Children and adolescents with obsessive-compulsive disorder: A primer for teachers

Childhood Education, Fall 1999 by Adams, Gail B, Burke, Robert W

In sum, it is crucial for teachers to realize that neither psychological conflicts nor problems in early childhood, such as inappropriate toilet training, appear to be the root cause of OCD (Greist, 1997; Rapoport, 1991). Thus, although stress from family conflict certainly can affect OCD symptoms, parents do not cause OCD.

Treatment of OCD

Several different treatments have been shown to be beneficial in managing OCD symptoms. A specific form of cognitive behavior therapy known as exposure and response prevention (ERP) has been very effective for many children with OCD (March & Mulle, 1998). Medications that alter the transmission of serotonin in the brain also are used widely to treat OCD, including Anafranil, Prozac, Luvox, Paxil, and Zoloft. Like all medications, such drugs may produce side effects including sedation, insomnia, stomach and intestinal upsets, increased or decreased appetite, and restlessness (Johnston & Fruehling, 1997). Although rare, more serious side effects may occur, including elevated heart rate, dizziness, blackouts, psychiatric symptoms, and seizures. Teachers should notify parents immediately if any of the latter symptoms are observed at school (A. J. Allen, personal communication, June 3, 1997).

Although behavior therapy and medications, alone or in combination, are effective for large numbers of children with OCD, additional treatment components are essential in many cases. Included among these are cognitive therapy, social skills training, support groups, and individual and family therapy (Rapoport, Leonard, Swedo, & Lenane, 1993). For children who struggle with OCD at school, it is very important that educational interventions be a fundamental part of treatment (Adams & Torchia, 1998).

Conditions Associated With OCD

OCD frequently co-exists with other disorders and conditions such as Tourette Syndrome (TS), Attention Deficit/ Hyperactivity Disorder (AD / HD), depression, disruptive behavior disorders, and anxiety disorders other than OCD (e.g., panic disorder and separation anxiety) (Hanna, 1995; Swedo, Rapoport et al., 1989). Children with OCD also commonly exhibit a type of learning disability known as a nonverbal learning disability (NVLD). Language and reading skills are intact in children with NVLDs, but they may experience difficulties in nonverbal areas that tap visual-spatial areas. Such difficulties can lead to problems with math, handwriting, and processing socialemotional information (March&Mulle, 1998).

It is essential that teachers recognize another potentially debilitating condition that usually occurs with OCD: family stress. Parents may experience stress as a result of many different factors, including feeling guilty that they may have caused or passed on the disorder; taking a child to numerous physicians, only to receive incorrect diagnoses; and witnessing or feeling pressure to participate in a child's rituals (e.g., the child may insist that a parent repeatedly check a door or wash clothing). In addition, parents frequently have difficulty distinguishing voluntary behavior (behavior that is within the child's control) from involuntary behavior (OCD-related behavior that is outside the child's control) (Adams & Torchia, 1998; A. J. Allen, personal communication, August 22, 1997).