When ADHD Accommodations Inflame OCD in Kids
Some supports for ADHD can intensify a student’s OCD symptoms. Here’s what teachers need to know.
School accommodations unlock learning for many neurodivergent students. But when a child has ADHD and obsessive-compulsive disorder (OCD), certain commonly used accommodations may unintentionally trigger symptoms, and lead to harmful effects.
Here are several accommodations that should be carefully reconsidered when supporting a student with ADHD and OCD:
Granting extra time on assignments and tests.
This is helpful for students who struggle with processing speed and focus. However, students with OCD may use that extended time to check and recheck, reread and rewrite, and overthink their answers. In other word, they will fill the extra time for testing with compulsive behaviors.
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OCD generally expands to fill the container it is given. Think of the classic OCD compulsion of handwashing. Without time restrictions on how long an individual can spend in the bathroom, the washing may take longer and longer. Time boundaries provide at least some limit to OCD behaviors.
Allowing a child to eat in a separate area.
Some neurodivergent students experience distraction and/or disgust in cafeterias, so their parents worry they won’t eat at school unless given this accommodation. When a child is allowed to eat in a separate lunch area at school, however, they become less willing to engage in public eating in general.
Children with OCD may benefit from being required to eat in a cafeteria, where they will be exposed to some of their triggers, such as fear of contamination, social challenges, and sensory experiences. Repeated exposure to OCD triggers can lead to desensitization over time, while consistent avoidance achieves the opposite. As educators and parent, we must be willing to allow our children to feel discomfort in the short-term so that they become stronger in the long-term.
[Self-Test: Avoidant Restrictive Food Intake Disorder (ARFID) in Children]
Allowing more time with a school counselor to talk about worries.
Sometimes, traditional therapy and school counseling techniques can exacerbate OCD symptoms. OCD treatment techniques are highly specific, and school counselors are seldom trained in this modality. Instead, the counselor may offer reassurance, anxiety check-ins, and other approaches that could fuel OCD behaviors.
No student should rely on their school counselor (or teacher) to regulate their compulsions and fears. OCD treatment involves allowing our children to feel anxiety and resist the urge to “fix” it (including by seeing the school counselor). OCD diminishes when a child no longer reacts to anxiety as though it were dangerous or disabling.
For children with ADHD and OCD, school accommodations must be thoughtfully considered. Generally, long-term accommodations are not recommended because they could lead students with OCD to become less resilient and more anxious over time.
Childhood OCD in School: Next Steps
- Read: OCD and ADHD – The Polar Opposites That Are Not
- Watch: “OCD in Children with ADHD – Navigating the Dual Diagnosis”
- Read: What if You Are Enabling Your Child’s Anxiety?
Natalia Aiza, LPC, is a therapist and parent trainer. She is the co-founder of Kairos Wellness Collective, an innovative therapy center that specializes in OCD and anxiety disorders.
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