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A 10-Step Guide for teachers and caregivers for recognising and separating traits seen in Asperger Syndrome and OCD



Teachers: for further advice relating to children you work with, and yourself, please link to TeacherSupportNetwork. You'll find the link at the bottom of this page above the disclaimer. You may also find the videos on this page helpful - these look more indepth at ADHD, OCD, Asperger's and SPD.

  10-Step Guide 

  • Below is a non-medical guideline to help recognise obsessive compulsive behaviours associated with OCD; behaviours associated with Asperger syndrome; or a combination of both
  • While Carol Edward's is not in a position to make a diagnosis for medical conditions, the information provided is based on her relevant studies and continuing professional development; and also lived experiences 
  • For easier reading, the term ASD is used to describe autism and Asperger's interchangeably 

1. Obsessions and collecting – One child I worked with appeared obsessed with a particular type of teddy and couldn't resist adding these to her collection - she saved her pocket money to buy these. While she seemed happy with her purchases she also felt highly distressed about how the compulsion to buy the teddies made her feel. She said she felt she had to collect them, or something bad would happen. In this sense, apprehension associated with collecting is more than likely attributed to OCD. In comparison another child who had ASD would collect such things as stamps or ornaments and where this was done with a steady interest and usually without distress, unless interrupted. Children with Autism or OCD are also sometimes known to suffer distress when they are separated from a particular item from their collection, or if they are prevented from adding to it. For example, a child with OCD might think something bad will occur if they cannot find/have or add to their collection; whereas a child who has ASD will feel lost or confused without their item, which causes their distress. If an OCD/ASD overlap occurs, each behaviour will need sieving from the other to be able to deal with the child's situation sensitively, and in which a solution can be found and agreed on. For ASD this would be emotional management, and for OCD building distress tolerance around probability - e.g., discussing with the child the likelihood of something bad occurring being close to zero if they don't have their item (actually zero, but because the child has to learn to live with uncertainty, therapists work on low probability). Talking about magical thinking is appropriate in this instance, and having the child cut back on compulsions, such as reassurance seeking, checking, and so on to disprove their fears, which helps them grasp better probability and also that thoughts do not make bad things happen.

2. Idiosyncrasy – This is a behavioural quirk attributed to the person only, thus a distinguishing trait of a child with ASD might be to skip or hop once after every few steps without feeling distress, unless they are prevented. However, a child who has OCD might do the same behaviour to gain temporary anxiety relief only, and this is cyclic. You may see this type of behaviour in the playground, and if repetitive, it may be that the child is using this action as a ritual to 'ward off danger' or 'just to 'feel right' in which case stopping the child abruptly could result in high anxiety or panic. Usually the child falls back into the 'norm' of things if they think they have done what OCD wants, in which case lesson times resume without too much distress. In cases where the behaviour 'takes over' however, it might be worth discussing the problem with the child's parents in the first instance. 

3. Rituals – A child with an ASD might prefer to follow a ritual. For example, Harry dresses in the same way every morning and will follow through with the sequence usually without distress. He follows a ritual because he prefers regularity. On the other hand, Sam, who has OCD, dresses in the same way every day but feels troubled at having to follow the pattern because it isn't what he really wants to do – he has a compulsion to do the ritual and unless he carries it out, his anxiety increases. This type of compulsive behaviour is usually to 'ward off danger' or 'just to feel right'. Care is needed during school sports because changing into their sports kit, and then back into their uniform can cause distress if interrupted. Dressing up for school plays also needs careful handling. Discussing the problem with teachers in the first instance can be helpful. Some kids who have OCD often have problems choosing which colour clothes to wear too, for example, if they choose white socks or other item of clothing, OCD will say choose blue or something bad will happen. 

4. Routine – Children with an ASD usually follow a routine when getting ready for school, which may include using only some types of products in the bathroom. Doing/using things in a particular order makes them feel grounded and secure. This is really just typical of ordinary behaviour in terms of any person preferring familiarity. That said, a neuro-typical person will usually feel little anxiety if a routine is broken, but a person with an ASD may feel intense distress. 

OCD rituals

In contrast, a child with OCD may look like they're following a routine such as doing things in a certain order before leaving for school, but this is more in keeping with doing what the OCD wants, not what the child wants. For example, a child's 'routine' could actually involve a symmetry and ordering ritual, or a checking ritual. Observing behaviours such as the child saying they've forgotten something or they need to go to the toilet just as they are about to leave the house might be a sign to say this could be OCD, and not a preferred routine. In other words, they might be nipping upstairs to double check on something, e.g. that all toys are 'perfectly' aligned, or that all windows are locked. Quite often this repeated behaviour makes the child late for school, so it might be worth a parent mentioning the problem to teaching staff to lessen the impact when the child enters a full classroom with the register already done.

5. Tics – For a child with an ASD, this would usually be attributed to a mannerism belonging to that child only. That said, a person who has OCD or Autism, tics can also occur. In this case, the child will usually make involuntary movements and sounds that serve no purpose. On the other hand the child who has OCD sometimes has the urge to make sounds and movements that appear to mimic Tourette's. The child may blink fast, shrug, or shout out a single word or phrase. But this is done to neutralise unwanted thoughts, images or impulses. As such, the 'tics' are voluntary with the purpose that the behaviour temporarily reduces anxiety. However, children with involuntary tics may need time in a safe room (accompanied by support staff) to release their tics - it's very difficult for them to suppress these for too long. For the child with OCD, strategies for intrusive thoughts that involve tics to 'ward off danger' may already be set in place with a cognitive behavioural therapist outside of school hours. For better clarification for either tics associated with Tourettes, Asperger's, OCD or a combination, connecting with the child's parents can help. Generating strategies for the child during class-times can then be agreed on.

6. Intrusive thoughts, images, impulses and irrational fears – These are attributed to OCD and can overlap with ASDs. Unless children are able to express what they are thinking it's not easy to know the content of their unwanted thoughts, but certain behaviours can help to reveal when the intrusions are likely to be happening. For example, if Sarah hears an ambulance siren while in school (trigger), she gets the thought that her mother has been involved in an accident (thought content), which leads to further obsessive thinking in which she imagines her mother in hospital. When the teacher inadvertently snaps Sarah out of her thoughts, Sarah continues to experience internal distress. Intrusive thoughts often terrify children because they believe that getting a sudden thought about something bad happening can actually make it happen, so a regular habit of a child seemingly in a world of their own could be a clue to take care.

Noise sensitivity in children with an ASD 

Bear in mind that the sound of a siren can trigger a reaction in children with an ASD because they are often noise sensitive; therefore they might cover their ears or flap, but unfortunately may still get told off for being 'silly' or 'disruptive', especially if the teacher is unfamiliar with the characteristics of Autism, and if the child has no formal diagnosis. Again, if the behaviours are consistent, talking with parents and caregivers can help throw light on what the child's difficulty is.

More OCD examples

With reference to the above OCD example, this is only one instance, and there are many more, including: 

  • Children living with contamination fears may have an aversion to being touched. In this case they might be seen to 'shake off' the feeling from someone brushing against them. This may cause class or playground squabbles in which the child might get in to trouble for appearing 'naughty' or 'unfriendly'. It may be that their behaviour needs differentiating from an ASD since a child with autism may present similarly but this is often due to tactile response, not contamination fears.
  • Some children are urged to repeatedly straighten their pencils before they start writing, usually to 'ward off danger' and to reduce anxiety.   
  • Some repeatedly rub out 'mistakes' because they have an urge to make their work look 'perfect'. These children are often afraid of criticism.
  • Other children are seen to tap a part of their body or the edge of a table to reduce anxiety. If the taps follow a repeated number sequence then this again is usually to 'ward off danger'. If the child taps one leg or arm and then taps the other leg or arm, it's because he or she probably has a need for symmetry. 
  • There are other times when children experience sudden intrusive impulses or disturbing images that go against their beliefs; for example, visualising poking another child in the eye with a pencil. Here you might see a 'tic' or the child may seem 'absent' - these are an indication that they are likely trying to mentally counter the impulse or image.
  • A child may appear not to 'hear' someone trying go get their attention, but it could be that the child is performing a mental ritual to neutralise an intrusion. It's only when they've finished the neutralising affirmation that they respond; or they may respond when interrupted and then repeat from the beginning the mental counter as soon as the person has stopped talking to them.
  • Some children get the urge to use the toilet at a particular time each day and fear that something bad will happen if they are not able to go.
  • There are also times when children experience defecation fears and will withhold faeces until they get home, because the only way they feel able to use the toilet is to take off all their clothes to avoid contaminating them.

Containing distress

Children feel so exhausted at containing their distress caused by their unwanted thoughts and behaviours that they may well have a meltdown to release themselves of the day's anxiety build-up when they get home. Also, on arriving to school the next day, they may present with separation anxiety, knowing they are going to have to face another day with their fears alone. 

7. Socialising and sensory issues or contamination fears? – One of the reasons children with an ASD often find mixing with other children difficult is due to touch sensitivity, which can be seen when they for example opt-out of game playing that involves touching. Other times they may decide not to join in after-school clubs involving noisy activities. Being sensitive to sensory input such as noise, touch, smells, sights is challenging for children living with Autism, which, to dispel the myth, is not related to bad manners or sulking about joining in. Instead, this is related to disordered neurological processing that often accompanies ASD. A further example associated with social and interaction issues is sharing a meal in the canteen. This can cause children with an ASD great distress since they often gag at the sight and sound of other children eating, again due to sensory processing problems. This is compounded by typical canteen noises, smells and kids brushing against each other to which they find very hard to tolerate. They experience more distress because they want to mix and socialise like other kids do and if they could do so without sensory difficulties (coupled with additional interaction and communication difficulties), they would. Allowing the child to sit by the door is one option. This gives them the choice to stand outside for a few minutes to take a few deep breaths (emotion management), and before rejoining the children at the table. Or another option might be allowing the child to take their lunch somewhere quieter, such as a safe room with a support worker, whilst working on integrating the child back into the dining room in graded steps.  Note: bear in mind that children with SPD may also experience similar difficulties whether they are on the autism spectrum or not.

Contamination fears

Children with contamination fears present very similarly to the description above. For example, they may opt-out of game playing or decide not to join after-school clubs but not because they're touch sensitive but because they fear that touching one another will spread germs, or make them filthy. At lunch time a child with contamination OCD may worry about catching germs from someone else's hands touching their food; or other children's food touching their food. Some children think the smells of foods in the air can transfer to their food and contaminate it too. As such, they will try to sit away from other children to eat, or may leave their food untouched. These problems are unrelated to sensory sensitivities; however when children with an ASD have an overlap of contamination fears, then recognising and separating each behaviour is important for generating appropriate solutions.  

8. Change of plan – A teenager with Asperger's said it takes at least 24 hours to get the scene in her head when plans to do something have been put to her. She said she is 'thrown off balance' when the plans suddenly change because she doesn't have time to re-arrange the scene in her mind. I asked her how this felt and she said, 'This would be like someone planning your day, you have the scene in your head, then the person with you says, "Come on, we're going to catch a flight to Australia."' This is interesting because it helps to grasp that what typically might be classed as a minor change of plan is in fact quite a major event for a child with Asperger's, even if that means a change of classroom or teacher for just one lesson. In comparison, when a change of plan occurs for the child with OCD, e.g. taking another route to school, they may get distressed because it might take them away from a certain compulsion; for example, touching a particular lamppost three times on the usual route to school to 'ward off danger'. Prior notice of any change is often helpful for children with an ASD. Discussing with parents ways to manage compulsions for the child with OCD when these affect class times is also worthwhile such as having parents agree to get their child up half-an-hour earlier so they're not late for school, and until CBT support is put in place to reduce compulsive behaviours.  

 9. Morbid rumination – It's not uncommon to see children with an ASD seemingly in their own world, or mentally distracted; however, when this is seen repeatedly in children with OCD, take care because they could be suffering a cyclic rumination in which hidden fears will be causing them to feel a constant floating anxiety. The content of their rumination is usually morbid but non-subjective, e.g. death, volcanic eruption or the world ending. If they are suddenly snapped out of their obsessive thinking they will be startled when the teacher inadvertently 'propels them back into the classroom' (or other person/place). All children daydream from time to time, usually about nice things, but because the content of the rumination is disturbing and repetitive for children with OCD, it causes great distress and often mindful distraction helps. Much care is needed here, and can be handled similarly to what's described in 'step 6' above on intrusive thoughts, images, impulses and irrational fears.  

10. Meltdowns - I remember last year seeing an image of a mother holding her distressed child in her arms. It took me back to an incident of a young couple with a little boy whilst I was taking a walk on the sea front. The mother seemed to be in control as she saw to her child's needs while the father held back, closely monitoring the situation. A man and woman, probably in their 50s, commented to the father that what the child needed for his temper tantrum was a spanked backside and that a good smack did them no harm when they were kids. The father replied calmly that their child was autistic and was in meltdown. An accompanying quote in the image made reference to autism and read: 'My child is not giving me a hard time; my child is HAVING a hard time.' This made me realise how identifying that a child with an ASD, who might appear to be having a temper tantrum in public is actually going through the symptoms of what typically might be experienced as a panic attack - likely brought on by being overwhelmed with sensory input. In raising awareness, parents can purchase autism awareness cards that they can take out with them. Nursery assistants and teachers can also take autism awareness cards with them when they accompany a child on a school outing for example. These can be purchased online by clicking this link: http://www.autism.org.uk/products/core-nas-publications/autism-cards.aspx See description in the box below. A pack of 50 only costs £2.00. 

Description

The NAS card has been developed in consultation with people with autism/AS and their families. The card can be carried by a parent or carer of a person with autism and handed out in difficult situations where they may find communication difficult. Suitable for all age groups.

The card contains the following text:

This person has autism

> Autism is a lifelong disability that affects social and communication skills.

> People with autism may behave in unpredictable ways as a result of their difficulty in understanding language and social situations.

> People with autism are likely to be extremely anxious in unfamiliar situations.

> Please help by being understanding, patient and tolerant.

Supplied in packs of 50 credit card-sized cards.


Seeing Beyond a Parent's Anxiety

Teachers and caregivers who see beyond a parent's anxiety make a huge difference. Being prepared to discuss any concerns for the benefit of the child is more than helpful because anxiety can overwhelm children suffering from Austism and/or OCD (with or without diagnosis). When anxiety increases overtime the child may go on to develop associated mental health problems such as depression, especially if they are left to cope alone for too long. Supporting a child with appropriate intervention fosters self-efficacy, eases tensions in the home and thus helps the child better manage separation anxiety, and can reduce the chances of further problems developing.

Note: Carol Edward's is aware that some teachers and caregivers are familiar with the conditions described in this 10-step guide and therefore wishes to say that her intention is not to insult those who already have this knowledge; instead, this guide is to help raise awareness and to also support uninformed teaching staff and relevant others. Please see the disclaimer at the end of this page.

TeacherSupportNetwork   

This is for teachers experiencing anxiety themselves, either through managing children with the problems described above, or as a self-help guide for coping with their own anxieties such as OCD, PTSD, depression, or something else. Developed with Anxiety UK, this guide looks at how anxiety develops and explains the physical, psychological and behavioural symptoms associated with anxiety. On TeacherSupportNetwork you will find guidance on the management and treatment of anxiety which details further support, if needed. Here is the link:

http://www.teachersupport.info/get-support/practical-guides/anxiety

Disclaimer

Carol Edward's 10-step guide is information-based only. While the contents are based largely on her own observations whilst living and working with children on both spectrums and also continuing her professional development in Asperger's and obsessive related conditions, it is still advised that after reading this information that teachers and other professionals discuss any concerns with the child's parents/carers who are then advised to visit their child's general health practitioner for further assessment. While the points raised are from Carol Edward's own evaluations, she respects that readers' ideas and opinions may differ. 

Thank you for reading  



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