What are Anxiety and OCD?

Children with anxiety or OCD are likely to exhibit symptoms in the school setting. For this reason, it's important to understand the signs and symptoms of Anxiety and OCD and to be able to differentiate between normal vs. abnormal behavior.

 

Anxiety in Kids

Everyone experiences anxiety at some point in their lives, from the very young to the very old.  In school, students may get nervous during a fire drill, before a test or presentation, or when saying goodbye to their families in the morning.  It is normal and common for students to get anxious in situations like these.  When a student’s anxiety starts to creep out of specific situations and into their everyday life, they might have an anxiety disorder.

 

Anxiety, as it relates to mental health conditions, is defined as chronic and/or generalized worry, fear, or nervousness that students express a lot of the time.  In other words, the anxiety the student feels is not driven by specific situations – they feel anxious most of the time, regardless of what is happening in their life.  In these cases, anxiety noticeably impacts a student’s behavior in school and at home, their ability to participate in class, their learning, and/or their ability to perform assigned tasks.

Types of Anxiety Experienced by School-age Children

There are many types of anxiety and anxiety-related disorders that school-age youth can experience, including:

  • Generalized Anxiety Disorder
  • Panic Disorder/panic attacks
  • Separation Anxiety Disorder
  • Social Anxiety Disorder
  • Selective Mutism
  • Specific Phobias
  • Post-Traumatic Stress Disorder

While each of these conditions have different symptoms, the common thread between them is that they cause severe, chronic disruption in a child's life.

What are Anxiety and OCD

OCD in Kids

While obsessive compulsive disorder (OCD) is one of the more common mental health disorders among school-age youth, it is not widely understood and is rarely included in discussions of mental health in the classroom. OCD involves both obsessions and compulsions that take a lot of time, get in the way of important activities -- such as school and extracurricular activities, developing friendships, and self-care -- and can cause severe anxiety in those affected.

  • Obsessions are intrusive and unwanted thoughts, images, or urges that occur over and over again and feel outside of the child’s control. These obsessions are unpleasant for the child and typically cause a lot of worry, anxiety, and distress.
  • Compulsions (also referred to as rituals) are behaviors the child feels they “must do” in order to get rid of the upsetting feelings caused by the obsessions. A child may also believe that engaging in these compulsions will somehow prevent bad things from happening.

In general, OCD is diagnosed when these obsessions and compulsions become so time-consuming that they negatively interfere with the child’s daily life. Typically, the obsessions and compulsions become gradually more severe over time until they get to this point.

Is it Anxiety/OCD or is it Typical Behavior?

It is common for students to have anxiety/fears, and to have certain routines/rituals for certain times.  What makes anxiety and OCD different from these common fears and behaviors is the frequency and intensity at which they occur, and whether or not they get in the way of the student’s daily life.  The following chart can help distinguish between fears and behaviors that are developmentally appropriate, and those that might constitute anxiety and/or OCD.

Typical Fears/RoutinesAnxiety/OCD
The content is usually commonplace (e.g. fear of thunderstorms, wanting to eat the same breakfast every day, etc.)May seem bizarre or unusual, out of sync with what is happening. May be extreme or disproportionate responses to the situation.
Age-appropriate (e.g. wanting to be tucked in at night).The student may have fears that are not typical to their age group (e.g. sexual/violent intrusive thoughts).
Do not consume an inordinate amount of time nor interfere with daily functioning.Experience of fears and/or performance of rituals is excessive, time consuming, and has a negative impact on the student’s functioning.
Associated with enjoyment or satisfaction; the student wants to do them, or likes doing them.Students find their behaviors distressing and/or overwhelming.
Responsive to logic or reason.Reason or common sense do not stop or help the student’s fears or behaviors. Students often cannot be comforted or reassured.
NOTE: Younger students may not realize that their fears are bizarre or unusual (i.e. they may lack insight).
Are able to be stopped or interrupted at will.The student feels they cannot control their fears or stop doing their behavior(s). Interrupting the behavior will cause the student a lot of distress.

Adapted from “Students with OCD: A Handbook for School Personnel” by Gail B. Adams, EdD

 

Anxiety disorders and OCD are not something a student can simply “snap out of.” Students with anxiety that is disproportionate to the situation find it difficult to manage their feelings. Likewise, students with OCD typically have little control over the obsessions they suffer from and the compulsions they perform to try to get rid of their bad feelings.

Signs/Symptoms of Anxiety and OCD in School

What are the signs and symptoms of anxiety and OCD that a child may exhibit in school?

 

In this video, Eric Storch, PhD, talks about the different ways that children may exhibit signs and symptoms of anxiety and/or OCD in the school setting.

 

Read below for additional information about the signs and symptoms of anxiety and OCD in school.

Anxiety Signs/Symptoms in School

When it comes to OCD in a school setting, you may notice some of the following signs/symptoms:

  • Anxiety may make a student appear to be cautious, nervous, shy, or fearful.
  • Anxious students may express their fears by crying or throwing tantrums, and it may be very difficult for them to calm down.
  • Some students may seek constant approval or reassurance from others.
  • Students may describe feeling physical symptoms, like headaches, stomachaches, racing heartbeat, or difficulty breathing.
  • You may notice that they are sweating, or that they are trembling/shaking. In some cases, students may experience full-blown panic episodes or panic attacks.

OCD Signs/Symptoms in School

OCD compulsions

When it comes to OCD in a school setting, you may notice some of the following compulsions:

  • Repeated lining up, checking, ordering, or arranging items on desks, in backpacks, or lockers
  • Wanting to complete assignments “perfectly,” checking, and re-doing it
  • Sloppiness or carelessness in completing assignments, which is not typical for the child
  • Erasing repeatedly until the paper has holes in it, the ink is smudged, and the writing or drawing is illegible
  • Reading letters, words, or sentences repeatedly, repeating syllables until they sound right
  • Incomplete assignments or homework, although the child is capable of doing them
  • Frustration or anger when things are disorganized, interrupted, or routines change unexpectedly
  • Asking the teacher or other students the same questions repeatedly even though the child knows the answer
  • Frequent trips to the bathroom either to use the toilet or wash hands
  • Refusing to touch others’ books, pencils, the ball in gym, etc. or getting upset if own personal items are touched by others
  • Sudden avoidance of familiar things or reluctance to try new things
  • Odd behaviors such as walking in specific patterns through doorways, counting tiles or syllables, touching or tapping in symmetry, or sitting and standing repeatedly
  • Opening doors, lockers, desks, or books with elbows or with tissue in hand, holding hands in the air to avoid physical contact, refusal to shake hands, share pencils, or other supplies.
  • Excessive reassurance seeking (e.g., always asking “Are you sure I’m going to be okay?”).

OCD Obsessions

Common obsessions that fuel these compulsions may include:

  • Worrying about germs, getting sick, or dying.
  • Extreme fears about bad things happening or doing something wrong.
  • Feeling that things have to be “just right.”
  • Disturbing and unwanted thoughts or images about hurting others.*
  • Disturbing and unwanted thoughts or images of a sexual nature.*

 

* PLEASE NOTE: Students who have sexual and/or violent intrusive thoughts find them to be very upsetting and distressing.  The experience of these thoughts does NOT mean these students have any desire or intention to act on them.  It can be scary for school personnel to hear about these thoughts, but it is very important to note that these students are not at risk and should not be confused with students who may have a history of or intent to perform antisocial, aggressive, or otherwise violent behavior.

How Can Anxiety and OCD Impact School Performance?

Anxiety and OCD can have a significant impact in the school setting.  These conditions can affect a students classroom behavior, academic performance, and social interactions. To learn more about the potential impact of anxiety/OCD at school, click here.