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Transcript of Nassp Obsessive
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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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