The Role of School Personnel: Social Support Strategies
Social Support Strategies
Students who have OCD may benefit from social support strategies at school. Teachers, principals, school nurses, social workers, psychologists, counselors and paraprofessionals can play a pivotal role in helping a student who is having social difficulties because of OCD.
Students with OCD are often unhappy -- if not depressed -- and feel isolated. They know their behavior isn't normal, which creates stress that other students don't experience and are not likely to comprehend. Children and adolescents have reported believing that they were “crazy” before discovering their obsessions and compulsions were caused by a real mental health disorder. The social difficulties experienced by many students with OCD are frequently compounded by the fact that OCD usually co-exists with one or more other disorders (e.g., AD/HD, Tourette Syndrome, learning disabilities) -- each of which may bring to bear its own set of difficulties related to social functioning.
When OCD is untreated, it can cause extreme anxiety or distress in young people. Even students who have been treated or are in the process of receiving treatment may have recurring symptoms to varying degrees. And the symptoms may shift, as well. Obsessions and compulsions regarding contamination fears and washing, for example, may change to worries and rituals related to washing and checking. Stress and normal peer pressure can intensify the severity of OCD symptoms in some students.
During the childhood and teen years, anxiety and stress related to OCD complicate the already complex process of building social skills. School personnel who understand what OCD is, and how it affects young people, can take positive steps to help the student overcome many of the barriers OCD creates that block normal childhood or teen relationships, interactions, teamwork and fun. Because school personnel are also in a position to influence how others interact with the student who has OCD, they can make a significant difference in improving the school experience for students with the disorder.
Setting an Example
Students of all ages derive social “cues” from a variety of sources. Some of the most influential are those seen on television, in the movies and on the Internet. Young people frequently model their own behavior after characters and scenarios portrayed in fictional broadcast programs and learn both good and bad social habits from web site content, special interest email groups, and videos and blogs, which are often on or connected with social networking sites on the Internet.
But school is a very important place where students closely observe the way people treat each other and learn about social interactions in the real world. It is essential that school personnel be positive role models, teaching tolerance and appreciating diversity, including individual differences associated with a variety of disabilities. This is no easy task because students with OCD (and other disabilities) can and do present difficult challenges. Understanding that OCD is a neurobiological disorder, and that students with this disorder are not to blame for their symptoms, may help educators respond with compassion rather than frustration or anger. And students who see that school personnel respect children and teens with OCD, and treat them with respect rather than scold, discipline or ignore them, are more likely to take on a healthy attitude toward all individuals who exhibit differences from the "norm."
Social Support Strategies
Students with OCD frequently experience difficulties or exhibit certain behaviors that may be observed by their peers. When these behaviors are very obvious -- or worse yet, appear odd or unusual -- there is a strong potential for the student with OCD to be stigmatized because he or she seems "different," if not weird. School personnel can play an important role in preventing or defusing OCD behavior to limit social stigma. Following are some examples of social support strategies that may be used to help the student with OCD. It's important to keep in mind that there is no "one size fits all" approach when it comes to accommodations or support strategies for students with OCD. What may work beautifully with one student may be ineffective -- if not a disaster -- for another.
|Observed Behavior||Example of Accommodation|
|Various OCD-related compulsive behaviors that may appear odd to peers; e.g., getting up and down out of the chair many times before being seated, repeatedly rearranging items on or in desk, or checking book bag contents||
Prevent or defuse teasing, bullying or gossip by including explanations of OCD and other mental health disorders in health or science class.
Teach tolerance and use strategies listed elsewhere on this web site to manage the classroom.
Keep the lesson going when a student with OCD engages in rituals; when the teacher stops and focuses on the student, all eyes will turn to the student, increasing the student's embarrassment about his or her actions.
|Chronically late for school in the morning -- may be from lack of sleep after a long night of revising homework or engaging in morning rituals||
Provide accommodations for the student that will facilitate homework completion, e.g., reduce length of homework assignments, allow the student to record answers on a tape recorder rather than write them out, etc.
Draw as little attention as possible to the student when he or she enters the classroom late. Refrain from engaging in public reprimands or displays of anger or frustration.
Allow the student to start classes later in the morning, rather than earlier, if possible (e.g., alter high school class schedule).
Refrain from giving official penalties for tardiness. When students know that there will be no punishment for being tardy, stress is usually relieved, and they are often able to arrive on time much more readily.
|Disrupting the classroom||
Allow the student to leave the room when he or she begins to feel or is feeling overwhelmed and go to a pre-arranged “safe” place (library, counselor’s office) to calm down. Arrange a private signal with the student that is to be used when the student needs to leave (e.g., card on desk, hand in air with closed fist).
Avoid trying to stop a ritual when the student is experiencing high levels of anxiety; a major conflict could arise.
|Difficulty with transitions/change in routine (e.g., transitioning from one class to another; making transitions between in-class activities; changes in schedules)||
Allow the student to leave the class perhaps 3-5 minutes early, so he or she can avoid crowded hallways during passing period. Arrange a private signal to indicate when the student may leave.
Allow the student to leave the class perhaps 3-5 minutes early, if additional time is needed at the locker to prepare for the next class. Arrange a private signal to indicate when the student may leave.
Provide the student extra time to make in-class transitions from one activity to another.
Use a timer or other auditory device to signal that it's time to start a different task/activity.
Send a note home, whenever possible, to notify the student/family of an upcoming change in schedule (e.g., substitute teacher, assembly) to give the student time to process/prepare for the change.
|Student appears to be socially isolated||
Structure classroom activities to build social relationships between students with and without disabilities using cooperative learning groups (e.g., Jigsaw Classroom; or Peer-Assisted Learning Strategies). Including the student with OCD with a partner/group of peers who demonstrate empathy/respect for all students may be helpful.
Avoid situations and activities in which a "team captain" chooses team players; the student with OCD may be the last one chosen (as may other students with disabilities or "differences.")
Provide education to all students about various disabilities.
|Repeatedly asking to go to the bathroom (generally to wash because of contamination fears)||
Set up a pre-arranged signal or use a small card the student can place on his or her desk when overwhelmed by an urge to leave the classroom to wash.
Work with the student to try to reduce the number of bathroom requests, if they are frequent. You will need to determine the current number of times he or she asks to go to the bathroom in order to set a reasonable limit, gradually reducing the number of bathroom requests; e.g., it would be inappropriate to try to reduce the number of bathroom requests from 10 (current number) to 1 all at once.**
(**Note: It would be most advantageous if the teacher, a school mental health professional such as the school psychologist or social worker, the parents, and the student collaborated to design and implement an intervention of this nature.)
Allow the student to use hand sanitizer at his or her seat in lieu of constantly going to the bathroom.
Bullying, Teasing, and Aggressive Behavior
Anecdotal records have indicated that students with OCD may be at higher risk for bullying than "normal" students, for several reasons. First, when OCD rituals are obvious to others, they may make the student with OCD look different, if not "strange." Second, because children and adolescents with OCD often have a reduced network of friends, they may not have the physical and emotional support necessary to ward off bullying. Third, students with OCD may also have coexisting conditions that increase the risk of being teased and bullied.
It is difficult enough when even one student teases or bullies a child or adolescent with OCD. Because of peer pressure, however, other students sometimes "jump on the bandwagon" of bullying or teasing, making the situation even worse. Bullying can involve psychological or emotional abuse such as name calling, whispering campaigns, laughing at, taunting, and shunning the student, as well as physical harm (e.g., pushing, shoving, hitting). The effects of bullying can be devastating and may create a vicious cycle: additional stress may trigger more OCD symptoms. It may even drive a student who has OCD into depression, which makes the situation even worse.
A recent research study on peer victimization among students with OCD supports anecdotal records of bullying. Researchers found that students with OCD experienced peer victimization significantly more than "normal" peers and even peers with Type 1 diabetes (because of potentially different eating habits such as avoiding junk food, the need for injections, etc., children with Type 1 diabetes may appear to be different from others, possibly increasing the potential for teasing). In fact, of the students with OCD, more than one quarter were being victimized regularly by their peers. The results of the study also indicated that more severe OCD symptoms led to more victimization, leading to higher levels of depression, loneliness, and externalizing and internalizing problems among students with OCD.
Although teachers believe that they almost always intervene in bullying incidents, actual observations have indicated very low rates of teacher intervention. This may be because many bullying episodes are verbal, brief, and frequently take place during times of little teacher supervision. As a result, students sometimes believe that teachers just cannot do anything about bullying or are indifferent to it. Research has even indicated that, when a teacher is present during a bullying incident and does nothing about it, it is even more harmful to the students being bullied, because it connotes acceptance of bullying. School personnel who do nothing -- allowing bullying, teasing or the more aggressive pushing and hitting -- are doing damage to the self-esteem of a student who has OCD.
This information underscores the importance of school personnel being vigilant for the presence of peer teasing and bullying in children and adolescents with OCD. Many schools are taking a zero-tolerance position on bullying, just as they have on any form of physical aggression. If a school does not have a formal policy about bullying and teasing, teachers and other school personnel can develop a position themselves. In addition, a number of anti-bullying programs are available today, such as The Olweus Bullying Prevention Program and The Bully Buster program. School personnel should review bullying programs carefully to determine which one is the best match for their schools in terms of the students' ages, cultural/ethnic make-up of the student population, etc.
While it’s not possible to make children or adolescents like or want to be friends with each other, teaching tolerance, empathy, respect and alternative conflict resolution strategies can limit situations that are damaging to self esteem. Clear behavioral expectations and consequences for bullying, teasing, or any kind of aggression should be in place and the response to these behaviors should be consistent and prompt.
Celebrating Skills and Talent
Students who have OCD are likely to have above average intelligence and may excel in a subject or have a particular talent. When these students have abilities in art, music, singing, athletics, poetry, science, or other areas, it may be very helpful to provide opportunities for them to demonstrate their talents and single them out for recognition. This simple technique will highlight the student's strengths and can improve self-esteem. It works on two levels: it can help the student with OCD see that he or she is a valuable individual who is not defined by OCD, and it also helps classmates appreciate a side of the student they may not have recognized previously.
Improving Activity Dynamics
When classroom or lab assignments require small groups of students to work together on a project, it is sometimes helpful for the teacher to assign the groups, being sure to include the student with OCD in a group of respectful classmates or with a single partner who gets along well with the student. If students are allowed to choose their own groups, the student who has OCD may be the last to be chosen, or find all the groups “full” when he or she tries to join one. The severity of the OCD symptoms may dictate whether classmates are kind, neutral or cruel toward the student who has OCD. But if a student has social difficulties because of OCD (or possible OCD), the best course of action is to preempt opportunities for classmates to exclude that student.
Physical education class can be particularly challenging for some students who have OCD, including those who avoid being touched, those who fear contamination by people and environments such as gyms and locker rooms or those highly sensitive to odors. These concerns may also apply to extracurricular activities involving physical activities. In fact, many students with OCD avoid contact sport of any kind.
If team sports are required as part of the physical education curriculum, school personnel should work with the student, the parents, and the student’s therapist (if he or she is being treated for OCD) to determine ways to include the student without causing severe stress that might make the OCD worse. For example, a student who has OCD might initially be asked to assist the teacher with equipment or recordkeeping rather than take part in the sport itself, if physical contact would be unbearable for the student. This would allow the student to be seen as part of the team, rather than someone who was excused because of a disability. In addition, as previously noted, when forming teams for P.E. activities, it is preferable to use a method other than having team captains choose team members; a student with OCD may be the last one chosen.
Social Skills Training
Research has indicated that up to 80% of individuals with OCD have onset during childhood. As a result, there is a high risk that OCD will interfere with normal child development. Therefore, it is imperative that school personnel provide social skills training to students with OCD who have difficulties with social functioning. In some cases, these students need to be taught basic social skills (e.g., how to join in a group conversation, how to say "please" and "thank you" appropriately); in other cases, students know basic social skills but they don't actually apply them in social settings.
In order to be successful, students must know and be able to use interpersonal skills in countless social situations. Understanding and appropriately engaging in verbal and nonverbal exchanges, initiating social interactions, and developing strategies for handling social conflicts, for example, are critical to social competence.
One specific and direct approach for fostering social relationships is the "social autopsy." Developed by Rick LaVoie, the social autopsy is a strategy in which an adult helps a student improve social skills by jointly analyzing the child's social errors and developing alternate strategies.
In some cases, formal social skills training will be necessary to assist the student who has OCD function within school and other social contexts. A number of commercial programs for teaching such skills are available (e.g., Skillstreaming the Elementary School Child: A Guide for Teaching Prosocial Skills/Program Forms, by Drs. Goldstein and McGinnis) and are frequently used in educational settings. It may be extremely helpful to consult with your school’s social worker, school psychologist, or counselor to discuss social skills training for students with OCD who have difficulties with social competence.