family that the disorder can manifest itself into a much worse degree of OCD (Waters & Barrett, 2000).  Another reason family play a role in treatment is also because there are some implications  that OCD is hereditary and it might help the psychologist to know certain things the parents or relatives have done to overcome the disorder or maybe it would be possible to help the as well.  It is good to have the family involved because family therapy teaches how to deal with the disorder and even some coping mechanisms for dealing with the disorder and not making it worse than it is (Waters, Barrett & March, 2001).  The family unit plays a major role in effective treatment of OCD and especially in childhood disorders.              Behavioral interventions are a must and these can be presented a number of ways.  The most effective form of psychotherapy/behavior therapy is cognitive-behavioral therapy (CBT). It has been seen to be very effective in treating the OCD in adults and has since been applied to the pediatric setting with excellent results (Rapoport & Inoff-Germain, 2000).  This involves many types of procedures like extinction, coping and relaxation techniques, and exposure (Adams, et al., 1994).  The idea behind extinction is that are certain factors that maintain a behavior.  This could be like gaining attention for washing hands or other behavioral acts so these behaviors need to be ignored or just not put emphasis on by the parents and other primary care givers.  This means the behaviors are not being reinforced so the frequency should lesson if this is the reason why the OCD has manifested.  The next element under CBT is the idea of teaching coping and relaxation.  This is for when the child experiences anxiety related to the disorder they will be able to calm down or alleviate some of the anxiety through practice of these skills instead of performing the maladaptive behaviors or thoughts associated with OCD.  The final component of CBT is exposure and this is used if there is a particular or specific phobia.  Exposure is what it implies that the person is exposed to a particular aversive that they would not normally come in contact with and gradually they lesson their fear as a result of this exposure (Adams, et al., 1994).  CBT helps with the behavioral aspect of OCD and is good in long term maintenance of the disorder.             Medications are controversial for some disorders but for others they are a necessity and can be responsible for eliminating many of the debilitating symptoms of OCD.  The most research has been conducted on a drug called clomipromine.  In a double blind study on clomipromine the researchers found that there was a 30% decrease in the symptoms of OCD (Adams, et al., 1994).  The FDA has recently allowed the use of SSRI’s (selective serotonin reuptake inhibitors) to be used in the treatment of OCD (Thomsen, 1998).  These drugs have not been on the market as long so they really have not been researched for long-term affects on children.  Many of the medications being used to day have been okayed by the FDA for adults and have little empirically based research to back up the use in children.  Even so if medication is necessary it is imperative that a psychiatrist make that decision and should not be left in the hands of the family physician or other clinicians that do not know the research.             Within the school setting all of these therapies can be modified to be utilized in the school system.  Medications can be administered by the school nurse at the proper times.  CBT can be outlined for the teacher in specific ways and if an IEP is enacted then they can put it as one of the goals within the plan.  It is important above all that there is good communication among members of the school and the parents of the OCD child (Adams, et al., 1994).  This will ensure the child is receiving the proper care and it also makes it easier to know what needs to be modified to help the child even more.     <>Conclusion               Obsessive-compulsive disorder can be manifested in several ways.  It can range anywhere form ritualistic behaviors to excessive thoughts or images that are unwanted.  Approximately 3% of our nation youngsters are affected by OCD (Grados & Riddle, 1999).  The disorder has many characteristics and can be seen as repetitive hand washing, recurrent thoughts, thinking there will be harm brought to self, and even have a problem with fear of contamination.  Issues in the classroom are there and the child can be affected in many ways liked delayed school ability and coming to the school late do to certain rituals (cited in Adams, et al., 1998).  As seen in the last section on treatment there are many ways a child can receive help.  So do not give up hope there are many options parents and teachers can take to help a child who is suffering from OCD.  Do not give up hope and remember the child is still a child they are not OCD and they must not be labeled as such.

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