https://www.gosh.nhs.uk/wards-and-departments/departments/clinical-specialties/department-child-and-adolescent-mental-health-dcamh/the-tic-service/tourette-syndrome-and-ocd-in-the-classroom/

Tourette Syndrome and OCD in the classroom

Obsessive-compulsive disorder (OCD) is common in young people with Tourette syndrome (TS). This page explains the impact of OCD on students and provides suggestions on how to best support them within the classroom.

What is OCD?

Obsessive-Compulsive Disorder (OCD) is an anxiety disorder where a person has intrusive and distressing thoughts (obsessions) and does time-consuming rituals (compulsions) to deal with the obsessions. OCD affects about 1-4% of the population, so it's helpful for school staff to know about it. In people with Tourette Syndrome (TS), OCD is common, especially in students from late primary to secondary school age. Around 35% of young people with TS also show OCD tendencies.

What are the signs of OCD?

Young people with OCD may feel embarrassed and try to hide their symptoms. However, if the obsessions and compulsions become hard to control, they might do things that other people notice. For example, some young people with OCD may need to write their work in a specific way or arrange their books, pencils, or belongings in a particular order.

Other compulsions might include repeatedly checking belongings, light switches, or making sure all the taps are off in the school toilets. These behaviours can also affect schoolwork, as the student may need to destroy or reread their work, repeating it until they feel it is ‘perfect’ or feel ‘just right’. Checking and touching rituals are also common in people with TS and OCD.

How does OCD affect young people?

A young person with OCD may experience intrusive thoughts, images, or impulses, which make them feel they must carry out certain behaviours to reduce anxiety. Some children and adolescents with OCD find it difficult to explain their obsessions to other people.

Managing intrusive thoughts and stopping compulsions can be distracting and exhausting. People with OCD often know their thoughts and behaviours may be irrational, so might keep their anxiety a secret. Research has shown that cognitive behavioural therapy (CBT) and/or medication can be effective in helping the young person and their family manage OCD. If there are concerns that a pupil may have OCD and it is negatively affecting their lives, please speak with the parents and encourage them to make an appointment to discuss the concerns with their family doctor (GP). Most commonly a referral can then be made to the local Child and Adolescent Mental Health Service (CAMHS). In some areas, schools can refer to CAMHS too.

Students with OCD often experience difficulties in school, so it is helpful for staff members who have contact with the young person to understand the condition. It might be helpful to share this page with all colleagues at school from classroom teachers to dining room staff. The more school staff who understand the pupil’s difficulties with OCD, the better their support network will be. It is important to discuss sharing the information with the student’s parent and the student themselves and explain the rationale for doing so.

How might OCD affect a young person at school?

The following may be reasons to think that a young person has OCD (although it is important to note that these could all be signs of other difficulties):

School refusal
Frequent lateness: carrying out rituals may mean the pupil is late for lessons.
Easily distracted and experiences difficulties with concentrating: they may be distracted by intrusive thoughts.
Checking and repeating work very frequently
Separation anxiety from family members, for example, an obsession may be that a family member is at risk.
Low self-esteem
Problems getting along with peers.
Repeatedly asking to leave the room: they may be carrying out rituals outside the classroom.
Difficulties with sitting for extended periods.
Poor handwriting.
Difficulties with consistent or flexible thinking.

Helping a young person with OCD in school

The best way to help a student who has OCD in school is to ensure they are getting effective treatment from the local Child and Adolescent Mental Health Service (CAMHS). This is most likely to be a Psychologist or Cognitive Behavioural Therapist. You may be able to help by speaking with the health professional to form strategies to support the young person at school.