Obsessive compulsive disorder - OCD treatment and therapy from NOCD

Back to School with OCD: A Survival Guide for Children, Teens, and Caregivers

14 min read
Stacy Quick, LPC

It’s that time of year again: The weather is starting to get a little crisper, and soon the leaves will begin to turn color. The end of summer is a time of change, and a time to start anew for many. With it, this time of year can bring excitement, nervousness, and many questions for those getting ready for a new school year: What will this year look like? What will my new class schedule be? Will I like the people in my class? What if I get that teacher no one wants to have? Will my friends be with me in class? 

These are all expected uncertainties that students face at the start of a new school year. But for many children and teens who have OCD and their caregivers, there will undoubtedly be many additional things to worry about. 

For students with OCD, school can be a struggle. They may appear to be daydreaming, distracted, or disinterested, when really, they are often struggling with distressing unwanted thoughts, fears, images, or urges—also known as obsessions. This can lead them to be focused on compulsions—the rituals they complete in an attempt to alleviate the anxiety and distress their obsessions cause. 

To understand how OCD may be affecting your child or loved one, let’s consider scenarios kids and teens with OCD may find themselves in.

What OCD may look like in elementary school

Amy is a 9-year-old girl going into the third grade. She has been struggling with contamination worries for the last year and has become skilled at avoiding anyone or anything she thinks may have germs. If a person sneezes within a mile radius of her, she can be thrown into a tailspin of compulsions. She carries hand sanitizer with her wherever she goes. She even has a small container of Lysol wipes that she uses in “emergency” situations. 

Amy has a very rigid set of guidelines that she must follow when she feels she has been in contact with germs. She avoids touching the floor because she knows that shoes can track in all kinds of germs. Last year her school had “circle time” that required the children to sit on the floor, so Amy would often fake a stomachache so she could avoid it. When that didn’t work, she would be sure to go to the bathroom following circle time to try to clean her pants with soap, as they had touched the ground. This still was distressing, and when she got home from school, she would immediately have to change and shower. 

What others may not realize is that Amy is not worried about becoming sick herself; instead, she is worried about carrying germs home to her loved ones. In particular, Amy has a little brother who has an autoimmune disorder, and any sickness could wind up being a catastrophe for him. Her days and nights are filled with what-ifs and the fear that she could somehow be responsible for harming her brother unintentionally. She must do everything right: His life is at stake, and it would be her fault if something bad happened to him. Amy’s parents are at a loss for how to help her.

Ryan is a 6-year-old boy entering the first grade. He is excited because he has never had full schooldays before. Ryan is smart and thoughtful, and he likes to do good work. He wants to ensure that everything he does is correct. His parents worry because he always wants a lot of reassurance from them. They have three other children, so they have realized that Ryan’s needs for reassurance and approval are excessive compared to their other children. They try to give as much encouragement to him as they can, but he often requests more, even for seemingly mundane things.

Ryan and his parents have been practicing his writing skills all summer in anticipation of the new schoolwork he will be expected to do. Although he enjoys writing, this nightly practice has turned into a bit of a nightmare for his parents. They notice that he erases his sentences repeatedly and wants the letters to line up “just right.” This process can take up to two hours a night for just one sentence. He becomes frustrated and cries when he feels that his writing is not neat enough. No matter how much his parents comfort him and tell him that he is doing good work, it is never enough. 

Emily will soon turn  11 and is getting ready to start 5th grade at a whole new school. She recently moved into a new home with her mother, so the past summer has been full of changes. Emily has always been energetic but is easily distracted. Her teachers at her old school often asked her mom whether Emily had been diagnosed with any attention difficulties.  It was not uncommon for her to wander off away from her teacher and classmates when her class was headed to recess or lunch. She was often seemingly lost in her thoughts and was described by many as a daydreamer. 

Last year, Emily’s teacher noticed that she began repeating movements, such as going in and out of the classroom doorway several times. When her teacher asked her why she needed to do this, she refused to answer. After several visits to the school counselor’s office, she finally opened up and said that she has to do certain things in a certain way for a certain amount of time so that no one she loves will die. At one point, Emily was having to go back and redo these steps in various doorways up to 10 times a day. She also had begun to touch items throughout the classroom over and over again. The teacher became frustrated and felt that Emily was being oppositional.  

Learning became very difficult for Emily, and she often came home from school depleted and sad. She would spend most of her evening sleeping, exhausted from her days at school. Emily’s mom was also stressed and unsure of what to do. She wants her to be happy and not to worry so much about all of these things, but she doesn’t know how to help her.

What OCD might look like in junior high or high school

Jose is a 15-year-old high school student. He has been struggling with nagging thoughts about whether his friends really like him or not. No matter how hard he tries, He cannot seem to shake these thoughts. He asks them repeatedly if they do, but he can tell that they are getting annoyed with him. Over the summer break, he wasn’t able to see them as much and noticed that they didn’t go out of their way to invite him to any gatherings. He starts to worry if this is because of his constant questioning. Jose wishes he could stop this, but he just can’t seem to. 

Sienna just turned 18 and is a senior at last. Although this should be a time of excitement for her, she cannot help but feel sad. During her summer break, she spent some of her days with her friends at the lake. On one occasion, there were people from another school that she hadn’t previously met. Sienna got introduced to a new guy that day and later that evening, they kissed. They started to date, and she began following him on social media. That’s when she realized that he had just turned 17 years old. She immediately broke up with him and ignored his calls. She became devastated as she liked him, but she could not shake the guilt and shame that she felt. She feels she has done something wrong and questions whether she is attracted to children because he is younger than her. Now, every time she sees a guy she is attracted to at school, she is worried that he might be younger than her.

Marcus is a very conscientious 13-year-old. He always wants to do the “right thing.” When he feels he hasn’t, he is compelled to tell someone what he has done “wrong,” confessing every possible mishap. This has left him in many awkward situations. Marcus understands that this is illogical and realizes that not many people tell everyone everything that they may have done wrong, but he still feels the urge to do so. That’s because when he resists confessing, he feels that he cannot shake the thoughts, and he is unable to move on with his day until he does. He has noticed that people give him odd looks and some people have even called him names because of this habit. This has left him worried about the new school year and what it will bring. 

How to help your child as they prepare to go back to school 

These scenarios are just some of the countless ways in which OCD impacts young children, teens, and their loved ones. OCD comes in many themes and can manifest in so many different ways that it would be nearly impossible to capture them all. Yet, these stories all have a commonality: These children are suffering at a deep level, and likely so are the people that love them the most. It can be devastating to see your child or loved one go through the experience of OCD. 

In fact, the family unit as a whole may be suffering. Often, when a child experiences this disorder, there is a domino effect—it impacts nearly every area of a family’s life. Family members may find themselves unwittingly pulled into compulsions, giving reassurance constantly, or avoiding things that used to be fun, all in a feeble attempt to rid their child or teen of the intense anxiety that they are feeling. So what are the loved ones of these children or teens to do? How can they help them as they are returning to school, given all the unknowns that will arise? 

Preparation is key. For younger, elementary-aged students, you will want to prepare your child for the new school year. Talk about it frequently, and find out what their concerns are. If it’s possible, try and have a meeting with their teacher before school starts. Just meeting the teacher may help ease some jitters, and you may even want to include other staff members who will be interacting with your child. 

Your child’s teacher may be willing to make some accommodations that can help limit their distress. Many children do well with an emergency plan—a plan where if their anxiety gets too high, they can go somewhere to calm down. Just having this can help a child press through when they are struggling.  

For a teenager, things may look a little different. You can help them to prepare for triggers that are specific to their symptoms. Help them to develop greater awareness of what their OCD looks like and how attending school may impact them. Likewise, you can help them come up with a plan that suits their needs. 

You can ask your teen how they feel about talking with school personnel about this and whether they think it will be beneficial to include teachers or other staff in their plan. If your teen is uncomfortable sharing personal details about their OCD with their teachers, perhaps having an escape plan in place for when they feel that the anxiety is unbearable is the best course of action. This could be a code word that they text a parent or a phone call home to alert the parent. Or maybe it is having a special pre-approved, stress-free zone at school that they can go to until the anxiety is more manageable.  

Predictability plays a role in most children’s success no matter their age, and this can be true with school in particular. Just as adults thrive in structured and predictable environments, kids do, too. Remember that OCD wants rigidity, predictability, and to know with 100% certainty about any given concern (which is impossible). Of course, we all know that not everything can be planned out, and things do happen that are unaccounted for. 

That is why it’s key not to focus so much on the particular theme, fear, or concern the child has, but rather on the underlying components of the disorder. OCD causes people to doubt everything and to fixate on the what-ifs. OCD will try and convince them that this time it really is different and so they must do what OCD tells them to do. This often sounds like “if I do this compulsion just one more time, then everything will be okay.” The more they are aware of the way that OCD works and are equipped to respond to it, the less likely they are to fall for it. Help your child understand that no matter what the anxiety latches onto, OCD is fueled by uncertainty and doubt. Help them recognize OCD and have a plan for how they can deal with it when it shows up. 

Awareness of triggers is important. We know that OCD often attaches itself to things or people we value, so what affects one child with OCD will be different for another, even though they have the same disorder. To help bring awareness, it is important to first identify or recognize what your child values. Then help your child understand that the thoughts OCD latches onto are ego-dystonic, meaning that they are aligned with what your child desires. That is why your child is so troubled by the thoughts and why they get “stuck” on them. It can be beneficial to help them separate who they are from what they think. Thinking about something is not the same as doing something—this is a very important distinction.

Helping your child long-term

It is worth noting that the intent here is not to accommodate the child’s rituals and compulsions. This would not be helpful in the long run. Instead, these suggestions are intended to help you support your child and ease them into the new school year. This allows the child to feel heard and can reduce the stress and fatigue that often accompany OCD. Helping them and their teacher(s) understand what is happening is an important part of facing the bully that is OCD. This is a gradual process; your child’s OCD didn’t get to this point overnight, and it likely won’t diminish quickly either. 

These suggestions are also meant to be short-term solutions part of a much larger treatment plan. Caregivers should be working alongside someone specialty-trained in treating OCD to help develop a more robust plan of action.  Hopefully, your family has been doing exposure and response prevention (ERP) already and knows some skills that can guide this process. If not, this is highly recommended to start ERP, as it is the highly effective, clinically proven treatment for OCD. In conjunction with an OCD specialist, you and your child can come up with ideas for how to confront their fears at a manageable level, even in a school setting. 

Through ERP, your child will learn how to sit with uncomfortable feelings and resist the urge to do compulsions. They will see that anxiety, like any other feeling, eventually passes, and they don’t have to do anything to make this happen.

There is also help available through accessing special education services within school settings. It is important to note that many school personnel may not be aware of OCD and what this may look like, so you and your child’s treatment team will play a crucial part in advocating for what your child needs. But schools are required by law to help students with OCD. 

According to the International OCD Foundation, “the Individuals with Disabilities Education Act (IDEA) is a federal law in the United States that governs how states and federally funded public agencies provide early intervention, special education, and related services to children with disabilities. Although the law does not include OCD as a specific disability, children may be eligible to receive special education services through an ‘Other Health Impairment’ (OHI) or ‘Emotional Disturbance’ (ED exception).”

Above all else, your child must know that they are not in this alone. They have a wider support system—they have people around them who care for them and who are willing to walk with them as they learn to handle this debilitating condition.

Taking ERP to school

If your child is struggling with OCD, NOCD can help. Our licensed therapists deeply understand OCD and are specialty-trained in treating OCD with ERP. We work side-by-side with the OCD experts and researchers who designed some of the world’s top OCD treatment programs – and that means the best care for our members and their families.

Your child’s therapist will help identify a specific, personalized treatment plan that works for your child and your family to tackle their OCD fears. Working alongside a therapist can help your family to determine what fighting OCD will look like when your child is at school and at home. Ultimately, ERP can help your child and family regain the freedom that OCD has taken.  

To learn more about how your child can get started with OCD treatment, book a free 15-minute call with our team.

NOCD Therapists specialize in treating OCD

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Taylor Newendorp

Taylor Newendorp

Network Clinical Training Director

I started as a therapist over 14 years ago, working in different mental health environments. Many people with OCD that weren't being treated for it crossed my path and weren't getting better. I decided that I wanted to help people with OCD, so I became an OCD therapist, and eventually, a clinical supervisor. I treated people using Exposure and Response Prevention (ERP) and saw people get better day in and day out. I continue to use ERP because nothing is more effective in treating OCD.

Gary Vandalfsen

Gary Vandalfsen

Licensed Therapist, Psychologist

I’ve been practicing as a licensed therapist for over twenty five years. My main area of focus is OCD with specialized training in Exposure and Response Prevention therapy. I use ERP to treat people with all types of OCD themes, including aggressive, taboo, and a range of other unique types.

Madina Alam

Madina Alam

Director of Therapist Engagement

When I started treating OCD, I quickly realized how much this type of work means to me because I had to learn how to be okay with discomfort and uncertainty myself. I’ve been practicing as a licensed therapist since 2016. My graduate work is in mental health counseling, and I use Exposure and Response Prevention (ERP) therapy because it’s the gold standard of OCD treatment.

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