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Obsessive–compulsive symptoms are associated with psychiatric comorbidities, behavioral and clinical problems: a population-based study of Brazilian school children

Abstract

Pediatric-onset obsessive–compulsive disorder (OCD) is underdiagnosed, and many affected children are untreated. The present study seeks to evaluate the presence and the clinical impact of OCD and obsessive–compulsive symptoms (OCS) in a large sample of school-age children. In Phase I, we performed an initial screening using the Family History Screen (FHS). In Phase II, we identified an “at-risk” sample, as well as a randomly selected group of children. A total of 2,512 children (6–12 years old) were assessed using the FHS, the Development and Well-Being Assessment (DAWBA), the Strengths and Difficulties Questionnaire (SDQ), and the Child Behavior Checklist (CBCL). Data analyses included descriptive and multivariate analytical techniques. 2,512 children (mean age: 8.86 ± 1.84 years; 55.0 % male) were categorized into one of the three diagnostic groups: OCD (n = 77), OCS (n = 488), and unaffected controls (n = 1,947). There were no significant socio-demographic differences (age, gender, socioeconomic status) across groups. The OCS group resembled the OCD on overall impairment, including school problems and delinquent behaviors. However, the OCD group did have significantly higher rates of several comorbid psychiatric disorders, including separation anxiety, generalized anxiety, and major depressive disorder, than OCS or unaffected controls. Moreover, the OCD group also scored higher than the SDQ, as well as on each of CBCL items rated by the parent. Our findings suggest that there is a psychopathological continuum between OCS and OCD in school-aged children. The presence of OCS is associated with functional impairment, which needs further investigation in longitudinal studies.

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Acknowledgments

The authors thank Luis Augusto Rohde, Guilherme Polanczyk, Giovanni Salum, Jilian Mulqueen and Monica Rudner for previous contributions and for help in preparing the manuscript.

Conflict of interest

Michael H. Bloch has received support from the National Institutes of Health (salary and research funding), Tourette Syndrome Association (research funding), Patterson Trust Foundation (research funding) and the Rembrandt Foundation (research funding).; James F. Leckman, MD, PhD, has received support from the National Institutes of Health (salary and research funding), Tourette Syndrome Association (research funding), Grifols, LLC (research funding), Klingenstein Third Generation Foundation (medical student fellowship program), John Wiley and Sons (book royalties), McGraw Hill (book royalties), and Oxford University Press (book royalties).

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Correspondence to Pedro G. Alvarenga.

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Alvarenga, P.G., do Rosario, M.C., Cesar, R.C. et al. Obsessive–compulsive symptoms are associated with psychiatric comorbidities, behavioral and clinical problems: a population-based study of Brazilian school children. Eur Child Adolesc Psychiatry 25, 175–182 (2016). https://doi.org/10.1007/s00787-015-0723-3

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  • DOI: https://doi.org/10.1007/s00787-015-0723-3

Keywords

  • Child and adolescent psychiatry
  • Comorbidities
  • Epidemiology
  • Obsessive–compulsive disorder
  • School-aged children