Obsessive Compulsive Disorder Mandy Housley Meleah Clark

What is OCD  Obsessive-Compulsive Disorder, OCD, is an anxiety disorder and is characterized by recurrent, unwanted thoughts (obsessions) and/or repetitive behaviors (compulsions). Repetitive behaviors such as hand washing, counting, checking, or cleaning are often performed with the hope of preventing obsessive thoughts or making them go away. Performing these so- called "rituals," however, provides only temporary relief, and not performing them markedly increases anxiety. A person with OCD may be of above average intelligence and educational level, may have an obsession, a compulsion or both, and is perfectly aware that the situation is irrational but is unable to control it.

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Symptoms  Obsessions often have themes to them, such as: Fear of contamination or dirt Fear of contamination or dirt Having things orderly and symmetrical Having things orderly and symmetrical Aggressive or horrific impulses Aggressive or horrific impulses Sexual images or thoughts Sexual images or thoughts  OCD symptoms involving obsessions may include: Fear of being contaminated by shaking hands or by touching objects others have touched Fear of being contaminated by shaking hands or by touching objects others have touched Doubts that you've locked the door or turned off the stove Doubts that you've locked the door or turned off the stove Thoughts that you've hurt someone in a traffic accident Thoughts that you've hurt someone in a traffic accident Intense distress when objects aren't orderly or facing the right way Intense distress when objects aren't orderly or facing the right way Images of hurting your child Images of hurting your child Impulses to shout obscenities in inappropriate situations Impulses to shout obscenities in inappropriate situations Avoidance of situations that can trigger obsessions, such as shaking hands Avoidance of situations that can trigger obsessions, such as shaking hands Replaying pornographic images in your mind Replaying pornographic images in your mind Dermatitis because of frequent hand washing Dermatitis because of frequent hand washing Skin lesions because of picking at your skin Skin lesions because of picking at your skin Hair loss or bald spots because of hair pulling Hair loss or bald spots because of hair pulling

Symptoms  As with OCD obsessions, compulsions typically have themes, such as: Washing and cleaning Washing and cleaning Counting Counting Checking Checking Demanding reassurances Demanding reassurances Performing the same action repeatedly Performing the same action repeatedly Orderliness Orderliness  OCD symptoms involving compulsions may include: Hand washing until your skin becomes raw Hand washing until your skin becomes raw Checking doors repeatedly to make sure they're locked Checking doors repeatedly to make sure they're locked Checking the stove repeatedly to make sure it's off Checking the stove repeatedly to make sure it's off Counting in certain patterns Counting in certain patterns Making sure all your canned goods face the same way Making sure all your canned goods face the same way

History  Fourth Century BC explained as “melancholia” Caused by an imbalance in the four bodily fluids or humors. Caused by an imbalance in the four bodily fluids or humors. Satanic possession Satanic possession  Sigmund Freud ( ) linked to unconscious conflicts manifested as symptoms of the illness. linked to unconscious conflicts manifested as symptoms of the illness.  Modern theories abnormality in the neurochemistry abnormality in the neurochemistry serotonin.serotonin. OCD sufferers may have blocked or damaged receptor sites in the brain, preventing serotonin working correctly.OCD sufferers may have blocked or damaged receptor sites in the brain, preventing serotonin working correctly.

Causes  Biology. Insufficient serotonin, production or reception Insufficient serotonin, production or reception Strep throat (controversial) Strep throat (controversial) genetic component, but specific genes have yet to be identified. genetic component, but specific genes have yet to be identified.  Environment. habits that you learned over time. habits that you learned over time.

Other issues that may coexist  Tourette’s Syndrome  ADHD  Substance abuse  Eating disorders  Other Anxiety disorders  Autism  PANDAS – autoimmune response

Social Implications  Social Interactions: A student with OCD may be perceived as “different” or “crazy” which may lead to increased stress in the student (which can make OCD symptoms worse). A student with OCD may be perceived as “different” or “crazy” which may lead to increased stress in the student (which can make OCD symptoms worse). Depression is a real danger for students with OCD who may become withdrawn, feeling isolated from classmates. Depression is a real danger for students with OCD who may become withdrawn, feeling isolated from classmates. Academic failure due to OCD can cause a student to be labeled as “stupid” or “dumb,” which can affect friendships, sometimes causing friends to “drop” the student from their social set. Academic failure due to OCD can cause a student to be labeled as “stupid” or “dumb,” which can affect friendships, sometimes causing friends to “drop” the student from their social set. Some children with OCD spend so much time ritualizing, that little time is left for socializing with friends and family. Some children with OCD spend so much time ritualizing, that little time is left for socializing with friends and family.  Social Skills Impaired by OCD: In many cases, they are struggling not only with OCD but also other coexisting conditions which may affect their proficiency with social skills. They may have difficulties with: In many cases, they are struggling not only with OCD but also other coexisting conditions which may affect their proficiency with social skills. They may have difficulties with: Recognizing how others feel, uncertainty regarding how to respond to others or a frustrating inability to respond to them in any appropriate way Recognizing how others feel, uncertainty regarding how to respond to others or a frustrating inability to respond to them in any appropriate way Expressing their own feelings or choosing appropriate language to express themselves Expressing their own feelings or choosing appropriate language to express themselves Generating ideas and/or using creative problem-solving techniques Generating ideas and/or using creative problem-solving techniques Figuring out how others will react to what they say or do Figuring out how others will react to what they say or do Being flexible and reacting appropriately to situational changes Being flexible and reacting appropriately to situational changes Reigning in impulsivity Reigning in impulsivity Acting appropriately assertive, or being too aggressive for the situation Acting appropriately assertive, or being too aggressive for the situation Building friendships that last Building friendships that last

Educational Implications  Difficulty paying attention  Difficulty turning assignments in on time  May avoid school because afraid teachers or peers may react negatively to their behaviors  OCD behaviors may exist only at home, only at school, or at both locations. Teachers may be aware of symptoms, but parents never see them Teachers may be aware of symptoms, but parents never see them Parents may be aware of symptoms, but teachers never see them Parents may be aware of symptoms, but teachers never see them

Prevalence  3.3 million adults in the United States  1 million school-aged individuals in the US  Occurs equally regardless of gender, racial, or socioeconomic backgrounds

Laws  Section 504: Many students with OCD – frequently those with milder cases – are served under Section 504. Section 504 is a civil rights law which provides that “no qualified individual with a disability in the United States shall be excluded from, denied the benefits of or be subjected to discrimination under” programs that receive federal funding. Many students with OCD – frequently those with milder cases – are served under Section 504. Section 504 is a civil rights law which provides that “no qualified individual with a disability in the United States shall be excluded from, denied the benefits of or be subjected to discrimination under” programs that receive federal funding.  IDEA: Many students with OCD, particularly those with more severe cases of OCD, are served under the Individuals with Disabilities Education Improvement Act (IDEA), the federal law governing special education and related services. Eligibility for special education services under IDEA is based on a formal assessment of the student, in which it must be determined that the disability has an adverse effect on the student’s educational performance. Many students with OCD, particularly those with more severe cases of OCD, are served under the Individuals with Disabilities Education Improvement Act (IDEA), the federal law governing special education and related services. Eligibility for special education services under IDEA is based on a formal assessment of the student, in which it must be determined that the disability has an adverse effect on the student’s educational performance.  Family Educational Rights and Privacy Act of 1976: The Family Educational Rights and Privacy Act (FERPA) protects students who have disabilities by requiring that all school records remain confidential. It also allows parents (and students age 18 or over) the right to review the student’s records. The Family Educational Rights and Privacy Act (FERPA) protects students who have disabilities by requiring that all school records remain confidential. It also allows parents (and students age 18 or over) the right to review the student’s records.

Team  General education teacher  Special education teacher  Parents  Child  Administration  School nurse  Counselor  Psychologist or Psychiatrist

Teaching Strategies  Functional Behavioral Assessment AntecedentBehaviorConsequence HypothesisPlan

Teaching Strategies  CALM SAFE ENVIRONMENT Limit distractions Limit distractions Try to redirect student, don’t punish children for OCD behavior Try to redirect student, don’t punish children for OCD behavior Respect physical boundaries of students who are afraid of germs Respect physical boundaries of students who are afraid of germs Keep students busy, but provide break area for students to use when needed Keep students busy, but provide break area for students to use when needed Educate all students about OCD so they will be more accepting Educate all students about OCD so they will be more accepting Don’t point out student during episode Don’t point out student during episode Post daily schedule where students can see it Post daily schedule where students can see it Be aware of any medications Be aware of any medications

Teaching Strategies  Differentiated assignments Talk to the student to find out what might be most helpful Talk to the student to find out what might be most helpful Allow more time to turn in assignments Allow more time to turn in assignments Allowing student to turn in assignments that are less likely to trigger their behavior Allowing student to turn in assignments that are less likely to trigger their behavior Give students few repetitive problems (esp. in Math) to complete, but make sure they know the information Give students few repetitive problems (esp. in Math) to complete, but make sure they know the information If students are afraid of handling materials try to teach hand on activities visually instead If students are afraid of handling materials try to teach hand on activities visually instead Technology Technology Testing accommodations Testing accommodations EnvironmentEnvironment Allow them to write on test bookletAllow them to write on test booklet Possibly oral testingPossibly oral testing

Treatment  Cognitive behavioral therapy (CBT) most effective form of therapy most effective form of therapy Retraining your thought patterns and routines so that compulsive behaviors are no longer necessary. Retraining your thought patterns and routines so that compulsive behaviors are no longer necessary.  Exposure and response prevention Gradually exposing you to a feared object or obsession, and teaching you healthy ways to cope with your anxiety. Gradually exposing you to a feared object or obsession, and teaching you healthy ways to cope with your anxiety.  Antidepressants Usually tried first Usually tried first may help increase levels of serotonin may help increase levels of serotonin  Psychiatric hospitalization, Residential treatment, Electroconvulsive therapy (ECT), Transcranial magnetic stimulation, Deep brain stimulation.

Transition  Students with OCD can go on to college and have normal social lives, once they need to learn how to control their symptoms (through therapy or medication). They may need to make sure that others understand that they might need special considerations, in case their symptoms come back.  It can take 9 years after being diagnosed to find the correct treatment

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Resources       cecp.air.org/fba/problembehavior/indivinterv.htm cecp.air.org/fba/problembehavior/indivinterv.htm   Q Q Q