In a comprehensive outpatient and day program for youth aged 12-20, the Intake and Counselling Unit accepts referrals identifying a wide variety of problems. Assessment reveals a complex set of interacting factors, including personality traits, that can play a major role in determining the presenting problem. In this interdisciplinary setting, collaboration is initiated as the need arises and takes place between a psychiatrist and an academic consultant. It became apparent that obsessive-compulsive personality traits contribute significantly to problems of school failure. From this finding came the more specific awareness of the necessity for modification of both classroom environment and teaching strategies. Finally our investigation centered on ways to best achieve this end through consultation in the school.
Three case examples are presented that illustrate character traits usually associated with descriptions of obsessive-compulsive personality. These traits which interfere with performance include worrying, excessive expectations, dissatisfaction with results, competitiveness, procrastination, need for control, and self-criticism. These "B type" traits, described by Sandler, contrast with those that are syntonic and contribute to success, such as care with detail, punctuality, consistency, and tidiness. (Sandler & Hazari, 1960).
A variety of treatment options are discussed and the role of the psychiatrist in school consultation is explored and compared with other professional consultation resources. Also described is the expansion of this role in the development of classroom strategies that meet the needs of the student with obsessive-compulsive personality difficulties. The rationale for their use is given along with a discussion of the difficulties experienced in the process of consultation and in achieving change in the classroom.
Three examples were selected to provide background to frequently seen problems. In none of these cases were the personality difficulties the identified problem at the time of referral. In all cases, school failure was noted and performance assessed as achieving less than student's potential. All had been identified as a major concern by school counselors, and all were at risk of failing their year. However, two were of above-average intelligence with skills beyond age-grade level. Of these students, one had a significant and unrecognized skill deficit. In each case, it was felt that obsessive-compulsive personality traits were major factors in school problems and that improved academic success could be achieved by following our recommendations.
A ten-year-old girl, the eldest of three in an intact, professional family, was seen at the family's request because of concerns over recurring "tantrums." These were scenes of verbal abuse directed toward the mother when things did not go right or mother failed to meet the daughter's needs or expectations. They centered on conflict over such matters as going to bed and what was served for breakfast--wishes that were catered to, more often than not. The mother was a very conscientious and kind parent while the daughter was perfectionistic and demanding. Both parents were willing to examine their role in the problem, and together with their daughter were seen for family counseling. In time, the goals of reconciling parental consistency and authority with daughter's responsibility and independence were largely achieved.
Two years later the family presented again, this time with concerns about their daughter's lack of concentration and success in school. She was known to be a bright student with consistent "A" grades in a high-achievement school. In October of the academic year, she had been given a series of assignments to be completed within a given time. She was becoming increasingly upset about going to school, and feared she would fail her …