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Obsessive-compulsive disorder in students: what it means in the school setting

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Students with obsessive-compulsive disorder (OCD) suffer from unwanted and intrusive thoughts that they can't seem to get out of their heads (obsessions), often compelling them to repeatedly perform ritualistic behaviors and routines (compulsions) to try and ease their anxiety. Most adults who have OCD are aware that their obsessions and compulsions are irrational, yet they feel powerless to stop them. However, children with OCD may not realize that their obsessions and compulsions are excessive. Some students with OCD spend hours at a time performing complicated rituals involving hand-washing, counting, clapping or using other physical rituals, or checking to ward off persistent, unwelcome thoughts, feelings, or images. Although many students are able to achieve academic success despite OCD symptoms, these symptoms can often interfere with a person's normal routine, schoolwork, family, or social activities.

Students who achieve academic success despite OCD symptoms and/or private diagnosis are often not found eligible for special education services because the disorder is not significantly impacting academic progress. For students in this situation, it is often the parent's responsibility to advocate for private therapy or services available within the general education setting, such as counseling, classroom accommodations, a home-school communication or reinforcement system, or a 504 Plan. Many students also benefit from a low dose of anti-anxiety medication, when recommended by a pediatric psychiatrist. These supports can be extremely effective and life-changing for a student with a milder form of OCD.

Students who are experiencing significant academic deficits (including social, behavioral, or emotional issues impacting academic performance) related to their OCD symptoms and/or diagnosis may be found eligible for special education services. Typically, the eligibility criteria that students diagnosed with OCD meet are Emotional Disturbance (ED), Other Health Impairment (OHI), and/or Autism (AUT). The reason for this is that there currently are no specifically designated criteria for OCD diagnosis in the special education code; examples of how the same student diagnosed with OCD could qualify under all three categories are listed below.

  • A student with OCD may meet the ED criteria due to a high level of anxiety related to OCD symptoms that impairs social and academic activities at school. For example, the student may be so nervous that his or her compulsive behaviors will be noticed by peers that the student refuses to come to school.
  • The same student with OCD may meet the AUT criteria due to a high level of peculiar, repetitive motoric behaviors which result in social impairments at school. For example, the student may feel the compulsion to clap every time a person says his or her name, and, feeling anxious about this, the student withdraws from peers and adults to avoid hearing his or her name.
  • The same student with OCD may meet the OHI criteria due to a limited alertness to educational materials related to their medical diagnosis of OCD. For example, the student is so preoccupied with his or her obsessions that the student cannot concentrate on school work and receives several failing grades.

Once a student with OCD has qualified for special education services, the IEP (Individualized Education Program, or Individualized Education Plan) team will decide what services are necessary to support the student so he or she can succeed at school. These supports can include psychological counseling, behavioral support, a behavioral support plan, occupational therapy services, speech therapy services, specialized academic instruction, or modifications in the school day or program, to name a few. Most students with OCD will not require the full spectrum of services; however, in cases where OCD is combined with other disorders- such as autism spectrum disorder (ASD), learning disability, or speech and/or language impairment- more services may be recommended.

Although students with moderate to severe OCD symptoms may benefit from special education supports and services, most students with OCD will have successful school careers and require minor, if any, accommodations at school. Mild OCD tendencies, when controlled, can even support students in demonstrating organization and attention to detail- qualities that are valued both in school and in many occupations.

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