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Assessment and Medication Management of Paediatric Obsessive-Compulsive Disorder

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Abstract

Paediatric obsessive-compulsive disorder (OCD) is a common, yet under-recognized, neuropsychiatric illness in both clinical and community settings. Symptoms tend to be hidden or misunderstood by affected youth, and parents may inadvertently accommodate OCD, thus worsening its severity. These symptoms may include compulsive reassurance seeking, confessing and ‘just right’ rituals, in addition to more classic OCD behaviours. Fortunately, numerous psychometric measures are available to assist in clinical assessment of this disorder and its sequelae. Once properly diagnosed, paediatric OCD is highly treatable with empirically proven approaches including cognitive-behaviour therapy (CBT) and serotonin reuptake inhibitor (SRI) medications. Clinically meaningful symptom improvement is the norm following these strategies, although full remission is not, as symptoms tend to wax and wane over time. Paediatric OCD is highly co-morbid with other anxiety disorders, tic disorders, depression and attention-deficit hyperactivity disorder, which also require specific attention. For moderate to severe OCD, an interdisciplinary approach combining individual and family CBT with SRI trials is recommended. For severe treatment-refractory illness, early evidence supports the benefit of augmenting agents, such as atypical antipsychotics and potentially those with glutamatergic activity. Clinical outcome assessment in paediatric OCD should always include broad domains of individual and family functioning, in addition to symptom improvement.

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Acknowledgements

The authors would like to acknowledge the invaluable assistance of Rhonda Ellwyn and Annie Kuan in manuscript preparation and formatting. In addition, Dr Stachon received funding from a Toronto Hospital for Sick Children Research Institute Clinician-Scientist Training Program Scholarship. Dr Stewart received funding from several sources that were used to support the article preparation: the Michael Smith Foundation for Health Research (MSFHR), American Academy of Child and Adolescent Psychiatry (AACAP), University of British Columbia (UBC) and British Columbia Mental Health and Addictions Research Institute (BCMHARI). None of the authors have conflicts of interest to report.

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Authors and Affiliations

  1. McLean Hospital, Belmont, Massachusetts, USA

    S. Evelyn Stewart

  2. Massachusetts General Hospital, Boston, Massachusetts, USA

    S. Evelyn Stewart & Dianne Hezel

  3. Harvard Medical School, Boston, Massachusetts, USA

    S. Evelyn Stewart

  4. University of British Columbia, Vancouver, British Columbia, Canada

    S. Evelyn Stewart & Andrea C. Stachon

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Correspondence to S. Evelyn Stewart.

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Stewart, S.E., Hezel, D. & Stachon, A.C. Assessment and Medication Management of Paediatric Obsessive-Compulsive Disorder. Drugs 72, 881–893 (2012). https://doi.org/10.2165/11632860-000000000-00000

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