Obsessive-compulsive disorder in children — viva

Stem

Examiner-led viva on paediatric OCD. ^[22]

Examiner: How do you open this "lateness and anxiety" presentation? ^[22]

Strong answer: I greet the child first, then ask directly and privately about intrusive thoughts that keep coming back and rituals he performs to settle them — children hide obsessions, so I do not wait for him to volunteer them. I frame this as a full assessment, not a same-day label. ^{[17] [22]}

Examiner: He admits that unless his laces feel "just right" his mother will die. What defines this as OCD rather than a quirk? ^[22]

Strong answer: The impairing obsession–compulsion cycle: an intrusive, ego-dystonic thought (mother dies) drives a repetitive ritual (retying) that gives brief relief and restarts, consuming more than an hour a day and causing distress and impairment — unlike a normal ritual, which is enjoyed, time-limited and not impairing. ^{[17] [22]}

Examiner: Parents are now tying his laces for him. What is that, and does it help? ^[14]

Strong answer: That is family accommodation. It is well-intentioned but prevents extinction learning, maintains the cycle and predicts poorer response — so reducing accommodation (without blaming the parents) is an explicit treatment target within CBT/ERP, not a sustainable solution. ^[14]

Examiner: What is first-line treatment for moderate OCD? ^[1]

Strong answer: Cognitive–behavioural therapy with exposure and response prevention, roughly 12–16 sessions, is first-line and often effective without medication. The family is involved to reduce accommodation and support exposures. ^{[1] [22]}