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©istockphoto.com/ADDitude MagazineFranklin's OCD Story
Franklin’s symptoms highlight the diagnostic difficulties of discerning between OCD and ADHD.
I consulted with the 15-year-old and his parents when he was in tenth grade. Franklin couldn’t stay on task and fidgeted in class, and while doing homework. At a recent school meeting, a teacher suggested that Franklin may have ADHD. Franklin’s parents had him examined by his family doctor, who started him on a trial of methylphenidate. His problems got worse.
When Franklin visited with me, I discovered that his teachers and doctors had never asked him why he acted the way he did. He told me that he could not stop his behaviors.
"I can’t start schoolwork until everything is in its place," he said. He told me that his pen had to be at the top of, and parallel with, the desktop. The paper he wrote on had to be positioned at a 45-degree angle. He stacked books only on the right corner of his desk. He "had to" do these tasks.
"Sometimes it takes so long to get everything where I need it to be that I run out of time," he said.
When he writes, each letter and word has to be formed perfectly. If it isn’t, he erases it and writes it again -- and again. Sometimes the paper tears, and he has to start over. "Doing schoolwork in class or at home is exhausting," Franklin said.
He went on to describe another frustration when he did homework. "I keep wondering whether I locked the front door before coming upstairs. I have to go down and see that it is locked -- even if I know that I already checked." Franklin told me that these behaviors started in fourth grade. He managed them well until high school, when written work started to overwhelm him.
Franklin's OCD Diagnosis
Even though the minutes from his teachers’ conference strongly suggested that he had ADHD, I was fairly certain he had obsessive-compulsive disorder (OCD), a neurologically based disorder that causes anxiety.
Classroom teachers often interpret inattention and poor classroom performance as ADHD. Many teachers are familiar with the symptoms, but they may not know that a diagnosis requires that the observed behaviors be chronic and pervasive. Franklin’s behaviors were first noticed in middle school, and they occurred only when doing written work in class or homework.
When I met with Franklin and his parents to discuss my impressions, his mother was surprised. His father smiled and admitted that he had some of the same symptoms. I explained that the stimulant medication Franklin was taking for his misdiagnosed ADHD could make his OCD symptoms worse. I took him off the stimulant and put him on a selective serotonin reuptake inhibitor (SSRI). I also recommended that he see a cognitive behavioral therapist.
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