Obsessive-Compulsive Disorder (OCD)- Supporting Children in Schools

In this article, Delyth Hughes explores obsessive-compulsive disorder and looks at some of the practical steps schools can take to support children.

Children who have obsessive-compulsive disorder (OCD) are plagued with unwanted thoughts, images or impulses that they find difficult to suppress and obsessions; all of which cause great stress and worry. To alleviate this anxiety they perform repetitive, ritualised actions which are called compulsions. For example, a child with OCD might need to line things up or touch things in a certain order before being comfortable to leave the room or they may wash their hands repeatedly.

Common compulsions include:

• Obsession with contamination – this is the most common obsession seen in children. A child may worry about:
  • Adults and other children sneezing, coughing or displaying other signs of being unwell;
  • Touching things that might be dirty;
  • Getting sick in a variety of different ways.
• Being plagued by what ifs – where children are plagued by many thoughts about bad things they could do, even though the likelihood of such actions are remote e.g. 'What if I hurt someone? What if I stab someone? What if I kill someone?';
• Fulfilling the 'just right' feeling – needing to do something until they experience self-satisfaction that it has been done correctly. Between the ages of six to nine years children usually are unaware why they have this compulsion, just that they have to do it until it feels right. For example, they may need to colour sequence items in a certain way. As they grow older, over time this compulsion evolves into magical thinking and becomes more superstitious in nature;
• Magical thinking & superstition – like thinking that is taken to extremes. The child may worry that their thoughts or failure to complete action sequences may cause another person to become ill or hurt. For example, a child might think that unless they line items up in a certain way, harm will affect another person;
• Catastrophising – jumping to the conclusion that something terrible has happened e.g. if someone is late to collect them that they have been permanently abandoned;
• Scrupulosity – when children are overly concerned that something they thought or did might be a sin or other violation of religious or moral doctrine. They have obsessive worries about offending God or being blasphemous in some way.

Emotional-obsessive-compulsive disorder affects people differently, but usually causes a particular pattern of thoughts and behaviours. There are 3 main elements:

1. Obsessions – where an unwanted, intrusive and often distressing thought, image or urge repeatedly enters a person's mind;
2. Emotions – where the obsession causes a feeling of intense anxiety or distress;
3. Compulsions – repetitive behaviours or mental acts that a person with OCD feels driven to perform as a result of the anxiety and distress caused by the obsession. The compulsive behaviour temporarily relieves anxiety, but the obsession and anxiety soon return causing the cycle to recommence.

Common OCD obsessions include:

• A fear of deliberate self-harm or harming / attacking others;
• A fear of self-harming or harming others by mistake;
• A fear of contamination e.g. diseases, infections;
• The need for things to be symmetrical and ordered.

OCD Treatment

OCD can be treated. The two main treatments are:

• Psychological therapy – therapy to help the person face their fears and obsessive thoughts without actioning their compulsions;
• Medicine – usually antidepressant medicine that helps by altering the balance of chemicals in the brain.

These treatments can be very effective, but can take several months before any benefit is seen.

Treatment and support enable those with OCD to better manage their symptoms thereby improving their quality of life. Those with OCD may also have or develop other mental health difficulties including anxiety disorders, eating disorders and depression. In the most severe cases, those with OCD and depression may experience suicidal feelings.

Practical OCD support for children

Children with OCD may struggle with the routines and confines of school life however, there are some simple general ways they can be supported in addition to any individual needs specified in their care plan. These include:

• Breaking tasks and setting work into much smaller activities. Sizeable tasks overwhelm children with OCD, so rather than being focussed on completing the work they worry and become anxious about the amount of work they have to complete. So by dividing the work or tasks into smaller tasks they are more likely to focus on the task, complete the work and make less mistakes;
• Avoiding situations which involve them reading aloud, especially in front of the class or to an audience. Children with OCD can feel a real need to read perfectly and, as a result, may reread sentences or whole paragraphs over and over to make sure they have got them right;
• Thinking very carefully about seating arrangements. Research shows that children with OCD do better, are less overwhelmed and are more in control of their thoughts and their actions if they're in a quiet place away from the other children. They may be easily distracted by noise so will benefit from sitting in quieter areas of the room. For those with observable symptoms such as fidgeting, rocking or inability to remain seated, the back of the room or sitting near to an exit may be more appropriate;
• Enabling access to support technology. For some children with OCD writing, repeated rewriting and multiple correction erasing is problematic. Although not a solution for all tasks, access to a laptop may help to alleviate anxiety and assist learning;
• Allowing extended time for tasks. Children with OCD may obsess on striving to find the perfect way to complete tasks, and as a result will need more time if tasks are to be completed. This also includes extending timescales for ongoing project work and homework.

Employing the above simple strategies can be hugely beneficial in supporting children with OCD, enabling them to more easily cope with structured school life.

Want to know more about supporting mental health? Check out our Supporting Mental Health and Wellbeing training.

Delyth Hughes

Senior Leader Children's Mental Health Recovery Unit