Obsessive compulsive disorder (OCD) can significantly affect a child’s academic, social, and emotional functioning, which is collectively defined as his or her “educational performance” by the Individuals with Disabilities Education Act (IDEA). Fortunately, parents and educators can work together to address the educational needs of youth with OCD. In fact, schools are required by law to assist students with disabilities such as OCD. However, they may do so in different ways depending on the nature of the child’s symptoms, his or her academic functioning, and the availability of resources.
The Individuals with Disabilities Education Act (IDEA)
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. Due to the way that state boards of education interpret IDEA, schools in some states may need a physician or psychologist to provide a recent medical report establishing a child’s disability. Further information may need to be collected suggesting that commonly used treatment interventions were ineffective before a student is diagnosed with an OHI. To qualify to receive services for an ED exception, a student must display one or more of the following characteristics over a long period of time and to a significant degree that negatively affects his or her educational performance:
- An inability to learn that cannot be explained by intellectual, sensory, motivational, lack of academic engagement, or health factors
- An inability to build or maintain satisfactory interpersonal relationships with peers and teachers
- Inappropriate types of behavior or feelings under normal circumstances
- A general pervasive mood of unhappiness or depression
- A tendency to develop physical symptoms or fears associated with personal or school problems.
Additionally, a student’s problematic behavior or emotional responses must be significantly different from age appropriate, cultural, or ethnic norms and data may be needed suggesting that commonly used research-based interventions were ineffective for consideration for an ED exception.
Any legal guardian can request an evaluation to determine if his or her child may benefit from special education services. However, a request does not guarantee that a comprehensive psychological and educational evaluation will be conducted. Under the 2004 reauthorization of IDEA, state departments of education now have several options to govern how school personnel should evaluate and address student needs. Because of problems with quickly and efficiently delivering special education services, the 2004 reauthorization of IDEA blurs the lines between assessment and intervention, which allows schools to simultaneously provide research-based intervention services and collect data on a student’s response to these services.
Regarding the former, many schools now use a response-to-intervention (RtI) approach to determine students’ disability status and provide supportive resources. This approach involves providing students with intervention services as soon as a problem is identified to fix the problem and avoid over-identifying students with disabilities. Therefore, under IDEA, students with OCD may receive services through RtI even though this is not yet a common practice or due to being diagnosed with having an OHI or ED exception. Additionally, following a gradual service delivery approach, students with OCD may initially receive services under a RtI framework but then receive additional special education supports if they fail to respond to research-based interventions.
It is important to note that “research-based interventions” provided during the RtI process or prior to evaluating a student for an exception differ from “well-established” and “probably effective” interventions as defined by the American Psychological Association’s Task Force on Promotion and Dissemination of Psychological Procedures (1995), which includes cognitive behavioral therapy (CBT) with exposure and response prevention (ERP) as a well-established treatment because of its excellent performance in properly designed research trials. In other words, the “research-based interventions” that the schools provide may not align with what OCD and psychology experts have found to be particularly effective for treating OCD in children. Research-based interventions that are commonly implemented in schools for students with OHI and ED exceptions may be behavioral in nature and have research-based support; however, they generally are not as rigorously evaluated as they should be. Therefore, it is unlikely that a student will receive CBT with ERP to treat his or her OCD symptoms at school.
Individualized Education Plan (IEP)
Once a student is diagnosed with an OHI or ED exception and becomes eligible to receive special education services, these services are then outlined in an Individualized Education Plan (IEP). An IEP describes how a student’s disability influences his or her educational performance. Furthermore, it lists academic and behavioral goals and the academic/behavioral supports needed to help the child achieve these goals.
Legal guardians must be invited to participate on the IEP team, which generally includes the student’s teacher, a special education teacher, a school administrator, a school psychologist, and other school personnel. A legal guardian also may invite others to attend IEP meetings such as a trusted associate, child advocate, or attorney. If a legal guardian does not agree with the IEP or the IEP team’s decision regarding special education eligibility, he or she must be informed how he or she can challenge the decision.
Section 504 of the Rehabilitation Act
Section 504 of the Rehabilitation Act guarantees rights to people with disabilities. It aims to decrease discrimination and promote equal opportunities by requiring schools to provide reasonable accommodations (e.g., extra time on tests, use of computer-aided instruction) for children with disabilities. These accommodations can address temporary or chronic problems, and no diagnosis is needed for students to receive them. Thus, 504 accommodations can be implemented quickly and flexibly. However, in contrast to services provided under IDEA, school systems do not receive federal funding to provide 504 accommodations.
Children with OCD may be eligible to receive 504 accommodations if their symptoms significantly limit at least one major life activity (e.g., walking, speaking, learning, reading, writing, performing math calculations, working, self-care) as determined by a school-based team that usually includes the same individuals who sit on IEP teams. Section 504 requires the review of multiple sources of information provided by different individuals (e.g., school psychologist, parent, teacher) prior to providing accommodations.
Similar to IEPs associated with IDEA, eligible 504 students receive accommodations through an Individual Accommodation Plan (IAP). This plan simply lists specific accommodations and interventions that may help a student overcome his or her disability. These plans often list specific instructional materials that a student may need, modifications to tests or assignments, grading and assessment changes, and behavioral interventions.
Supporting and Accommodating Students with OCD
Some caregivers may believe that students with IEPs are automatically placed in a special education class, while children with IAP or 504 plans are allowed to remain in a general education classroom. However, this is not accurate. Although students with IAPs generally receive instruction in regular educational settings, students with IEPs may receive instruction in general and special education settings under the assumption that they will be served in the least restrictive setting possible.
Students who receive special education services under IDEA are automatically protected under Section 504 so there is no reason for them to have an IEP and an IAP. Generally, students who qualify for special education services under IDEA have more severe and intractable disabilities than students with 504 plans do. However, this is not always true, and students can transition back and forth between service delivery plans depending on their response to interventions and progress toward achieving IEP goals.
Similarities exist between the types of interventions and accommodations that can be provided for children with IEPs and IAPs. Common interventions and accommodations for children with OCD include but are not limited to the following:
- Counseling (individual or group) (it will be important to determine if this type of therapy is specific to OCD or more supportive in nature)
- Changes in the amount of time available to take tests
- Changes in where tests will be taken
- Provision of frequent breaks during instruction
- Shortened assignments
- A behavior improvement plan
- Preferential seating
- Transition plans
- A special pass to use the restroom/office
However, members of IEP and IAP teams should carefully select accommodations and interventions that will help a student and not reinforce his or her OCD symptoms, especially if the child is in treatment with a mental health OCD specialist. For example, extra time on a test can cause a child with perfectionistic concerns to spend even more time fruitlessly erasing and rewriting his or her answers. Moreover, providing a seat cushion to a child with contamination obsessions could undermine effective treatment for the child’s OCD. Therefore, in addition to including caregivers, it is important for school personnel to collaborate with a student’s treatment providers when determining potential accommodations and interventions.
Discipline and Manifestation Determination
Students who have IAPs or 504 plans can be expelled from school if a behavior problem is not related to their disability. However, students with IEPs have the right to fair and appropriate educational programing under IDEA, even if they are expelled from school. In other words, schools are required to provide special education students with behavior problems with educational services in some capacity, whereas students who manifest similar problems and have an IAP — yet not an IEP — may not be eligible for these services. Therefore, students who have OCD, and a co-occuring exception as recognized by IDEA (e.g., autism, developmental delay, OHI, ED), as well as display significant behavior problems, may be better protected from being expelled if school personnel evaluate and diagnose them with the co-morbid disorder.
The Individuals with Disabilities Education Act (IDEA) and Section 504 of the Rehabilitation Act and the Americans with Disabilities Act allow children with OCD to receive intervention services and accommodations in school settings. Depending on a school-based team decision, students with OCD may be classified as having an Other Health Impairment (OHI) or and Emotional Disturbance (ED) exception and be provided with an Individualized Education Plan (IEP). Alternatively, they can receive services through Section 504 and provided with an Individual Accommodation Plan (IAP). Furthermore, schools also may decide to provide students with research-based interventions to see if they adequately respond to these interventions and do not need intensive supports or a special education diagnosis. However, schools are required to do something to help children with OCD if their symptoms negatively impact their educational performance.
In conclusion, schools are legally required to assist children with disabilities and include caregivers in the process. However, school personnel may be unfamiliar with OCD and unaware of steps they can take to better support affected children. Therefore, caregivers and mental health professionals should collaborate with members of school communities to ensure that children with OCD are adequately supported in school settings.
By Michael L. Sulkowski, PhD, & Eric A. Storch, PhD, University of South Florida