Individuals with Obsessive-Compulsive Disorder (OCD) have difficulty processing information. They do the same thing again and again to alleviate their unwanted and distressful thoughts. These illogical thoughts, urges and images are called obsessions and can include marked fear of germs, being hurt, hurting someone, and doubting themselves. It is estimated that one to two percent of American children have OCD and that a correct diagnosis and appropriate treatment are often unavailable.
Obsessions lead to compulsive actions or rituals that individuals are driven to perform. Some examples are: excessive hand washing, hoarding, arranging things in exact order, and repeatedly checking to see if the stove or faucet is turned off. Other compulsions are continually repeating words or numbers and avoiding certain objects or situations that an individual may perceive as harmful.
Although OCD usually begins in adolescence or young adulthood, elementary-aged children, as well as preschoolers, have been diagnosed with OCD. In primary school children with OCD usually become aware that their thinking or actions are different than those of their peers and family members. They often begin to think of themselves as being stupid or crazy. Other common reactions are embarrassment or hiding or suppressing their symptoms. As a result their self-esteem is adversely affected.
OCD can significantly interfere with a child's normal functioning, academic progress and social relationships. Particular obsessions seem to change as children grow older. Some sufferers experience a progression of traits, while others have symptoms that increase and decrease over time. The disorder may last a lifetime.
A child with OCD may exhibit the following behaviors at school:
- Rechecks work repeatedly;
- Erases and rewrites assignments;
- Orders or arranges things in a certain way;
- Insists that his or her things must stay in exactly the same place;
- Repeats words or numbers over and over;
- Tries to avoid certain areas of school;
- Hoards items;
- Tattles on other students;
- Appears preoccupied, anxious, temperamental, and/or pressured;
- Washes hands often;
- Exhibits poor eating habits;
- Lacks energy and physical well-being;
- Complains often of having a headache or an upset stomach;
- Displays inadequate social skills; and/or
- Hides or ignores his or her compulsive behaviors.
Behaviors that may occur at home, include:
- Exhibiting symptoms that take up most of his or her energy and time;
- Following a predetermined set of procedures without variation;
- Spending more than one hour per day to complete rituals;
- Taking long showers;
- Changing clothes often;
- Expressing concern that if the rituals are not completed correctly, the day will be ruined;
- Becoming antagonistic if someone tries to interrupt his or her rituals;
- Having unrealistic fears;
- Expressing concern that germs, dirt, or toxic substances may cause him or
her to become ill;
- Avoiding eating certain foods for fear that they may be contaminated;
- Stating safety concerns about him or herself and/or family members;
- Repeatedly checking to see if the doors and windows are locked;
- Having worries involving religion and/or moral issues;
- Praying repeatedly;
- Stating the fear that he or she may have harmed himself or others; and/or
- Verbalizing concern about losing control and behaving inappropriately or aggressively.
Questions to Consider
- Has the child been diagnosed with other disorders such as Tourette's syndrome, tic disorder, panic disorder, social phobia, developmental disability, depression, oppositional defiant disorder or attention-deficit hyperactivity disorder?
- How long (weeks, months, years) has the behavior been extreme?
- How often during a day does he or she exhibit illogical behavior?
- In what ways do the child's actions interfere with his or her daily living activities?
If a child's behavior is extreme, the teacher, school counselor and/or administrator need to meet with a parent or guardian to share their concerns.
Children with OCD are usually treated by an adolescent psychiatrist with a combination of cognitive and behavioral techniques and, at times, medication. The disorder often occurs in families, but a child may be diagnosed with OCD without a family history of the disorder. Open communication among all of those involved with the child is necessary to increase understanding of the complex issues associated with OCD.