Obsessive Compulsive Disorder (OCD)

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Definition

Anxiety Disorder causing the sufferer to experience repeated, unwanted thoughts and compulsive behavior

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Behavioral Characteristics

Compulsions are actions and rituals that individuals perform to relieve, prevent, or undo the anxiety or discomfort created by the obsessions

• Form rituals (repeating the same behaviors) Frequently washing hands Brush teeth excessively Check repeatedly if a door is locked-- Rechecking Repeat words and counting Placing objects just right; touching thingsSmelling or LickingErasing or writing and rewriting letters until perfect

(Adams, 2004; Szechtman & Woody, 2004)

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Communication Characteristics

• Repeating words like “um”

• Tourrette’s Syndrome verbal tics (a related disability)

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School CharacteristicsInfluence of obsessions:

1. May avoid feared objects, places, or situations, including refusal to go to school

2. May avoid open-ended tasks 3. Difficulty paying attention, which has been

rerouted to obsessive thoughts and fears 4. Students with severe OCD tend to show…

• Hoarding• Difficulty initiating or completing tasks• Difficulty making decisions• Schizotypal Personality disorder (magical

thoughts)

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School CharacteristicsInfluence of compulsions:

1. More likely to be tardy or absent, which is judged by teacher as laziness or poor attitude

2. More likely to be ridiculed by peers, because their behavior looks ‘weird’. For example, they might:• Line up school supplies in certain order• Repeat words, or behaviors• Touch objects multiple times• Re-enter rooms • Wash or clean often (themselves and objects)

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Accommodations1. Keep stress levels low

2. Capitalize on the strengths & talents

3. Establish a private signal to use in the classroom

4. Change time and quantity required:a) Provide extra time on tests, different locations, oral

tests, or testing breaks

b) Reduce the amount of homework (Adams, 2003)

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Look at this link

http://www.youtube.com/watch?v=WQYLkmwyd9w

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Depression

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Behavioral Characteristics

Hyde (2002)

1. “Depressed children may act out their sad feelings through behavior instead of words because children and younger adolescents are often unable to pinpoint exactly how they feel, and they may not have the vocabulary to describe their inner feelings.”

2. Depressed children tend to emit more negative and aggressive behaviors than non-depressed children.

Segrin (2000)

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Social CharacteristicsDepressed pre-adolescent children:

1.frequently look sad, tired, or ill.

2.are irritable

3.reduced appetite and weight loss OR increased appetite and weight gain

4.express depression by:1. less facial animation than non-depressed people,

except for conveying sadness.2. engaging in less eye contact with others 3. engaging in less gesturing and head-nodding.4. holding their head in a downward position more often

5.have little frustration tolerance

6.are demanding and difficult to please--nothing can make them happy

7.complain about everything; say they do not feel well or complain of frequent stomachaches and/or headaches

8.become increasingly clingy and dependent

9. may start acting babyish again (Quinn, 1997; Peacock, 2000; Segrin, 2000)

Depressed adolescents:

1. are ill-tempered

2. are “touchy”

3. are over-reactive

4. can be difficult to get along with

5. are aggressive and/or disruptive

6. engage in delinquent behavior

7. are compulsive party-goers

8. are extreme thrill seekers or daredevils

Quinn (1997)

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Etiology cont.Life Stressors--children:

1. With a learning disability or having difficulty in school

2. Who experience family losses

• 41% of depressed patients had lost a parent (divorce or absence) before age 15

• conflict (blended families, SES low)

• parental pathology

3. Who have been in some type of disaster

4. Who have suffered some type of abuse

5. With medical problems

6. Who are gay or lesbian

7. Who are pregnant

Harrington (1993); Sarafolean (2004)

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Cognitive Characteristics & Distortions

Harrington (1993)

1. tend to have negative thoughts toward themselves and others in all circumstances.

2. unable to recall as many positive experiences they have had.

3. have poor concentration

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1.alone more often and initiate fewer social interactions.

2.lack of interest in playing with other children; withdrawn

3.doesn’t enjoy participating in organized activities such as sports, games, etc.

4.repeated rejection by other children(Conner) (Glide & Pine)

Social Characteristics

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Academic Characteristics

1. have poorer cooperative working skills

2. have lost interest in academics

3. skip school frequently

(Glide & Pine) Hamilton (1997), Quinn (1997); Hyde (2002)

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Communication Characteristics

1. “speak more slowly, speak less often, exhibit longer pauses [when speaking], and take longer to respond to the speech behaviors of others. They generally speak with less volume and more silences and hesitancies.”

2. in a monotonous tone and with a lower pitch, making their speech less clear, and more difficult to hear and understand.

3. tend to withhold their negativity when talking to strangers. However, they are more inclined to introduce negative topics into conversation when talking with a friend.

Segrin (2000)

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Accommodations

Madison (2004)

1. Don’t ignore the depressed student. It shows that you don’t care and invites the student to give up, guaranteeing their failure. Draw them out in class discussion and do whatever it takes to stimulate their minds so they don’t, in turn, learn to ignore you.

2. Let them know that you care, but without getting too personal

3. Help them to update any missing assignments, or set up extra study time – whether they accept your efforts or not all depends on the severity of the depression.

4. Never give up on the student – regardless of how long they haven’t wanted to put forth any effort in your class. Students can tell when a teacher no longer believes in them and expects them to fail, and it only ends up making the situation worse.

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1. Make them active responders with activity programs to increase participation and decrease isolation-- depressed lawyer became a newspaper deliverer

2. Behavioral techniques--teach social skills, assertive training

3. Cognitive ---to change characteristically negative belief system with positive self-statements.

4. Task Difficulty--break up tasks, teach how to use charts for self-feedback, etc

5. Medication: Antidepressant drugs

Interventions

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Look at this link for early signs of depression

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Bipolar Disorders

• Episodes of major depression with episodes of mania– Mania = persistently

elevated, abnormally expansive, or irritable mood

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Communication

If a child is in a manic state they won’t stop talking, but if they are in a depressive state, they are not talkative

(Hillegers et al, 2005)

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Suicide Warning Signs• Sudden changes in behavior or affect• Giving away possessions or talk of not being

present in the future• Academic, social, or disciplinary problems at

school• Family problems (separation,divorce,child abuse)• Situational crisis (death, pregnancy or abortion,

arrest, loss of employment of self or family member)– Disturbed or disrupted peer relations (peer

rejection,breakup of romantic relationships)– Health problems (insomnia, loss of appetite, sudden

weight change, etc.)

• Substance abuse

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WORDS TO WATCH FOR

• “Life isn’t worth living.”• “I have no future.”• “Why get out of bed?”• “Who do you think would come to my

funeral?”• “Maybe things would be better if I weren’t

around.”• Depression is merely anger without

enthusiasm.

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IMMINENT DANGER OF SUICIDE

10 min interview Risk Factors:• male, • past attempts, • more than one previous attempt,• history of antisocial behavior, • close friend or family member committed suicide, • frequent drug and alcohol use,• depression, • incompatible social environment.

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Intervention PLAN:

IF 5 or more indicators are present, then youth judged to be in imminent danger--refer child to other professionals (counselor at school)

IF 2 or more present or if youth has current ideas or plans of suicide, take step 1 immediately:1. written promise: makes one not to engage in suicidal

behavior for specified period of time, such as 2 weeks2. compliments: delivers to self and others, which is

inconsistent with a pessimistic and hopeless outlook3. assess feelings: can rate feelings associated w/ emotional

discomfort and suicidal ideation4. Plans ahead: lays out steps for coping with threatening

circumstances in which suicidal impulse likely to emerge.

Take threats and attempts seriously