Obsessive-compulsive disorder in children and adolescents

Children and adults with OCD have similar obsessions and compulsions, as well as a similar response to most psychotherapeutic and pharmacotherapeutic interventions. A large proportion of adults with OCD, perhaps as high as 80%, have their onset during childhood or adolescence. The prevalence estimate of OCD in children is at least 2-4% and an even larger number may have subclinical OCD. Recent gains in OCD research have consisted in differentiating normal ritualistic behavior in children from OCD symptoms, realizing a more systematic assessment of OCD symptoms in children, refuting the impression that OCD in children is a rare condition and developing psychological and pharmacologic treatment strategies. Controlled studies of the phenomenology of OCD in children have been conducted. The vast majority of children with OCD have concurrent neuropsychiatric disorders including mood, tic, other anxiety and neurologic disorders, as well as pervasive developmental disorders. Recent investigations show that risk to relatives for OCD or subthreshold OCD is significantly higher in relatives than controls. Earlier age of onset also seems to be related to degree of familiality of OCD. The management of OCD in children entails an integrated approach of available behavioral, pharmacological, family therapy and supportive interventions. Illness education should be a major component of management and individualized treatment is important. Further research in OCD should serve to improve the prognosis of this mostly chronic condition in children.