Back to school with OCD
Now that my kids are finally back to school, I have a little bit more time to write again. Yay! The first request I received for new blog entries is about how to help teachers and coaches support their students and team members with OCD.
OCD, in a nutshell
The sufferer experiences intrusive and unwanted anxiety paired with disturbing thoughts, mental images, or impulses.
The sufferer has a belief that this anxiety will be alleviated by a visible OR invisible action that doesn’t reliably solve the problem. This is a compulsion.
The compulsion/safety-beahvior reduces anxiety temporarily, providing a powerful learning reward but the anxiety returns and demands more and more engagement with the compulsion over time, despite its long-term ineffectiveness in solving the problem.
Repeat and intensify over time…
As part of the gradual worsening of the OCD cycle, most OCD sufferers have to do more and more to appease their OCD and eventually, loved ones and therapists get looped into the cycle too. High quality OCD treatment is all about breaking the OCD cycle in a way that is kind, loving, and compassionate. So guess what… therapists and loved ones can help break the cycle by withdrawing their participation in it.
Helping as a teacher or coach
First, you are not students’ or team members’ therapist so you really need to act under the advice of their actual therapists to make sure that you are supporting their treatment plan. You don’t actually have to talk with each therapist (although that might be beneficial in some cases) but rather listen to your students, parents, and when available, school mental health professional. The most important thing you can do to support someone with OCD is to ask them how you can support them and do what you can within the constraints you have. Here are some ideas of things you may be asked to do to support a student or athlete with OCD that are within the realm of reasonableness, in my experience:
Notice OCD behaviors
Just notice when OCD comes up for your athlete or student, if it’s visible. You don’t have to call it out… just notice it in case you’re called to help them in the future. Things to watch for:
Reassurance seeking: This happens when an OCD sufferer asks someone around them whether they’re going to be OK in a direct or indirect way in order to soothe their anxiety, with limited practical necessity or effectiveness. In other words, most people would agree that the asker is not going to be getting extremely useful information from the answerer, as a result of the conversation.
Examples of reassurance-seeking:
What do you think of this spot on my hand? (I’m not a dermatologist.)
Would you wash your hands again? Should I? (I’m not an infectious disease expert.)
Would you eat food I handed you right now? (I’m not a food safety expert.)
Do you trust me to babysit your kid? (I mean… I’m pretty desperate for babysitters so you’re not going to get useful information from me on this one.)
Did I just hit someone with my car (when driving and clearly did NOT)?
Anxiety-focused accommodation-seeking: OCD accommodations can include providing reassurance but are also much broader and include everything an OCD sufferer might ask you to do to help them engage in anxious-coping that doesn’t serve an important practical function.
Common accommodation-seeking behaviors:
Taking frequent breaks for hand washing, surface cleaning, hand sanitizing, etc.
Needing to run, walk, or touch objects in a particular way that seems odd or not in line with goal-directed behavior.
Taking inexplicable breaks that don’t seem to serve a clear purpose, often alone.
High-fiving a child OCD sufferer exactly five times when they arrive home from school at their insistence, with no room for variation.
Apparent counting rituals or trying to get their movements to be symmetrical in shape or number.
Insistance on “healthy” meals that don’t look appetizing or other rigid adherence to diet or exercise (this doesn’t ONLY happen in OCD but it CAN be an OCD symptom)
Compulsive visits to various physicians, searching for an explanation of symptoms, when reasonable diseases have been ruled out.
Accommodation requests tend to get more elaborate and time consuming as the OCD goes on until things become unworkable. These requests tend to come without the acknowledgement that OCD is driving them.
How to withdraw OCD-accommodations
At some point in treatment, OCD sufferers need to invite their support people (including teachers and coaches) to withdraw OCD-related accommodations as part of their treatment plans. Other times, teachers or coaches simply cannot maintain the accommodations previously offered and must withdraw them due to their own boundaries.
Please communicate with your student, athlete, parents, and/or involved mental health professional when doing this, whenever possible. Here is some very general advice on accommodation withdrawal. We withdraw accommodations slowly and with LOVE. Love, kindness, respect, validation, transparency, and intent are all so important to making this happen in a loving way that supports our OCD sufferer.
Step One: Identify target behavior and reason for needing change
If you’re a teacher or coach who has overextended yourself in offering OCD accommodations, you have to reflect on and define your boundaries with your student or athlete. What are your limits and goals for disengaging yourself from the OCD cycle? Alternatively, your student or athlete may be coming to you to ask you to set a limit for them, to support their recovery. In either case, you can frame the new boundary as follows:
Define the behavior that is impeding your role as teacher or coach or the student themselves,
Set a goal for flexibility with that behavior,
State the reason you (or your student/athlete) will benefit from resetting this boundary.
Example: 1. My student is leaving class 10 times a day on a bathroom pass . 2. I need them to be able to stay in class with no more than five breaks a day for safety and academic reasons. 3. I am worried that my flexibility in offering bathroom passes may be contributing to the worsening of this student’s OCD AND I’m also concerned about them falling behind in class.
Step two: Develop a script for initial enforcement and try to get buy-in
After sharing these boundaries with the OCD sufferer, the loved one or therapist will either work on a script together with the sufferer or will present a script to them (if they refuse participation) on how to remind them of the boundary in a kind way. This script will have a few components to it:
Gently verbally label (name) the OCD sufferer’s pull for accommodation or reassurance.
Restate the boundary.
Remind them of the value behind it.
Affirm love and compassion for the OCD sufferer.
Ask them how to support without accommodation or reassurance.
Example: <<Privately setting the boundary>> I notice that you’re leaving the classroom 10 or more times a day on a restroom pass and are gone for a very long period of time. I’m worried about you missing instruction time and falling behind on class. I also know you’ve mentioned OCD and I don’t want my lack of limits on the pass to make it worse. Can I do something to support you managing this so you can be in class more often? I really want you to be safe, successful, and to be fully supported in this process. I would like to work towards a goal of five bathroom trips per day. Could we cut one trip a day, per week, until we get to the goal? Can you ask your therapist about the appropriateness of this goal and get back to me next week?
Step three: Enforce consistently and move slowly
Assuming therapist, student, and parent buy-in, you can proceed with enforcement of the established boundaries.
When the student/athlete pushes the established boundary, tell the OCD sufferer that you want to get back to a workable life for you and that you know it’s important to move slowly and deliberately toward that future.
Ask them where this request for accommodation fits within their OCD treatment plan and whether THEY think it’s a good idea for you to accommodate or hold the boundary. “Will it make your OCD better long-term if I refuse to accommodate or if I allow this boundary to be breached today?”
If the student/athlete simply has no capacity to manage with withdrawal of the accommodation, refer them back to their therapist for problem-solving. That generally means that the plan to reduce accommodations wasn’t realistic and you need more instruction on how to engage.
Example: <<Privately enforcing the boundary>> This week, I thought we set a goal for no more than seven trips to the bathroom in a day. I notice that you’re asking for an eighth. I’m worried that if I say yes, I may be making your OCD worse. Do you think you could delay this trip until later or not go? I really want to support you in reducing this target behavior. Can we figure out a way to ride this wave together or is today not the day and you need to talk to your therapist first because you’re too stuck?
As a teacher or coach, you should not have to draw a hard line with a student or athlete. A soft/moderate reminder of the boundary should be sufficient or the plan wasn’t realistic to begin with. Refer this back to the parents and therapist or other mental health team if you don’t have a realistic plan. OCD therapy IS uncomfortable but it shouldn’t be sudden or torturous. If it feels that way, make the mental health professionals work out a plan and come back to you with solutions.
Neurodiversity and why REASONABLE accommodations are different
Reasonable accommodations: These differ quite a bit from OCD accommodations in that they are allowances for normal differences between students/athletes that do not make OCD cycles worse. Here are some examples, and of course consult a mental health professional to distinguish reasonable accommodations from OCD accommodations. Reasonable accommodations include:
Making time for an autistic person with OCD to stay engaged in a special interest so they can enjoy a state of flow to increase their wellbeing,
Allowing fidget toys, sensory tools, or noise cancelling headphones, to help the student/athlete cope with distress,
Other ADA accommodations as recommended by therapists or healthcare practitioners of all types.
These are all reasonable things any person, with OCD or not, may need to account for variations in sensory processing, social engagement capacity, and personal preferences. These should almost NEVER be limited.