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1、Pediatric OCD,Joe Edwards, Psy.D. Stephanie Eken, M.D. David Causey, Ph.D.,Prevalence of OCD in children,OCD is considerably more common than once thought1 in 200 are thought to suffer from OCD3 or 4 in each elementary school have itUp to 20 adolescents in an averaged-sized high school have OCD7 mil
2、lion in the US will suffer OCD during their lifetime (15 million OCD spectrum disorders),Prevalence of OCD cont.,Unfortunately, only 4 of 18 children found to have OCD were under professional mental health care (Flament et al., 1988), of those 18 had been identified as having OCD OCD has been called
3、 the “hidden epidemic” (Jenike, 1989),Factors contributing to underdiagnosis of OCD,Factors in OCD: secretiveness & lack of insight Fear of being seen as Crazy Factors with healthcare providers: incorrect dx.s, lack of familiarity with (or unwillingness to use) proven treatments, differentiating var
4、iants of OCD symptoms Access to good treatment,DSM-IV criteria for OCD,OCD is characterized by recurrent obsessions and/or compulsions that cause marked distress and interference with social or role functioning,Children may present with either obsessions or compulsions (most have both) In youth, the
5、 types of symptoms, can change rapidly,DSM-IV criteria for OCD,OCD behaviors can occur in a child without meeting criteria for OCDDSM-IV specified OCD symptoms must cause distress, being time-consuming ( than 1 hr/day) , or must significantly interfere with school, social activities, or important re
6、lationships,DSM-IV criteria for OCD,Obsessions are more than simply excessive worries about real life problemsObsessions originate from within the mindAt some point in the illness, the person recognizes that the O/C are excessive and unreasonable,DSM-IV criteria for OCD,Specific content obsessions a
7、re not related to another Axis I disorder (obsessions about food in an eating disorder or guilty thoughts with ruminations in depression),Common OCD symptoms in children,Obsessions Contamination themes Harm to self or others Aggressive themes Sexual themes Scrupulosity/religiosity Forbidden thoughts
8、 Symmetry urges Need to tell, ask, confess,Compulsions Washing or cleaning Repeating Checking Touching Counting Ordering/arranging Hoarding Praying,Common OCD symptoms in children,OCD symptoms frequently change over timeBy the end of their adolescence most all of the classic symptoms have been exper
9、ienced by the child,Assessment of OCD,*See Merlo et al., 2005Clinical InterviewBe sure to include: Impact on activities (which ones) Impact on family (and family dynamics) Accomodation behaviors (see scale) Childs attitude toward symptoms (ego- dystonic versus ego-syntonic),Diagnostic Interviews,Anx
10、iety Disorders Interview Schedule (Silverman & Albano, 1996) not high agreement between child and parentSchedule for Affective Disorders and Schizophrenia for School-Age Children (Kaufman et al., 1997),Measures,Children Yale-Brown Obsessive Compulsive Scale (CY-BOCS) (Scahill et al., 1997) Clinician
11、 Rated (past week) Assess severity of symptoms, controlSome evidence that clinician-rated is superior to subject-rated (Stewart et al., 2005),Measures,Leyton Obsessional Inventory-Child Version (Berg et al., 1988) Includes a short formChildrens Obsessional Compulsive Inventory (Shafran et al., 2003)
12、Childrens Yale-Brown Obsessive-Compulsive Scale-Child Report and Parent Report (Storch et al., 2004),Measures,CBCL Obsessive-Compulsive Scale (Storch et al., 2005) 6 items; adequate psychometricsChild Obsessive Compulsive Impact Scale (Piacentini & Jaffer, 1999)* School activities, home/family activ
13、ities, social activitiesFamily Accomodation Scale (Calvacoressi et al., 1995)* Correlation with severity and family dysfunction,What is not OCD,Developmental FactorsMost children exhibit normal age-dependent obsessive-compulsive behaviors (Liking things done “just so” or insist on elaborate bedtime
14、rituals (Gessell, Ames, & Ilg, 1974) By middle childhood, these behaviors are replaced by collecting, hobbies and focused interests,What OCD is not,Individuals who display excessive worry that does not cause severe discomfort or disrupt daily lifeO-C PDobsessive people who are punctual and/orderly (
15、but perfectionism, stinginess, or aloofness can interfere with their life or the quality of relationships) Compulsive eaters, Pathological Gambling, Promiscuous sex, or Drug abuse (these people derive pleasure from the compulsive activity),Comorbidity with OCD,More than one disorder is often present
16、 (the Dx. of OCD is not exclusionary) Many children become so distressed and overwhelmed by OCD symptoms that they develop MDD,Comorbidity with OCD,Tic disorders, anxiety disorders, LD, & disruptive behavior disorders are not uncommon OCD is a spectrum disorder Disorders on the OCD spectrum include: trichotillomaniabody dsymorphic disorderTourette Syndrome/tic disorders Only a small number exhibit signs of OC personality disorder,What does not cause OCD,Overly strict toilet training Watching a parent or sibling carry out OCD rituals (those without a genetic predisposition),
