Notes

Outline

Obsessive-Compulsive Disorder

OCD often starts before adulthood Community surveys of adolescents suggest 1% to over 3% are currently experiencing symptoms of OCD. Children as young as 5 or 6 can show full-blown OCD. Between 30% and 50 % of adults with OCD reported that their symptoms started during or before mid-adolescence.

Obsessive-Compulsive Disorder The individual must have obsessions and compulsions that cause distress and last at least one hour per day. Adults usually have some insight into the fact that their symptoms are excessive or unrealistic. Children often do not have this insight. DSM-IV American Psychiatric Association

Obsessions Impulses, images or thoughts that occur repeatedly and result in significant anxiety. These thoughts must be more than  excess worries about present life situations. The individual tries to get rid of the thoughts by using other thoughts or actions. DSM-IV American Psychiatric Association

Compulsions The individual feels compelled to perform certain repeated ritualistic behaviors in response to a mental obsession DSM-IV American Psychiatric Association

Evaluation Meet with the child and ask specific questions about obsessions and compulsions Meet with parents or other primary caregivers Obtain information from school Checklists: Y-BOCS

What causes OCD?

Psychodynamic Neurotic fixation

Biological Abnormalities in the sub-orbital cortex        (the underside of the front part of the brain) and the basal ganglia Serotonin may be involved in mediating the interaction between these two parts of the brain Increased activity in sub-orbital cortex normalizes with effective treatment.

Other biological causes PANDAS-Antibodies to Beta-hemolytic streptococcus attack segments of the brain

OCD Spectrum Disorders Tourette Disorder Tricotillomania Body Dysmorphic Disorder Habit disorders

Untreated OCD Becomes chronic Some wax and wane over time Some worsen and become more globally impaired Can lead to depression

Children and Adolescents are Different from Adults May have less insight May be oppositional and in denial Family is more of a factor May have difficulty verbalizing the problem Size and metabolism are different

Treatment Cognitive-behavioral psychotherapy Medication Family and school support

Cognitive-Behavioral Therapy Educate child and family that the enemy is the disease not each other Hierarchy Exposure and response prevention Relaxation and other tools

Medication SSRIs Clomipramine Other medications Beta blockers, buspirone, benzodiazepines, augmentation strategies

Long-Term Planning

How School Staff Can Help

How the school can help the clinician School-based intervention designed collaboratively by the classroom teacher, school psychologist and outside clinician to address: Frequent bathroom requests Frequent requests for reassurance Visible compulsions and rituals Positive reinforcement of progress

Managing OCD Symptoms in the Classroom Do not punish behaviors the student cannot control Boost self-esteem Increase positive peer interactions Discourage peers from teasing the student Assign student to an empathic teacher “Safe” place or person for when the student feels overwhelmed

Managing OCD in the Classroom Be aware of possible medication side effects Track behavior changes with checklists if requested Support parents Educate peers about OCD