Psych · Child and adolescent psychiatry — OCRD
Childhood-onset OCD
Also known as Paediatric OCD · Pediatric obsessive-compulsive disorder · Juvenile OCD · Early-onset OCD · Child OCD · Adolescent OCD · CY-BOCS
Exam-exhaustive fellowship reference on childhood-onset OCD — DSM-5-TR criteria, family accommodation, CY-BOCS, ERP and family-based CBT (POTS/POTS Jr), SSRI evidence with paediatric monitoring, tic-related and PANDAS/PANS exam nuance. FRANZCP-primary, globally tagged.
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Target exams
Red flags
- Suicidal ideation or self-harm linked to intrusive forbidden thoughts, shame, or SSRI activation — urgent risk assessment and safety plan
- Severe self-neglect, dehydration, or inability to leave home because of contamination rituals — intensive care pathway and safeguarding
- Acute dramatic overnight OCD/tic onset with possible post-infectious features — consider specialist PANDAS/PANS work-up without delaying standard OCD care
- Poor insight labelled as psychosis without OCRD formulation — avoid antipsychotic-first reflex for primary OCD
- High family accommodation maintaining severe rituals — treat the system, not only the child
- SSRI black-box window: new or worsening agitation, suicidal thoughts early in treatment — close monitoring, contact plan
Meet the patient
A 12-year-old is two hours late for school most mornings. His hands are cracked to the knuckle. He asks his mother the same question — "are you sure the door is locked?" — an estimated forty times a night, and she answers every time, because when she stops he cries until 2am. His homework is rewritten until the letters look right. He has told nobody about the thought that he might hurt his little sister, because he is certain it means he is dangerous.[4][10]
Two things in that story are treatable this month: the rituals and the answering. The examiner's question is "who else in this house is doing the OCD's work?"[4][10]
References18ShowHide
- [1]Pediatric OCD Treatment Study (POTS) Team Cognitive-behavior therapy, sertraline, and their combination for children and adolescents with obsessive-compulsive disorder: the Pediatric OCD Treatment Study (POTS) randomized controlled trial JAMA, 2004.PMID 15507582
- [2]Franklin ME, Sapyta J, Freeman JB, et al. Cognitive behavior therapy augmentation of pharmacotherapy in pediatric obsessive-compulsive disorder: the Pediatric OCD Treatment Study II (POTS II) randomized controlled trial JAMA, 2011.PMID 21934055
- [3]Freeman J, Sapyta J, Garcia A, et al. Family-based treatment of early childhood obsessive-compulsive disorder: the Pediatric Obsessive-Compulsive Disorder Treatment Study for Young Children (POTS Jr)—a randomized clinical trial JAMA Psychiatry, 2014.PMID 24759852
- [4]American Academy of Child and Adolescent Psychiatry Practice parameter for the assessment and treatment of children and adolescents with obsessive-compulsive disorder J Am Acad Child Adolesc Psychiatry, 2012.PMID 22176943
- [5]Scahill L, Riddle MA, McSwiggin-Hardin M, et al. Children's Yale-Brown Obsessive Compulsive Scale: reliability and validity J Am Acad Child Adolesc Psychiatry, 1997.PMID 9183141
- [6]March JS, Biederman J, Wolkow R, et al. Sertraline in children and adolescents with obsessive-compulsive disorder: a multicenter randomized controlled trial JAMA, 1998.PMID 9842950
- [7]Geller DA, Hoog SL, Heiligenstein JH, et al. Fluoxetine treatment for obsessive-compulsive disorder in children and adolescents: a placebo-controlled clinical trial J Am Acad Child Adolesc Psychiatry, 2001.PMID 11437015
- [8]Riddle MA, Reeve EA, Yaryura-Tobias JA, et al. Fluvoxamine for children and adolescents with obsessive-compulsive disorder: a randomized, controlled, multicenter trial J Am Acad Child Adolesc Psychiatry, 2001.PMID 11211371
- [9]Watson HJ, Rees CS Meta-analysis of randomized, controlled treatment trials for pediatric obsessive-compulsive disorder J Child Psychol Psychiatry, 2008.PMID 18400058
- [10]Calvocoressi L, Lewis B, Harris M, et al. Family accommodation in obsessive-compulsive disorder Am J Psychiatry, 1995.PMID 7864273
- [11]Swedo SE, Leonard HL, Garvey M, et al. Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections: clinical description of the first 50 cases Am J Psychiatry, 1998.PMID 9464208
- [12]Ruscio AM, Stein DJ, Chiu WT, Kessler RC The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication Mol Psychiatry, 2010.PMID 18725912
- [13]Bloch MH, McGuire J, Landeros-Weisenberger A, Leckman JF, Pittenger C Meta-analysis of the dose-response relationship of SSRI in obsessive-compulsive disorder Mol Psychiatry, 2010.PMID 19468281
- [14]Koran LM, Hanna GL, Hollander E, et al. Practice guideline for the treatment of patients with obsessive-compulsive disorder Am J Psychiatry, 2007.PMID 17849776
- [15]Bloch MH, Landeros-Weisenberger A, Kelmendi B, et al. A systematic review: antipsychotic augmentation with treatment refractory obsessive-compulsive disorder Mol Psychiatry, 2006.PMID 16585942
- [16]Pauls DL The genetics of obsessive-compulsive disorder: a review Dialogues Clin Neurosci, 2010.PMID 20623920
- [17]Hirschtritt ME, Bloch MH, Mathews CA Obsessive-Compulsive Disorder: Advances in Diagnosis and Treatment JAMA, 2017.PMID 28384832
- [18]Fineberg NA, Hollander E, Pallanti S, et al. Clinical advances in obsessive-compulsive disorder: a position statement by the International College of Obsessive-Compulsive Spectrum Disorders Int Clin Psychopharmacol, 2020.PMID 32433254