While schools have a responsibility to look after the health and safety of a child in their care, it can be difficult for teachers to observe mental health problems which aren’t so readily visible.
A child or adolescent with obsessive compulsive disorder (OCD) may present in one of three ways in a classroom:
- They may just have obsessional thoughts, which can be intrusive and about bad things happening that lead to them feeling anxious. For example, a fear that someone they love might die, or they may get contaminated with germs.
- They may have both obsessional thoughts and compulsive rituals but the compulsive rituals may only be mental rituals. They may repeat numbers or words over and over in their head to prevent a bad thing in their obsessional thought from happening; therefore they can appear distracted and their work may deteriorate.
- They may have compulsive rituals that you can see, probably alongside obsessional thoughts. So they could be engaging in an activity repeatedly to reduce their anxiety, such as washing their hands, straightening everything on their desk, getting up to line things up in pots or shelves in the classroom.
If a child has OCD, they are likely to struggle to concentrate, they may find it hard to complete work on time and they may appear anxious or become disengaged with their peers.
Dr Hayley van Zwanenberg, Consultant Child and Adolescent Psychiatrist and Group Associate Medical Director at The Priory Group, has compiled an OCD Guide containing useful information and advice on how to understand the disorder in children. She expresses the importance of early intervention at a young age, with statistics from the Children’s Society indicating that approximately 70% of children who experience a mental health problem are not treated soon enough.
She says: “For many children, expressing how they feel can be a struggle and as a result it is even harder for adults to recognise that a child might be suffering from a mental health problem.
“A recent study of 269 patients aged 7 to 17, found that older adolescents generally benefited less from treatment of their OCD condition and, in addition, often had one or more other mental health diagnoses. However, the children aged 7 to 11 benefitted much more from the therapy, showing vast improvements in their condition as the study progressed.”
What signs of OCD may children display at school?
To help teachers more easily observe OCD behaviours, Dr Hayley van Zwanenberg describes what obsessions and compulsions may look like in a child with the disorder at school:
- Repeatedly getting up from an assigned chair to engage in repetitive behaviour
- Avoiding playground equipment
- Not interacting with other children in the playground
- Frequently requesting to go to the bathroom, with no medical explanation
- Asking repetitive questions or seeking reassurance from the teacher that an answer is correct
It is important to remember that not every symptom will remain consistent, as emotions such as stress and tiredness can cause rituals to increase or change altogether.
It can therefore appear that a child with OCD is improving when they are less stressed or tired or if a ritual stops. But this is in fact a common aspect of the illness, so help from a medical expert should still be encouraged.
What can I do as a teacher if I think a child is suffering from OCD?
It may take time to notice a routine that fits into the category of OCD. The perceived ‘quirky’ routines a child with OCD can demonstrate may be overlooked as a result. However, it is important to reiterate the distress a child experiencing such symptoms can feel and that spotting this illness early is in the young person’s best interests.
The benefit of being a teacher is that you are in the best position to act as a role model and confidante who can be trusted when a child wishes to divulge their innermost thoughts. Methods benefitting a child with OCD include introducing ‘self soothe’ boxes in the classroom. Allow children to decorate their boxes and place items inside to relax them so this becomes a ‘go to’ item of comfort whenever they feel stressed or anxious.
For older children, PHSE lessons or designated tutor group time focusing on mental health can be particularly useful. These can encourage students to talk about when they last felt worried or anxious and what they did to overcome this, developing vital coping strategies in the process.
Implementing time for relaxation can also be a huge benefit to a child with OCD symptoms. Select a key word to use to signify the start of the calming exercise each day, forming a pattern of routine that is comforting for the child.
What support networks are available in school if I think a child needs further help?
It can be daunting as a teacher when looking to provide the best possible support for a child exhibiting symptoms of OCD. Thankfully, there are a variety of support services in place to help both the child and the adults who care for them.
To ensure a child with OCD gets the help they need, arranging a meeting with parents to discuss your concerns is a difficult yet highly important first step, which can also be attended by a head teacher or senior colleague if you desire.
Explain and provide examples of the signs of OCD you have identified, before reasserting the school’s commitment to helping support them. Also, agree strategies that can help their child feel as comfortable as possible during school hours.
Dr Hayley van Zwanenberg adds: “If you would like to help raise awareness of mental health in your school, there are a number of online resources available, through well-respected organisations such as OCD UK and Mind. Charities such as Young Minds also offer training courses to support emotional wellbeing in schools, specifically targeted at education professionals.
Dr Hayley van Zwanenberg is a Child and Adolescent Psychiatrist, who has been working in child psychiatry for over 10 years and with the Priory Group since 2012.
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