OCD at School

Most children have occasional fears‹the monster under the bed or the ghost in the closet, not to mention other things that go bump in the night. But for kids with obsessive-compulsive disorder (OCD), fears can turn ordinary activities and daily routines into 24-hour nightmares. (See also School Health Alert December Œ98, p. 1.)

These youngsters don't leave their fears at home. Researchers Gail Adams and Marcia Torchia have compiled the obsessions and compulsions that are most likely to show up in school.

Obsessions (thoughts)

• Fear of contamination. Some children are inordinately concerned with germs, dirt, ink, paint, body secretions, excrement, blood, chemicals, and other substances.
• Fear of harm, illness, or death . Some children are consumed with fear for their personal safety or the safety of parents or significant others in their lives.
• Obsession with numbers. Boys, especially, are prone to be preoccupied with numbers. A child might think of certain numbers as safe and others as bad. In some cases, a number controls a child¹s thinking and actions; for example, the child might have to touch a doorknob 20 times, pound his chest 12 times, or repeatedly count to a certain number.
• Obsession with evil. Some children continually fret that they will do something bad or sinful. The counterpart to this obsession is having to confess, pray, or atone for their imagined wrongdoing.

Compulsions (actions)

• Washing and cleaning rituals. About 80 percent of children and adolescents with OCD feel compelled, at some time, to wash and clean themselves and their surroundings. In school, these children might ask to go to the restroom frequently to tend to their ritual.
• Checking compulsions. Children with OCD‹especially those who fear harm to themselves or others‹often feel compelled to check doors, windows, light switches, electrical outlets, water faucets, and appliances.
• Repeating compulsions. Some kids with OCD need to repeat an action over and over in an attempt to get it "just right." Some might need to go in and out of a doorway repeatedly until they¹re satisfied that they did it correctly.
• Symmetry compulsions. Children might need to arrange objects in a symmetrical or balanced arrangement. Some kids need to tie their shoelaces so that both shoes look exactly the same.
• Avoidance compulsions. Some children take extreme measures to avoid certain objects, substances, or situations that will provoke their obsessions. In school, kids might refuse to touch a glue bottle, clay, or scissors.
• Reassurance compulsions. Some children with OCD need constant reassurance that they are safe, free from contaminants, or doing their work the right way. Most of the time, a teacher¹s comforting words have a short-lived effect, and the student soon seeks another dose of reassurance.

(Black S . Overcome by fear. Amer School Board J March, 1999, pp. 31-34)

COMMENT: The newer psychotropic medications are having good results. Zoloft (sertraline) is discussed in School Health Alert, March Œ99, p. 4.)