Teaching Students With

Obsessive-Compulsive Disorder
Melissa Leininger, Tina Taylor Dyches, Mary Anne Prater
and Melissa Allen Heath

Obsessive-compulsive disorder (OCD) is a neurobiological condition affecting 1 of every 200 school-age chil-
dren. OCD greatly affects students’ academic, behavioral, and social functioning, and it can lead to additional
problem such as depression. To effectively collaborate with other individuals providing appropriate support to
students with OCD, teachers need to understand this disorder, particularly its manifestations in school settings.
This article addresses typical manifestations of OCD in school settings and provides general and specific accom-
modations for teachers to implement in their classrooms.

Keywords: obsessive-compulsive disorder; disabilities; classroom techniques; academic accommodations

O bsessive-compulsive disorder (OCD) is a neuro-

biological condition that typically emerges during
adolescence or young adulthood, although younger chil-
to 20 students in a large high school (March, Leonard,
& Swedo, 1995). Although some research has cited
OCD prevalence rates ranging from 1% to 4% for chil-
dren may also manifest symptoms (Adams, 2004; dren and adolescents (Zohar, 1999), more recent epide-
American Psychiatric Association [APA], 2000; miological research has indicated that it affects .25% of
Piacentini & Bergman, 2000). It is the fourth most com- children ages 5 to 15 (Heyman et al., 2001). Some of
mon pediatric psychiatric disorder in the United States the difference in cited prevalence rates may be due to
(Adams & Burke, 1999), and one third to one half of (a) significant increases in prevalence as children reach
adults with OCD report childhood onset (Rasmussen & adolescence (Heyman et al., 2001), (b) differences
Eisen, 1990). Frequently cited studies indicate that OCD between clinic-referred and nonreferred populations
affects 1 in 200 school-age students (Flament, 1990;
Intervention in School and Clinic, Volume 45 Number 4, March 2010 221-231
Flament et al., 1988), which is approximately three to DOI: 10.1177/1053451209353447 • © 2010 Hammill Institute on Disabilities
four students in an average-size elementary school or up http://isc.sagepub.com hosted at http://online.sagepub.com

221
222   Intervention in School and Clinic

(Zohar, 1999), (c) incorrect diagnosis (March et al., his washing compulsion surfaced. With prescribed med-
1995), (d) differences between self-report and clinician- ication, the boy’s washing compulsions subsided but
administered measures (Stewart, Ceranoglu, O’Hanley, & increased in severity during high school. At the study’s
Geller, 2005), and (e) disguising of symptoms by chil- conclusion, the young man was enrolled in college, only
dren and adolescents (Leonard, Ale, Freeman, Garcia, & mildly troubled by aggressive obsessions and compul-
Ng, 2005; Penn & Leonard, 2001). sions. The study concluded that his numerous OCD
If teachers are to effectively support students affected symptoms changed in content and severity over time.
by OCD, they need to be informed about this complex Although the exact causes of OCD are unknown, most
disorder (Adams, 2004). However, students with OCD evidence indicates that it is an anxiety disorder caused by
often attempt to keep people, including peers and teach- a chemical imbalance in the brain (Adams, 2004; APA,
ers, unaware of the disability by trying to hide their 2000; March, Frances, Carpenter, & Kahn, 1997; Paige,
symptoms (APA, 2000; Purcell, 1999). Yet, these stu- 2007; Piacentini & Bergman, 2000; Wagner, 2002). Other
dents must deal with their OCD symptoms daily, includ- factors that may influence the development of OCD
ing the impact on their schoolwork. In fact, a recent include genetics (Cameron & Region, 2007), viral infec-
study of 5- to 17-year-olds indicated that the two most tions (National Institute of Mental Health, 2008), and
common problems resulting from OCD in this age group stressful life events (Piacentini & Bergman, 2000).
were school related: (a) concentrating on schoolwork And although there is no known cure for OCD,
and (b) completing homework (Piacentini, Bergman, existing treatments help control its symptoms (Wagner,
Keller, & McCracken, 2003). 2002). In particular, cognitive behavior therapy (CBT)
Obsessive compulsive disorder is characterized by and medication have demonstrated effectiveness in
obsessions and compulsions that are time consuming reducing OCD symptoms in children and adolescents
(taking more than 1 hr per day) and cause marked dis- (Cameron & Region, 2007; Carter & Pollock, 2000;
tress, anxiety, or impairment in functioning (APA, 2000). Piacentini & Bergman, 2000). With CBT, individuals
Obsessions are intrusive, repetitive, and distressing are gradually exposed to their fears and anxieties while
thoughts. In an attempt to ignore, suppress, or neutralize being instructed to refrain from compulsive behavior.
these thoughts, the individual develops coping behav- They are taught to identify and correct dysfunctional
iors, referred to as compulsions. Though not well under- beliefs and evaluate the likelihood of feared consequences
stood by others and thus seemingly illogical, compulsions (Cameron & Region, 2007; Piacentini & Langley, 2004).
are repetitive ritualistic behaviors, such as repeatedly Selective serotonin reuptake inhibitors (SSRIs) such as
washing hands or erasing written work (APA, 2000). Zoloft, Prozac, and Luvox are often the pharmacologi-
Obsessive compulsive disorder is a chronic condition cal treatment for OCD in children (Cameron & Region,
with symptoms that wax and wane (APA, 2000; Franklin 2007; Wagner, 2002) because they help reduce anxiety.
& Foa, 1998; Leonard et al., 2005; Penn & Leonard, Within the past few years, Riluzole has proven effective
2001), meaning that an individual’s symptoms are in reducing glutamate production, which essentially
inconsistent across time. For instance, a student typically turns down the brain’s warning sensors (Pittenger et al.,
obsessed with hand washing, as evidenced by cracked 2008); however, pharmacological studies for Riluzole
and raw skin, may have several weeks of only washing have not included children.
hands occasionally. This period of reprieve is then fol- The Pediatric Obsessive Compulsive Disorder Treat-
lowed by a reemergence of excessive hand washing. ment Study Team (2004) and the OCD Expert Consensus
Obsessive behaviors are affected by stress, which Guidelines (March et al., 1997) recommend beginning
exacerbates symptoms (APA, 2000; Penn & Leonard, treatment for OCD with CBT alone or in conjunction
2001). Rettew, Swedo, Leonard, Lenane, and Rapoport with an SSRI. The sole treatment of CBT is preferred for
(1992) studied 79 children and adolescents with OCD children and adults with milder OCD symptoms (March
and provided illustrative case examples. One of these et al., 1997). Other researchers have suggested that SSRIs
case studies described a 14-year old boy who, after mov- should not be administered to children or adolescents
ing to a new neighborhood at age 4, began washing his unless they have co-morbid disorders or when CBT has
hands repeatedly. The hand washing subsided and disap- not been effective (Sloman, Gallant, & Storch, 2007).
peared after 6 to 8 months. No obsessive behaviors were Although evidence exists for the efficacy of these SSRIs
observed until he started junior high school. At age 12, in older children and adolescents, less is known about their
the boy exhibited multiple obsessive fears; specifi- effectiveness in preschoolers and younger children
cally, he compulsively checked the light, TV, and radio (Cameron & Region, 2007; Carter & Pollock, 2000). Also,
switches and repeatedly erased and corrected his hand- CBT for OCD in children and adolescents has only
writing. In addition to his new compulsive behaviors, recently received empirical support (March, Franklin, &
 Leininger et al. / Teaching Students with OCD   223

Foa, 2005). Freeman et al. (2007) conducted a qualitative Obsessive compulsive disorder also affects the social
review of child CBT research and found no treatment stud- functioning of students (Adams & Burke, 1999). They
ies examining OCD in children younger than 7 years old. may struggle with processing social-emotional informa-
Most of the studies also examined the efficacy of CBT in tion, which negatively affects friendships and interper-
conjunction with medication. Therefore, findings from sonal skills (Adams, 2004; Adams & Burke, 1999). As
many studies may not generalize to younger children, who students with OCD are often bullied or victimized
are less likely to be prescribed medication. because of their compulsive behaviors, they take great
measures to hide their compulsions from peers, which
Understanding Students With OCD may increase their social isolation (Adams & Burke,
1999; Adams, Waas, March, & Smith, 1994; Paige,
Because OCD behaviors can be easily misunder- 2007). Additionally, rituals are time consuming and
stood, teachers should learn to recognize when a student mentally exhausting, leaving children and adolescents
may have OCD tendencies. An increased awareness of little time or energy for friends (Adams & Burke, 1999).
symptoms can lead to early interventions, decreasing Character traits of individuals with OCD that interfere
the negative impact of OCD on learning (Cameron & with performance include incessant worry, excessive
Region, 2007; Freeman et al., 2007). Students with expectations, dissatisfaction with results, competitive-
OCD typically perform well below their potential in ness, procrastination, need for control, and self-criticism
areas of academic achievement (Parker & Stewart, (Parker & Stewart, 1994). Teachers must carefully note
1994). This decline in schoolwork often occurs because when such behaviors significantly interfere with stu-
symptoms of OCD are interfering with concentration dents’ functioning because misunderstanding students
and productivity (APA, 2000). For example, some stu- with OCD often leads to their discouragement, frustra-
dents may have trouble getting to school on time tion, and depression. It also leads to nonidentification of
because of countless morning rituals they perform to get the disorder or mistaken labeling of students with OCD,
ready for school. Some students may not be able to fin- as well as ineffective academic and behavioral interven-
ish their homework because they are frequently erasing, tions (Parker & Stewart, 1994).
redoing, and perfecting their work. Some students may Teachers should not assume, however, that any stu-
have anxiety attacks during tests or become too dent engaging in the behaviors described earlier in this
depressed to attend school (Purcell, 1999). article has OCD. Many children exhibit developmen-
Students with OCD tend to have more learning tally appropriate, typical behaviors that are somewhat
disorders—specifically, nonverbal learning disabilities similar to OCD behaviors (Adams & Burke, 1999),
(Adams, 2004)—than those without OCD. This means such as bedtime rituals (e.g., getting tucked in or hear-
that although some students with OCD may have ade- ing a story), childhood ritual games (e.g., “step on a
quate verbal skills in language, reading, and spelling, crack and break your mother’s back”), or having things
they may struggle with tasks that require visual-spatial done “just so” (Adams, 2004; Boucher, 1999). These
skills, such as mathematics and handwriting. can be comforting and help children overcome separa-
Also, OCD can exacerbate a preexisting learning tion anxiety and deal with the developmental issues of
disorder and cause problems with attention and concen- mastery and control (Adams, 2004; Boucher, 1999;
tration (APA, 2000; March et al., 1997). In the class- March & Leonard, 1998). These OCD-like behaviors
room, OCD may resemble attention-deficit-hyperactivity usually disappear by middle childhood and tend to be
disorder (ADHD) or oppositional behavior (Carter et al., replaced by collections, hobbies, and focused interests
1999; Schlozman, 2002). Students with OCD may have (March & Leonard, 1998).
trouble paying attention in class because they have a One way teachers can distinguish OCD from similar
hard time disengaging from their own thoughts or are but more developmentally appropriate behaviors is to
involved in mental rituals in response to their obses- remember that OCD “occurs somewhat later in develop-
sions. They may also try to avoid or delay carrying out ment, appears bizarre to adults and other children (if not
a compulsive behavior (Adams & Burke, 1999; Paige, to the affected child) and produces dysfunction, rather
2007). When students stare out a window or hover over than mastery” (Adams & Burke, 1999, p. 4). For exam-
a worksheet in a daze, the teacher could interpret these ple, it is appropriate for 2- to 3-year-old children to fol-
behaviors as “inattentive, lazy, or even defiant” (Adams low typical developmental routines for eating, bathing,
& Burke, 1999, p. 5). In some cases, these off-task and bedtime (Francis & Gragg, 1996), whereas strict
behaviors are related to a student’s OCD, and if they are adherence and insistence in following such routines and
properly treated, may subside (March et al., 1997). rituals at later ages may be cause for concern.
224   Intervention in School and Clinic

Obsessive-compulsive behaviors are distinctly differ- positive and negative effects of medications (Adams &
ent from typical developmental behaviors (Francis & Burke, 1999; Adams et al., 1994; Carter et al., 1999;
Gragg, 1996). Unlike students with typical ritual behav- Dornbush & Pruitt, 1995; Purcell, 1999). Teachers should
iors, students with OCD have obsessions and compul- be aware of side effects of medications. Negative side
sions that are all-consuming and fears that they may effects include sedation, insomnia, stomach and intesti-
never outgrow (Black, 1999; Schlozman, 2002). These nal upsets, increased or decreased appetite, and restless-
obsessions are not simply excessive worries about real- ness. More serious side effects include elevated heart
life problems (APA, 2000). Teachers should realize that rate, dizziness, blackouts, psychiatric symptoms, and
“neatness and correctness are virtues; unnecessary eras- seizures (Adams & Burke, 1999). Teachers are cau-
ing, redoing, and the inability to accept mistakes are tioned to report accurate information so the students’
concerns” (Parker & Stewart, 1994, p. 570). health care providers can make medication adjustments
as necessary; it is not the teacher’s responsibility to sug-
gest changes in medication or health care services.
Teaching Children and Teachers’ attitudes are critical to the success of stu-
Adolescents With OCD dents with OCD. Teachers will be more successful when
they understand that students who manifest obsessive-
One of the most important ways teachers can help compulsive behaviors are often trying to do their best
students who exhibit obsessive-compulsive behaviors is and that coping with their symptoms is not simply a
to recognize symptoms of the disorder. If students’ com- matter of willpower (Carter et al., 1999; Parker &
pulsions are impeding their academic or social skills, Stewart, 1994). Teachers should recognize that these
the teacher needs to seek help from specialists to iden- students often have low self-esteem and need additional
tify the problem as well as find solutions to promote positive attention (Adams, 2004).
academic and social success. Students who are diag-
nosed with OCD may qualify for services under General Classroom Strategies
Section 504 of the Rehabilitation Act or special educa-
tion services under the Individuals with Disabilities Although students with moderate to severe OCD may
Education Act ([IDEA]; Adams, 2004; Adams & need services beyond what teachers can provide, such as
Burke, 1999; Black, 1999). In the past, students with CBT or medical treatments (Heyman, Mataix-Cols, &
OCD have been classified under IDEA’s emotional Fineberg, 2006), teachers can implement many simple
disturbance category. OCD is now most often classified strategies to help students with OCD. The following
under other health impairment as a neurobiological strategies are not only applicable to students with OCD
disorder (Adams, 2004). General and special education but helpful for other students in the classroom (Parker &
teachers should be familiar with state and federal regu- Stewart, 1994). Before determining which strategies to
lations to provide evidence-based instruction, adapta- use, teachers should consider each student’s unique
tions, and accommodations. characteristics (Carter et al., 1999) and collaborate fre-
Another important way teachers can help students quently with parents to exchange observations, progress
with obsessive-compulsive symptoms is by collaborating reports, and advice (Black, 1999).
with parents and professionals (Paige, 2007). Teachers
may be asked to provide information from classroom Establish rules and expectations. Rules and expecta-
observations of students’ academic and behavioral func- tions for all students should be consistent and stated
tioning to their parents, school psychologist, or school positively rather than negatively (Dornbush & Pruitt,
counselor (Purcell, 1999). School personnel should edu- 1995). Because students with OCD frequently worry
cate parents about OCD and provide information regard- about doing something wrong, a nonpunitive, positive
ing services offered by the school and community approach to discipline can provide needed security and
(Paige, 2007). If a student with OCD qualifies for ser- comfort (Boucher, 1999). For example, a teacher should
vices under IDEA, the special education team would not threaten or severely punish a student with OCD for
also become involved (Adams et al., 1994; Black, being tardy or for forgetting a homework assignment
1999). Teachers should consult with the school psy- (Black, 1999) but instead should recognize such behav-
chologist or school counselor to develop interventions, iors as related to the student’s OCD (Adams, 2004;
monitor progress, and evaluate interventions (Adams Black, 1999). In a nonpunitive, positive approach, the
et al., 1994; Carter et al., 1999). teacher would not call attention to students’ tardiness
Teachers also may be asked by parents or health care but welcome them to school. The teacher could also
professionals to monitor, document, and report both allow students to submit their homework after school or
 Leininger et al. / Teaching Students with OCD   225

the next day. However, students with OCD should still ask questions such as, “Did things go O.K., even though
experience natural consequences for problem behaviors you were worried about them?” or “Did you need to
not related to their OCD (Adams, 2004). write the item down more than once?” (Boucher, 1999,
p. 214). Teachers can help students notice their positive
Help students transition from one task to another. thoughts and accomplishments and use these to build
Transitions can be challenging for students with OCD their self-esteem and work toward goals (Boucher, 1999).
because they may want to keep working on a task until Teachers can also help students with OCD develop
it is completed to their satisfaction. Teachers may begin internal control by teaching them to talk themselves
teaching the rest of the class and let students with OCD through difficult situations and by helping them recog-
join when they are ready, or they may set a specific time nize what they attend to, how they evaluate different
when they can return to the task (Carter et al., 1999; events, and how they identify expectations about their
Purcell, 1999). Teachers can also assign the student with capacity to handle stress (Boucher, 1999). Teachers can
OCD less time-consuming tasks that can be confidently also help students identify antecedents to anxious behav-
accomplished within the given time frame (Boucher, ior (i.e., recognize triggering situations) and teach them
1999; Dornbush & Pruitt, 1995). Stress can be reduced coping strategies to manage anxiety and foster self-
by providing students with OCD additional structure regulation. For example, if a student tends to become
and guidance during transitional periods (Boucher, anxious during testing situations, a teacher can show the
1999; Dornbush & Pruitt, 1995). student how to set aside time to prepare for the test and
Students with OCD like predictable routines so they coach him or her in strategies for answering true/false,
know what to expect in every situation. Having consis- multiple choice, and essay questions (Boucher, 1999).
tent routines, posting the daily schedule, and informing
children in advance of changes can help to prevent or Teach decision-making skills. Although many profes-
alleviate possible stress and provide security for anxious sionals encourage giving children choices, teachers have
students (Boucher, 1999; Dornbush & Pruitt, 1995). to consider carefully the choices given to students who
manifest obsessive-compulsive behaviors, as they may
Help students set goals. Many teachers help their have trouble making decisions (Carter et al., 1999).
students set short-term goals and chart their progress. Teachers should limit the number of options available and
This is particularly important for students with OCD not force students to make decisions with which they are
(Boucher, 1999) because they may have a distorted view not comfortable (Boucher, 1999; Carter et al., 1999).
of their degree of success. They may also feel threatened Teachers can foster students’ skills and confidence in
when their performance does not meet their expecta- decision making by teaching positive steps (e.g., ask
tions or the expectations of others (Parker & Stewart, questions, gather information, list benefits/consequences)
1994). Helping students achieve their goals can increase and by role-playing effective decision making. They can
students’ satisfaction with themselves and enhance their then reinforce students’ positive choices (Boucher, 1999).
sense of control (Boucher, 1999; Parker & Stewart,
1994). Initial success can be used to encourage and Specific Strategies for the Classroom
facilitate future success, with specific goals that stu-
dents can reach in 3 to 5 days. Teachers should not Students with OCD often have trouble with the fol-
expect their students to confront their “worst night- lowing specific issues related to school. By using
mare” but help them to move toward a reasonable goal appropriate strategies, teachers may reduce the stress
in small, nonthreatening steps (Boucher, 1999, p. 216). and anxiety that accompany these difficult situations for
students who display obsessive-compulsive behaviors.
Promote self-awareness and self-regulation. Self- See Table 1 for examples of specific strategies to facili-
awareness and self-regulation are skills that teachers of tate student success in the classroom.
young children in particular regularly teach. It is espe-
cially pertinent to students with OCD, particularly when Help alleviate stress during anxiety-provoking situa-
their symptoms reemerge or wane. Teachers can help tions. Learning experiences should be structured to reduce
students with OCD become self-aware by having them the chance of failure, particularly for students with OCD,
record the number of times they feel a need to perform who can become overwhelmed by excessive demands
a ritual and the number of times they do not perform that they place on themselves or by their fears or anxieties in
ritual (Boucher, 1999). Students with OCD can keep a certain situations. Teaching individual or class relaxation
daily journal of thoughts and worries and then discuss exercises (involving techniques for breathing control or
them with the teacher at the end of the day. Teachers can muscle relaxation) and modeling ways to accept and deal
226   Intervention in School and Clinic

Table 1 relationships with students with OCD so they feel com-

Specific Teaching Strategies for Students With OCD fortable coming to school (Black, 1999; Boucher, 1999).
Area of Concern Sample Strategies Teachers can help students with OCD who isolate
themselves from their peers become socially involved in
Anxiety-provoking Reduce chance of failure on learning tasks.
situations Model acceptance of mistakes. the classroom. They can facilitate friendships by provid-
Make a list of people the student can talk to ing structured social activities (Wagner, 2005). They
when he or she feels overwhelmed or can also set up cooperative learning groups and assign
anxious.
Reassurance seeking Praise on-task behavior.
group projects that focus on effective communication
Ignore reassurance requests or bring and group goals rather than on individual performance
attention to what the student is doing and (Parker & Stewart, 1994; Purcell, 1999). Rather than
have him or her determine why the worry
consistently letting children choose their own groups,
is unnecessary.
Getting stuck Give students another task to complete. teachers should form groups by counting off or by struc-
Provide encouragement to keep them turing and assigning them (Adams, 2004).
working on a task.
Allow students to take a short break.
Written assignments Provide the student with an outline of the
Ignore reassurance requests. Students with OCD
class lecture. often request verbal reassurance about their fears (APA,
Allow the student to complete his or her 2000; Heyman et al., 2006). Teachers should not provide
work orally or on tape, tell his or her
this reassurance because doing so reinforces students’
responses to an adult or peer writer, or
type his or her responses on a computer. compulsive reassurance seeking. Teachers should praise
Completion of Give simple directions and break down on-task behavior and either ignore reassurance requests
assignments complex tasks. (Adams et al., 1994; Boucher, 1999) or bring attention
Teach strategies for effective learning and
have the student create a strategy to what the student is doing and have him or her deter-
notebook. mine why the worry is unnecessary. Teachers could keep
Create contracts for long-term assignments track of how many times a student asks for reassurance
and homework, including time estimates.
Testing Provide extra time or alternate locations for
to make him or her more aware of its frequency (Boucher,
testing. 1999).
Allow the student to demonstrate knowledge
with alternative assessments. Help students get unstuck. When students with OCD
Note: OCD = obsessive-compulsive disorder. get trapped in their obsessions and compulsions, teachers
can help them switch to another task or provide encour-
agement to them to keep working on a task despite
obsessive-compulsive symptoms (Carter et al., 1999).
with mistakes are strategies teachers can use to alleviate For example, if a teacher notices a student is erasing his
students’ anxiety and stress (Adams et al., 1994; Parker & or her answers excessively, the teacher can provide
Stewart, 1994; Purcell, 1999). Students can also be taught assistance by attending to the task rather than the com-
how to talk themselves through difficult situations. pulsive behavior. The teacher can redirect the stuck
Another helpful activity is to make a list of people stu- behavior by reminding the student of the learning goal
dents with OCD may talk with about their fears and con- and, if needed, giving alternate options to reach that goal
cerns. Safe people may include the school counselor or (Boucher, 1999).
psychologist, school nurse, principal, or another teacher Students with OCD may need to take short breaks
with students can check in whom for 5 to 10 min when because pressures can build quickly and overwhelm
feeling overwhelmed or anxious (Boucher, 1999; Dornbush them. Having their desk close to the door will allow stu-
& Pruitt, 1995). dents with OCD to leave the classroom without others
Because students with OCD may have low self-esteem noticing (Carter et al., 1999; Dornbush & Pruitt, 1995),
(Adams, 2004), teachers should remind them of their and so they can clear their head quickly. Teachers can also
strengths and talents and call attention to their accom- set up a signaling system by which students use a green
plishments (Black, 1999; Boucher, 1999). For example, hand signal when they are hopelessly stuck in a ritual and
teachers can mark correct, rather than incorrect, answers need the teacher’s help and use a red signal when they are
(Dornbush & Pruitt, 1995). Classroom activities should trying to handle the problem on their own (Purcell, 1999).
be monitored so teachers can prevent peers from teasing
a student with OCD (Boucher, 1999). Teachers should Help students with written assignments. Students
be caring, empathic, and supportive—developing close with OCD may spend so much of their time erasing and
 Leininger et al. / Teaching Students with OCD   227

rewriting their assignments or checking and rechecking that help students independently solve problems. Students
to have everything exactly right that they may not com- may write down the steps to complete a task or term
plete their school work (Parker & Stewart, 1994). They paper, a solution they found for organizing their note-
may also miss large amounts of information because book, or a trick they have discovered for recognizing
they try to write down everything the teacher says. This when to ask for help (Dornbrush & Pruitt, 1995).
issue of missed information is of particular concern for Teachers should frequently check for students’ under-
students in junior high and high school, for whom there standing to make sure they are paying attention and lis-
is an increased expectation regarding taking notes in tening during lessons. Teachers can check every 10 to 15
class. Teachers can provide students who have difficulty min by asking questions or having students share with a
taking notes with an outline of class lectures (Adams et al., partner what they have learned so far (Boucher, 1999).
1994; Parker & Stewart, 1994; Purcell, 1999). They can Teachers can provide a peer tutor or even set a timer to
also teach specific note-taking techniques. The SQ3R help students focus and stay on target for in-class assign-
(Survey, Question, Read, Recite, Review) and the Cornell ments (Boucher, 1999; Purcell, 1999). Children with
system of note taking (Record, Reduce, Recite, Reflect, OCD may be fearful of getting in trouble, so teachers
Review) are effective strategies that may benefit all stu- should try to seat them away from disruptive children to
dents (Parker & Stewart; Purcell, 1999). enable them to concentrate (Dornbush & Pruitt, 1995).
Teachers can allow students to complete their work Long-term assignments or take-home work should be
orally, put their responses on tape, tell their answers to avoided at first because students may be overwhelmed
a peer or adult writer, or type their assignments on the or spend an excessive amount of time completing assign-
computer (Adams & Burke, 1999; Carter et al., 1999; ments. Teachers should monitor students’ in-class work
Dornbush & Pruitt, 1995). For some types of assign- first to help students stay on task, avoid obsessing over
ments, students can be given options such as creating a details, and stick to a time limit (Parker & Stewart,
poster, making a model, or giving an oral presentation 1994; Purcell, 1999). When the teacher determines stu-
instead of writing a paper (Dornbush & Pruitt, 1995). dents are ready, contracts for long-term assignments and
Some students may feel anxious about presenting or homework can be created to help them complete assign-
speaking in front of the class, and teachers should not ments on time (Parker & Stewart, 1994). Providing time
require a student with OCD to do so (Boucher, 1999). estimates for each assignment can also help students
Assignments can be graded on content instead of hand- with OCD stay on target (Wagner, 2005). Teachers can
writing, punctuation, or spelling, reducing students’ provide structure guides for longer assignments or essay
anxiety about having everything written perfectly assignments to guide students’ studying and writing
(Dornbush & Pruitt, 1995). (Parker & Stewart, 1994; Purcell, 1999). Setting spe-
cific deadlines also provides focus and necessary time
Help students stay focused and complete assignments. limitations for students with OCD (Purcell, 1999).
Students with OCD have trouble completing tasks that
require concentration because their obsessions are intru- Provide adequate support for testing. Students with
sive, distracting, and very disruptive to their overall func- OCD may experience anxiety in testing situations. They
tioning (APA, 2000). Providing simple directions and may spend more time on tests than other students because
breaking down complicated tasks into smaller steps can of their compulsive behaviors or perfectionist tendencies,
help students focus on important parts of assignments or they may work quickly through a test to guard against
(Boucher, 1999). Creating a signal to alert students that these OCD behaviors. Thus, their test scores may not
instructions are going to be given and writing direc- accurately represent their true abilities and accomplish-
tions and assignments on the board are helpful as well ments (Purcell, 1999). Before making testing accommo-
(Dornbush & Pruitt, 1995). For students with reading dations, teachers should check what is allowable under
compulsions, audiotapes or digitized recordings of chap- state and test guidelines for standardized and nonstandard-
ters in texts may be made available, a peer or adult can ized testing situations. Any accommodations made should
read out loud to the student, or shorter reading passages be included on the student’s individualized education pro-
may be assigned (Adams, 2004; Adams et al., 1994). gram (if applicable) and used consistently in the class-
Teachers can teach students to keep a strategy note- room prior to the testing situation.
book, where the students record strategies for success Students with OCD may need extra time on tests or
when they are completing a difficult task or dealing with alternative locations for testing that are free of distrac-
a recurring problem. These strategies should be methods tions (Adams et al., 1994; Carter et al., 1999; Purcell,
228   Intervention in School and Clinic

Table 2 including those with OCD, will experience greater suc-

Recommended Web Site cess in school.
Web Sites Description

Anxiety Disorders General information about OCD and Case Study

Association of America anxiety disorders in children and
www.adaa.org/GettingHelp/ adolescents, treatment options, and The following case study is presented as an illustration
AnxietyDisorders/ criteria for choosing a therapist. Free
OCD.asp downloadable brochure about OCD of what an elementary school teacher may do throughout
and self-screen for OCD. the school day to facilitate the academic and social suc-
National Alliance on Mental Information on manifestations and cess of a student with OCD. All names are pseudonyms.
Illness causes of OCD, medication, and
www.nami.org/Content/ behavior therapy. Hotline telephone
Zachary is a 10-year-old boy in fourth grade. Class-
ContentGroups/Helpline1/ number and free downloadable mates and teachers note that he likes everything to be
Obsessive_Compulsive_ guide. just right. This is most noticeable with his writing
Disorder_(OCD).htm
because he frequently erases and rewrites. His teacher,
National Institute of Mental General information about OCD and
Health instructions for locating services. Mrs. Vera, meets frequently with the school psycholo-
www.nimh.nih.gov/health/ Information also available in gist and his parents to discuss Zachary’s needs and to
topics/obsessive- Spanish. develop and evaluate academic and social interventions.
compulsive-disorder-ocd/
index.shtml This morning, Mrs. Vera welcomes her students and
National Mental Health Description of characteristics, causes, reviews the class schedule posted on the whiteboard.
Association and treatment of OCD. Crisis center Yesterday she talked with Zachary and his parents about
www.nmha.org/go/ocd hotline telephone number.
Obsessive Compulsive OCD questions and answers, free
a change in the usual schedule—an afternoon assembly.
Foundation downloadable brochure, online Advance preparation for change helps reduce Zachary’s
www.ocfoundation.org database of OCD therapists, anxiety. Afterward, the students gather in their reading
instructions for finding a local
groups to work on poster presentations based on the book
support group.
OCD Education Station Facts about OCD, recognizing OCD at they have recently finished reading. Mrs. Vera places
www.ocdeducationstation school, role of school personnel, Zachary with an understanding and patient group of stu-
.org tools and resources, and success dents. Artistic Zachary prefers to draw illustrations with
stories. Free downloadable OCD
guides. a compatible classmate; the two other students in the
group are assigned to write information on the poster.
Note: OCD = obsessive-compulsive disorder. Before transitioning to social studies, Mrs. Vera gives
the class a 10-min warning to clean up and prepare for
their next activity. Zachary is permitted to take longer if
1999). Teachers can be supportive of students who have he needs to and join the class as soon as he is ready. As
excessively high expectations by using alternate forms he joins the class, Mrs. Vera gives Zachary a copy of the
of evaluation, as well as emphasizing the importance of brief outline given to all students regarding what they
knowledge over grades (Parker & Stewart, 1994; Purcell, will be learning in social studies and encourages the
1999). Some alternate forms of assessment include admin- students to highlight important points.
istering tests orally, having students respond orally, or After the lesson, the students begin writing their reports
designing a shorter form of the test (Boucher, 1999). on counties in their state. Each student is given a paper
Because students’ OCD symptoms fluctuate, educa- with step-by-step instructions on how to begin the
tors must be flexible and adjust their expectations report. Mrs. Vera goes over the instructions with the
accordingly (Dornbush & Pruitt, 1995; Purcell, 1999). whole class, giving an estimated time frame for com-
Some weeks and months may be better than others, but pleting the in-class report.
teachers should understand that they may have to imple- As the students begin their work, Mrs. Vera checks
ment these classroom strategies indefinitely because with Zachary to make sure he understands the instruc-
OCD is chronic, and some students may never fully man- tions. Zachary begins to feel anxious and distressed as he
age or overcome its symptoms (Purcell, 1999). Resources works on his assignment. He puts a card on his desk,
for teachers and students are available on many Web signaling Mrs. Vera that he needs a break. He then leaves
sites (see Table 2). However, even with the outside sup- the classroom, talks with the school psychologist for a
port and available resources, teachers’ attitudes are a few minutes to calm down, and then returns to class.
key element in helping students with OCD. When teach- At lunch time, Mrs. Vera reminds Zachary’s lunch
ers are compassionate, positive, understanding, and group that it is their turn to eat with her in the classroom.
willing to implement individual strategies, all students, Zachary has formed friendships with the students in his
 Leininger et al. / Teaching Students with OCD   229

lunch group, and they often play together at recess. Mrs. child’s behavioral or emotional difficulties with a health
Vera reminds the recess monitor to keep an eye on care provider or school staff, and 5% of students
Zachary and to check in with her before picking up the received medication for these difficulties (Simpson,
class from lunch recess. Cohen, Pastor, & Reuben, 2008). Although ADHD is
After lunch, the students begin their math lesson, most frequently a topic of concern for teachers, stu-
starting their first day of long division. Because this is a dents with OCD are also at high risk for academic and
complicated computation, Mrs. Vera has broken down social failure because of the debilitating nature of their
the division process into simple steps. She has written symptoms. These obsessions and compulsions can
these on a poster, and as she teaches each step, she interfere significantly with their academic and social
has the students write the steps in their notebooks for success in school.
future reference. Zachary has been assigned a peer tutor In a school setting, students with OCD are educated
who sits next to him. Initially, the tutor checks in with with various levels of support. School-based interventions
Zachary to make sure he understands what to do. While may include individual or group counseling, CBT coordi-
working, Zachary repeatedly goes to Mrs. Vera, check- nated with community-based services, special education
ing to see if his numbers look right and are lined up services, or accommodations and adaptations provided by
correctly. Mrs. Vera ignores these attention-seeking general education teachers. Working collaboratively with
requests but praises his on-task behavior when she sees other professionals, teachers play a critical role in promot-
him working at his desk. ing and facilitating the academic achievement and adap-
After the class completes their math work and takes tive social functioning of students with OCD.
a short break, it is time for a science test. Zachary is Some strategies that are effective with most students
given time to refer to his strategy notebook, where he (e.g., teaching decision-making skills, goal setting) are
has written down test-taking strategies that Mrs. Vera also effective with students with OCD. Teachers can use
has coached him to use. He no longer needs to be tested these strategies as well as other strategies more specifi-
in a separate room with a parent volunteer serving as his cally designed to address issues and concerns of students
scribe for questions that require more writing than he with OCD (e.g., helping students get unstuck, ignoring
can comfortably complete. He is given more time to fin- reassurance requests). With compassion, understanding,
ish his test and joins his class in the auditorium for the and a willingness to make individualized adaptations,
assembly. teachers can create safe, positive classroom environ-
Mrs. Vera explains the homework assignment at the ments that will decrease anxiety and increase the aca-
end of the school day. Each student has a homework demic and social success of students with OCD.
sheet, and Mrs. Vera asks her students to write how
much time they should spend on each assignment. As
the students clean up, Mrs. Vera pulls Zachary aside to
About the Authors
review his goal for the week. He has set the goal of stay- Melissa Leininger, BS, is a graduate student in the School Psychology
ing within 10 min of the time limit for his homework Education Specialist program at Brigham Young University. Her current
assignment. Because he successfully met his goal for interests include bibliotherapy and working with families raising children
with disabilities. Tina Taylor Dyches, EdD, is an associate professor of
last night’s homework, he is allowed to place a check
special education at Brigham Young University. Her research interests
mark on his goal chart. Mrs. Vera comments on Zachary’s include family adaptation to disability, children’s literature, and multicultural
hard work and writes a quick progress note for Zachary issues in autism. Mary Anne Prater, PhD, is a professor and chair of coun-
to take home and share with his parents. seling psychology and special education at Brigham Young University. Her
current interests include children’s literature, multicultural special education,
and teacher preparation in special education. Melissa Allen Heath, PhD, is
an associate professor in the Department of Counseling Psychology and
Summary Special Education at Brigham Young University. Her current interests include
school-based crisis intervention, grief, and bibliotherapy.

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