Obsessive-Compulsive Disorder in Children: The Classroom, the Disorder, and the Issues
Disorder (OCD) is classified as a behavioral disorder by the Diagnostic
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
warning signs of OCD if they are not familiar with symptoms of the
already. Throughout the text, one will
gain knowledge about the disorder and how the disorder is manifested
school system and also common characteristics that can be seen across
population. Another section in the text
is dedicated to researched treatments that have been proven to be
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
school, home, or even in peer interactions.
Overview of Obsessive-Compulsive
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
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
characteristic of the individual and seemingly have a purpose to them
seem ritualistic or stereotyped in some way (Thomsen, 1998). Some other attributes to OCD are that it
getting in the way of the individuals life and is causing some sort of
to the individual.
Most children tend
to fit on the compulsion end of the continuum meaning that their
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
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
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
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
of terrible things happening to them or other things and people found
the child’s environment (Thomsen, 1998).
Taking all this
into consideration it still is a grueling process to identify the
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
catch this debilitating disease early and even to get an accurate
the disorder to help achieve quality treatment.
Statistics on Affected Population
can be found across the population whether those individuals are old or
young. For children and adolescents,
on the research, OCD can be seen in approximately 2-3% of our nation’s
(< 18) population (Grados & Riddle, 1999).
This is not
a large number yet it
is a substantial amount of children and adolescents suffering the
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
(Purcell, 1999). OCD tends to span
across the life cycle meaning that it is progressive and can occur over
course of an individual’s whole life (Eagle, Swearer, & Hope, 2000)
sex ratio for OCD is that that is an equal likelihood that it can occur
and females but the data shows that there is a better chance of seeing
males. This could be for a number of
reasons like just being noticed more in the classroom, home, or by a
or maybe the disorder in males is exhibited by more extreme forms of
(Thomsen, 1999). OCD is equally likely
to occur in males and females it may just be that the boys are easier
targeted for certain symptoms as opposed to girls.
the United States
there is a potentially high number of children and adolescents affected
in the population.
Characteristics of OCD
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
happen) (Turnbull, Turnbull, Shank, & Smith, 2004).
can appear to look like other disorders and also OCD is frequently
(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
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
(Schlozman, 2002). Even so there are still
a variety of other disorders that are commonly comorbidly diagnosed
and these range from specific phobias to eating disorders (Grados &
1999). OCD can be complicated on its own
and can become increasingly complex to treat with the addition of other
diseases that are diagnosed with OCD are specific phobias (i.e. germs),
generalized anxiety disorder (GAD), tic disorder, and even serious
(i.e. anorexia) (Grados & Riddle, 1999). One
other potential comorbid diagnosis is
depression and when ever there is depression that is competing with
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
when other disorders are diagnosed along with it. This
especially will become a problem when
addressing proper treatment techniques.
characteristics of the disorder can be seen in the school setting that
make it easier to pick up, here are a few:
using shirt or other apparatus
to cover hands when
excessive bathroom request
checking behaviors (doors,
windows, or outlets an even
to answers on a test)
repetitive movements (leaving
class, getting up and
arranging items on desk
avoiding contact with class
supplies (glue or paint)
rereading and scratching out
answers on assignments
(being a perfectionist)
(Adams & Burke, 1999)
Classroom Issues and Other Considerations
children are faced with many different factors upon entering social
such as a school setting. OCD can appear
in many ways within the classroom and even may not be detectable
secretive behavior. Some of these
behaviors may be exhibited as coming to school late because of
have trouble testing due to the illness, and also possibly slipping
depressive state or have a comorbid diagnosis of depression (Purcell,
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
a school psychologist. The psychologist
determines if the child in fact suffers from a particular disorder and
assessment and also how to help the child (Adams, Waas, March, &
1994). Several techniques can be used to
asses the children while in the classroom.
The most common are observation of the child, rating
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]
seriously emotionally disturbed if OCD-related symptoms adversely
child’s educational performance and characterized by one of the
an inability to learn
an inability to build or
inappropriate types of behavior
or feelings under
a general pervasive mood of
unhappiness or depression
[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
needed (Turnbull, et al., 2004).
across the members of the IEP team is also important because students
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
comes out when in the home setting. This
puts added strain on the family unit and this is why communication is
(Adams & Burke, 1999).
Ways teachers can
help the strain put on parents would be to facilitate the child’s
letting them wash there hands a few times or even talking to the
student about some of the child’s symptoms to alleviate some of the
that coincides with OCD (Schlozman, 2002). Communication between the
child and, officials at the school are important so that the child is
all aspects of their disorder instead of treating individual situations
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
& 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
for support and guidance.
looking at issues in the classroom it is important to remember
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
in terms of the disorder. A school
psychologist can be a useful person in finding out how severe or if the
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
component for increasing the chances of pinpointing and treating such a
Treatment of OCD: In the
Classroom and Beyond
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
some valuable findings. This is good
news for those who are suffering from the disorder and to those who are
information about OCD. Treatment can
take various forms but some of the better ones are education on the
psychotherapies, medication, and school based treatments (Grados &
first step to treatment is definitely getting oneself educated about
OCD. Reading this paper, checking
even talking with psychologist are all ways that a person can gain some
into what OCD is, some potential treatments, and even some of the
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
treatment and maintenance.
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
unit. It is even possible that without
support from the family that the disorder can manifest itself into a
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
relatives have done to overcome the disorder or maybe it would be
help the as well. It is good to have the
family involved because family therapy teaches how to deal with the
and even some coping mechanisms for dealing with the disorder and not
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.
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).
been seen to be very effective in treating the OCD in adults and has
applied to the pediatric setting with excellent results (Rapoport &
Inoff-Germain, 2000). This involves many
types of procedures like extinction, coping and relaxation techniques,
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
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
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
thoughts associated with OCD. The final
of CBT is exposure and this is used if there is a particular or
phobia. Exposure is what it implies that
the person is exposed to a particular aversive that they would not
in contact with and gradually they lesson their fear as a result of
exposure (Adams, et al., 1994). CBT
helps with the behavioral aspect of OCD and is good in long term
are controversial for some disorders but for others they are a
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
OCD (Thomsen, 1998). These drugs have
not been on the market as long so they really have not been researched
long-term affects on children. Many of
the medications being used to day have been okayed by the FDA for
have little empirically based research to back up the use in children. Even so if medication is necessary it is
that a psychiatrist make that decision and should not be left in the
the family physician or other clinicians that do not know the research.
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
within the plan. It is important above
all that there is good communication among members of the school and
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
disorder can be manifested in several ways.
It can range anywhere form ritualistic behaviors to
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
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
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.