Managing OCD in the Classroom
In any classroom, the teacher is the central figure who leads the class in learning, enlightens with insight, maintains order, promotes good behaviour and rewards good work. The teacher also sets the mood of the classroom.
When a teacher has a positive attitude, the students are also likely to be positive. Conversely, a teacher’s negative attitude can have an adverse impact on the class. A teacher’s approach is all the more important for students with OCD. When a teacher supports and encourages these students, and tolerates no ridicule or discrimination from other students, it can make a huge difference in terms of how the student with OCD progresses.
One of the most important things teachers must remember when faced with the challenge of managing OCD in the classroom is that children and adolescents are very impressionable. Peer pressure to fit in and to be part of a group of friends can be extremely hard for the student who has OCD.
There are a number of ways teachers can provide support. With some basic planning, a teacher can make accommodations that help the student academically, socially, behaviourally and emotionally. The following sections, beginning with Healthful Support Strategies, will provide ideas and strategies for teachers and other school personnel to work more successfully with and improve the school functioning of the student who has what may be a very distressing disorder.
Strategies for Managing the Student and the Situation
Some of the following strategies can help both the student who has OCD and the teacher who manages the classroom.
Focus on self-esteem issues – Building or maintaining the self-esteem of the student with OCD is extremely important. Students can be very cruel to one another and students with OCD may need some extra help realizing that they have value, talent and capabilities. They need to hear that OCD is not who they are, but just something they happen to have, just as asthma and diabetes do not define who a student is but, rather, are illnesses a young person may have. School personnel should look for the student’s strengths — perhaps creativity, artistic capabilities or athletic prowess. Educators should help them focus on their strengths, which can relieve some of the self-esteem issues that may arise from feeling “different.”
It may also be helpful to provide opportunities for students with OCD to demonstrate their talents. Such opportunities may help the student with OCD realize that he or she is not defined by OCD. They may also help peers see the student in a different light. Of note is that student talents should never be misused as a “carrot” that is given and taken away in a behaviour plan. An activity the student loves or one in which he or she excels should not be considered something to be taken away as a punishment or allowed only as a privilege to be earned.
Create a “safe” environment – A student who has OCD may get “stuck” trying to solve a problem or may falter and be unable to read aloud or present to the class. He or she may do poorly on an in-class assignment or a test. The student needs to know that the teacher will not become angry about these difficulties or lecture or punish the student for something over which he or she has no control. If school personnel treat students who have OCD with respect and understanding rather than anger and punishment (which can be difficult, given the challenges these students sometimes present), they will provide peers a positive model. Treating students who have OCD with respect and understanding can also boost their self-esteem.
There are many reasons why a student may do poorly in school. But when it’s known that the student has OCD (or it is strongly suspected), his or her patterns of problems may become more obvious and predictable. It’s unrealistic to expect disciplinary action to change what the student is unable to change (and is already upset about). In fact, punishment may actually create more stress for the already distressed student and therefore exacerbate OCD symptoms.
Allow a “break” to defuse anxiety – Sometimes the pressure of the anxiety, worry, doubt, and urges associated with OCD builds to a point where students feel as if they could explode. If an outburst occurs in the classroom, it has the potential to be very disruptive. Students can sometimes avoid an outburst when they experience mounting stress by taking a kind of “time out” to relieve the pressure. It’s important to note that this is not the traditional time out in which a student is asked to leave the classroom or go to a designated area as a result of inappropriate behaviour. When a child has OCD, he or she may be allowed to leave a situation in order to calm down, or regroup.
Some teachers have reported good success allowing students to leave the classroom for a few minutes before things get out of control, or before they cannot control their emotions. Surprisingly, this privilege generally is not abused by the student who has OCD –- he or she realizes it is a coping strategy. The child may just need to stand outside the classroom or walk down the hallway and back to feel better. Or the student may be allowed to leave the room briefly to get a drink of water, run an errand, etc. to help clear his or her mind of obsessive thoughts.
Sometimes the office of a staff member (such as the school nurse or counsellor) can be designated as a “safe” place where the student can go for a few minutes or talk with the staff member for a short time. To avoid classroom disruption, a small card can be developed with wording such as “GO” or “BREAK” on it. The student can lay the card on his or her desk and quietly leave the room without disturbing the class and drawing classmates’ attention to the exit (it may help these students if they sit near the classroom door). Teachers should make every effort possible to help students with OCD “save face” in front of their peers.
Another suggestion is to have the teacher and student develop a private signal (e.g., a hand signal such as raising the hand with a closed fist) that the student can use to indicate he or she needs to leave the room. A time limit should be established in advance for breaks, and, should a student be found to be using this privilege inappropriately, usual behavior management strategies should be implemented. Of note is that this is not a good strategy for a student who experiences contamination fears and wishes to go to the bathroom repeatedly to carry out washing rituals.
Watch for side effects of medication – Some problems students experience may be caused by a reaction to medication. While Cognitive Behavior Therapy (CBT) is frequently the first line of treatment for OCD, it’s possible that the student may also be taking medication. And in some cases, a student may be taking medication only. All medications, including those used for OCD, have potential side effects. Side effects such as nausea, increased anxiety, jitteriness, and insomnia are relatively common, especially during the initial phase of treatment. Any side effects — even those that are minor and hardly noticeable — should be documented. If side effects are frequent, unusual, or severe, however, parents should be contacted immediately.