OCD

The following is an excerpt from the ebooklet Working with children diagnosed with Obsessive Compulsive Disorder (OCD) by Murray Evely and Zoe Ganim, 2011.

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Introduction

Obsessive Compulsive Disorder (OCD) is a type of anxiety disorder that affects approximately 1 per cent of children. Children with OCD have persistent recurring obsessions (worries, thoughts, images, or impulses) that are unwanted, unpleasant and often the cause of extreme fear or anxiety.

Children with OCD feel compelled to perform compulsive behaviours to reduce the anxiety caused by their obsessions.

For some children, thoughts may be persistent recurring worries about daily life events.

Many of these children will be aware that these thoughts are a product of their mind and not based in reality and hence may try to hide the symptoms of this disorder.

Typical obsessions

Children with OCD have obsessions that may include the fear of:

germs, dirt, contamination or contagious disease
injury, illness or death, of themselves or someone else
things being out of place, not perfect or not straight
making mistakes
unlucky numbers.

Typical behaviours

Compulsive behaviours assist these children to stop or to reduce the obsessive thoughts or worries for a short period of time. The repetition of the action is somewhat comforting for these children, but impacts significantly on their day-to-day functioning.

A child who suffers from OCD may exhibit some or all of the following:

excessive washing of hands, body or objects
checking things repeatedly (e.g. that the door is locked, homework is finished, stove is off)
touching certain objects a certain number of times
counting a certain number of objects before completing a task (e.g. seeing three birds before entering a building)
arranging things (e.g. wardrobe, pencils) in a certain way
unexplained distress, agitation or marked anxiety in the classroom
repeating actions (e.g. re-reading, re-writing, walking through a doorway multiple times)
repeated questions about disease or preoccupation with danger
avoiding interaction with other students and increased social isolation
frequent absences from school
attempts to engage you or others in their rituals.

Caution

Children with OCD frequently hide their compulsive behaviours and obsessive thoughts as they think they are strange, shameful, ridiculous and embarrassing. This secrecy can further increase anxiety.

They may be so good at hiding their thoughts that it could take months for a parent or teacher to realise a problem exists.

Children will typically try to engage parents or others in their rituals to help relieve the anxiety. For example, the child may ask you to join them in counting five red cars outside the window before beginning to write a story, or ask you the same question each time a certain task needs to be performed.

Situational changes, such as starting school, the death of a close relative, moving house, a test or exam period, or an unknown biochemical imbalance can trigger the onset of OCD or amplify existing mild behaviours. Symptoms can tend to ‘wax and wane’, and the child with OCD does not need to experience a huge change or stressor—only something perceived by the child as a significant stressor—to cause another cycle of obsessive thoughts.

What to do if you suspect a child has OCD

If you suspect a child has OCD, it is important to inform the principal and the parents of your observations and refer the child via their parents to the school’s psychologist, the family GP or another mental health clinician. A psychologist or mental health therapist with OCD experience can provide treatment and, with parental consent, advice for school and classroom management. There are a range of highly effective behavioural and environmental strategies, not just medications, that can be used to assist the child.

Strategies to support the child diagnosed with OCD

Work in conjunction with the child’s mental health therapist and parents. It is important that you are aware of goals and suggested strategies formulated by the child’s mental heath professional. You can then help to reinforce positive behaviour in the classroom. However, some parents may be concerned with privacy and resist school involvement.

Develop an individual learning plan with the child, their parents/carers and other senior school staff. This plan should specify rules and boundaries the child is expected to follow in the classroom, outside the classroom and in play areas.

Do not allow the child to engage you in their rituals. Some children will attempt to engage an adult in their ritual to help relieve the anxiety, for example counting five clouds outside the classroom before beginning maths problems. If so, do not join in. Another example could be the child asking you if the door or cupboard is closed, when they are closed. This behaviour is known as ‘reassurance seeking’ and again the teacher should not respond ‘yes they are closed’ as this can help maintain the anxiety cycle. It is important to note, however, that you should not forcefully stop the child from engaging in the compulsions, as this will further increase anxiety. The child’s mental health practitioner should be able to assist you with strategies to suggest to the child to reduce or to use instead of the ritual. For example, some therapists will encourage the use of deep relaxation breathing to replace the ritual and decrease the anxiety. Be guided by the professional working with the child and be prepared to share with the therapist your observations of the child’s behaviour.

Praise the child immediately when they refrain from a compulsive behaviour. Where possible, assist the child to put a wedge of time in between the obsessive thought and the compulsion. For example, praise the child or encourage deep breathing as an alternative to or to help delay the compulsive behaviour.

ISBN978-1-921908-13-2

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