Nassp Obsessive

7/28/2019 Nassp Obsessive

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12 PrinciPal Leadership S e p t e m b e r 2 0 0 7

Marcuss parents became concerned

when he asked the same question every

night: How do people get AIDS?

They also noticed that Marcus frequently

washed his hands, which had become red and

chapped, and often kept them tucked into his

armpits.

Similar concerns suraced at schoolMarcus requently asked permission to leave

the classroom to go wash his hands, kept

them in his pockets, and oten stopped by the

nurses ofce with questions about contagious

ailments, particularly AIDS. He avoided inter-

acting with other studentsto the point that

he now ate lunch at a corner table by himsel.

During a session with the school psychologist,

Marcus indicated that he was overwhelmed

with ear that he would contract AIDS al-

though he never engaged in risky behavior.

Marcus story is an example o obsessive-

compulsive disorder (OCD), an anxiety disor-

der that can interere with normal lie

and cause serious social and academic dif-

culty in school. Although OCD is a psychiatric

disorder that requires proessional diagnosis

and treatment, there are several ways that

school personnel can help students who

have OCD.

Udrstadig OCD

Once thought a rare psychiatric illness, OCDis now known to be a more common disor-

der characterized by a cycle o obsessions and

compulsions that cause extreme distress, dys-

unction, and ear. It is not simply meticulous-

ness or worrying. Obsessions are involuntary,

recurring, and unwanted thoughts that cause

eelings o anxiety or dread. They are irrational

and interere with normal thinking. Compul-

sive behaviors are repeated to try to control the

obsessive thoughts.

Perorming rituals provides temporary

relie rom the anxiety created by the obsessive

thoughts. Sometimes there is a clear connec-

tion between the obsession and the compul-

sion (e.g., contamination and washing), but

this may not always be the case (e.g., counting

behaviors may be used to prevent harm to oth-

ers). Oten the urge to perorm the compulsivebehaviors becomes stronger over time. I the

original compulsion becomes less eective

in reducing anxiety, then other behaviors or

more elaborate rituals are added to provide

relie. The compulsive behaviors can become

extremely time-consuming and interere with

normal unctioning. Some people can delay

the behaviors, but this is very difcult and they

will nearly always need to perorm the ritual

later. Students who are able to delay their

compulsions while in class, or example, may

need a private place to go to perorm rituals at

a later time during the school day.

People who have OCD are not delusional.

They usually recognize that these thoughts and

behaviors are unreasonable but eel unable

to control them. Symptoms tend to wax and

wane, and they may worsen as a result o ill-

ness or stress. Washing; checking rituals; and

preoccupation with disease, danger, and doubt

are among the most common symptoms in

childhood-onset OCD (Swedo, Rapoport,

Leonard, Lenane, & Cheslow, 1989).Approximately 2%3% o people (in-

cluding adolescents) have OCD, although

this may be an underestimate because many

symptoms are kept secret. OCD can emerge

as early as preschool. The number o children

who develop the disorder peaks at puberty and

then again during early adulthood (National

Institutes o Mental Health, Pediatric Obses-

sive-Compulsive Disorder Research, 2006).

One-third o adults who have OCD developed

Chaacizd y ad havios inndd o conol cuing anxiis,osssiv-coulsiv disod oaly affcs a las on of you sudns.

By Leslie Z. Paige

lese Z. Pge is

a nationally certifed

school psychologist and agrants acilitator at

Fort Hays State University

in Hays, KS.

Sudn Svics isoducd in collaoaion

wih h NaionalAssociaion of School

psychologiss (NASp).Aicls and lad

handous can downloadd fo www

.nascn.og/incials.

Obsessive-Compulsive Disorder

studet se ves


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e p t e m b e r 2 0 0 7 PrinciPal Leadership 13

symptoms as c i ren. A t oug OCD oc-

curs equally in both sexes, there is an earlier

onset in oys t an gir s Nationa Institutes o

Menta Hea t , 2006; O sessive-Compu sive

Foun ation OCF , 2006 .OCD is re ate to tic isor ers, suc as

Tourettes syndrome, and some adolescents

ave ot . OCD can a so exacer ate ot er

disorders, such as Attention Defcit Hyperactiv-

ity Disor er ADHD , epression, an panic

isor er OCF, 2006 . Re ative y persistent in

a u ts, c i -onset OCD as a comp ete remis-

sion rate o 10% 0% y ate a o escence

Zo ar, 1999 . Wit out treatment, OCD may

ecome c ronic an resu t in severe y e-

creased unctioning. The eects on adolescents

can e consi era e, inc u ing epression,agitation, poor attention and concentration,

ee ings o s ame, s ow per ormance, an

ot er pro ems associate wit poor aca emic

unctioning and difculties with relationships

Paige, 2004 .

Cause and Diagnosis

The cause o OCD is unknown, but research

suggests t at it may re ate to a ioc emica im-

balance that intereres with the way the brain

rocesses in ormation an causes t e rain to

send alse messages o danger. OCD may be a

earne response to re uce anxiety or may e

triggere y a stress u event.

C i ren an a o escents may i e t eir

symptoms or ear o eing regar e as crazy

or weir . A o escents may e particu ar y

conscious o t e stigma associate wit OCD

symptoms and may be adept at devising

exp anations or t eir e aviors or ways to

avoid places or situations that trigger them.

Compu sive ritua s o ten egin gra ua y, an

arents may unintentiona y compensate orthe behaviors. I children and adolescents have

itua s t at are eve opmenta y appropriate

e.g., lining up stued animals in a certain

way or wearing a uc y s irt or a a game or

appear healthy (e.g., washing hands ater using

t e at room , parents may not initia y e

concerne y OCD symptoms. As a resu t, t ey

may not seek treatment or their child until

t e e aviors ecome signi cant y isruptive

Sni er & Swe o, 2000 .

Treatment

Treatment success and eective strategies de-

pen on t e age o t e stu ent an t e severity

o t e e avior. Common treatments inc u e

me ication an cognitive e aviora t erapyCBT . Me ications e p ecrease anxiety an

reduce the intensity o the symptoms so the

stu ent is etter a e to ignore t e o sessive

thoughts. CBT helps the student cope with ob-

sessive t oug ts an re uce is or er nee to

perorm compulsive behaviors. Many adoles-

cents who have OCD ear that they are going

crazy. CBT e ps t em un erstan t e isor er,

e ps ecrease t eir symptoms, exp ains t eir

e aviors, an teac es t em coping strategies

that can be reinorced by parents and school

sta mem ers.

Effects on School Performance

OCD can have a signifcant negative eect on

earning, particu ar y i e t untreate . Comp ex

ritua s may cause atten ance pro ems t at

appear simi ar to sc oo avoi ance. In sc oo ,

stu ents may avoi situations or p aces t at

increase t eir o sessive t oug ts or may spen

time per orming ritua s in secret, w ic can

result in missed learning time and increased

socia iso ation. O sessive t in ing may mimic

the symptoms associated with Attention Defcit

Disor er ecause stu ents are istracte y

t eir o sessive t oug ts or are trying to e ay

perorming a compulsive behavior. Teachers

s ou un erstan t at a stu ent w o as

OCD and appears to be inattentive or agitated

actua y may e ocuse on istressing o ses-

sive thoughts or trying hard to not tap a pencil

a certain num er o times. T e compu sive

e aviors may resu t in u ying or victimizing

t e stu ent w o as OCD. O sessive t oug ts

may create agitation or socia pro ems.

Hlpig Studts With OCD

Raise awareness. Early identifcation and

appropriate treatment are very important

to managingand recovering romOCD.

Sc oo personne s ou e a ert to t e

symptoms o OCD and seek appropriate

a vice rom t e sc oo psyc o ogist or sc oo

counse or. Pro onge or requent a sences

rom class, unexplained agitation, repetitive,

commo ompusos

ude:

excssiv washing

and claning

riiv chcking

and chcking

Couning o a-ing wods (usually

silnly)

rdoing, such as

oning and closing,

asing and wiing

Hoading uslss

is

paying (coninuous

o xcssiv)

Syy (ov-

ns o ojcs nd

o ach o oddin a cain way)

commo obsessos

ude:

Conainaion

Ha o slf o ohs

Sxual houghs

Dah

Douing

Sin o guil

blif ha hingsnd o don in a

cain way o nu

of is o avoid ha


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14 PrinciPal Leadership S e p t e m b e r 2 0 0 7

studet se ves

regimented behaviors might all be signs o a

problem. Some behaviors may not be directly

observed (e.g., hand washing) but can be

inerred rom indirect observations (e.g., raw,

bleeding hands). Reduce stigma by educat-ing sta members and students about OCD

and explaining the act that symptoms o the

disorder are not in the adolescents control and

are no more his or her ault than shortness o

breath is or a student with asthma.

Partner with parents. Parent involvement

is essential to helping a student cope with

OCD. Some parents may require education

about the disorder and how the school can

support their child. Some parents will seek col-

laborative support rom school, but others may

be concerned with privacy and resist schoolinvolvement in treatment plans. Parents and

adolescents eel more confdent and hope-

ul and interventions are implemented more

eectively when parents are inormed and are

embraced as partners in decisions about how

to help their child copeand succeedat

school.

Collaborate with community providers.

Ideally, school-based mental health proes-

sionals communicate with the students health

care provider regarding treatment plans and

behavior limits. The school psychologist may

be able to suggest strategies to decrease anxiety,

reinorce coping skills, and enhance academicperormance. The school nurse may need to

administer medication during the school day.

These school-based supports should be coordi-

nated with the students health care providers.

Provide appropriate support. Teachers

should know how OCD aects learning and at-

tention in general terms and how they aect a

particular student. They should also know how

to respond appropriately to a student who is

distressed or disturbed by unwanted thoughts.

Telling adolescents who have OCD to stop

worrying or that nothing bad will happen isnot sufcient, and punishing or embarrass-

ing them is ineective and may worsen the

symptoms.

Well-structured classroom environments

with clear expectations, smooth transitions,

and a calm climate are helpul or all students,

but especially or students who have OCD,

whose symptoms may be exacerbated by stress.

Some accommodations may be needed, such

as allowing extra time to take a test because o

a students compulsion to check and recheck.

The school should ensure that there is at least

one sta member (e.g., a school psychologist

or a counselor) to whom a student can turn

when struggling with symptoms. The school

may also need to arrange or a sae spot or

a student who is eeling overwhelmed with

intense thoughts or eelings. Some students

may qualiy or special education services i

the disorder impairs learning or behavior to a

signifcant degree.

SummaryOCD can cause extreme disruption and

distress or adolescents at a time when both

sel-actualization and socialization are vital

and disrupted learning can have serious conse-

quences. Fortunately, OCD is also manageable

when identifed and treated early and consis-

tently. School administrators can help students

with OCD by ensuring that sta members

understand the disorder, recognize symptoms,

and are prepared to provide the appropriate

idetfto d

Tetmet o OcD

2%3% of high school

sudnsnaly

500,000 individualshav OCD.*

OCD is highly an-

agal, vn cual

in 10%50% of cass,

u aly diagnosis

and an a

ioan.

Adolscns ay

hid hi syos

fo fa of ing lald

cazy.

A coinaionof dicaion and

cogniiv-havio

hay can hl

diinish syos.

*basd on 2007 nolln

sias fo h U.S.

Dan of educaion,

Naional Cn fo educaion

Saisics (2006).

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S e p t e m b e r 2 0 0 7 PrinciPal Leadership 15

support. Equally important, principals should

work to eliminate the stigma against those

who have OCD and other mental illnesses so

that all students eel sae, valued, and sup-

ported by their school community.Treatment or Marcus included medica-

tion and CBT in addition to special education

services or ADHD. The IEP team determined

that Marcuss obsessive thinking had interered

with his ability to concentrate and perorm

academically. In consultation with his thera-

pist and the school psychologist, the IEP team

added goals to address his OCD symptoms to

his IEP. He is better able to control his ears o

contamination, and his hand-washing behav-

ior has decreased to near normal. By monitor-

ing the condition o his hands, his parents andteachers can intervene as needed. PL

RefeRenCeS

n National Institutes o Mental Health. (2006).Anxiety disorders. Retrieved May 31, 2007, romwww.nimh.nih.gov/HealthInormation/ocdmenu.cm

n National Institutes o Mental Health, Pedi-atric Obsessive-Compulsive Disorder Research.(2006). FAQs about OCD. Retreived May 31, 2007,rom http://intramural.nimh.nih.gov/pocd/pocd-aqs.htm#FAQ-1

n Paige, L. Z. (2004). Obsessive-compulsivedisorder: Inormation or parents and educators.In Canter, A. S., Paige, L. Z., Roth, M. D., Romero,I., & Carroll, S. A. (Eds.), Helping children at homeand school II: Handouts for families and educators.Bethesda, MD: National Association o SchoolPsychologists.n Obsessive-Compulsive Foundation. (2006).What is OCD? Retreived June 1, 2007, rom www.ocoundation.org/what-is-ocd.htmln Snider, L. A., & Swedo, S. E. (2000). Pediatricobsessive-compulsive disorder. The Journal of the

American Medical Association, 284, 31043106.n Swedo, S. E., Rapoport, J. L., Leonard, H. L.,

Lenane, M., & Cheslow, D. (1989). Obsessive-compulsive disorder in children and adolescents:Clinical phenomenology o 70 consecutive cases.

Archives of General Psychiatry, 46, 335341.n Zohar, A. H. (1999). The epidemiology oobsessive-compulsive disorder in children andadolescents. Child and Adolescent Psychiatry, 8,445460.

resoues

Freeing your child rom

obsessive-compulsive

disorder. t. e. Chansky.

(2000). Nw Yok:th rivs pss.

Naional Insius of

mnal Halh

www.nih.nih.gov/

HalhInfoaion/

ocdnu.cf

tns Halh

h://kidshalh.og/

n/you_ind/

nal_halh/ocd.hl

OCD Foundaion

www.ocfoundaion.og

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Nassp Obsessive