Obsessive Compulsive Disorder Found Late in Children, Teens

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Although obsessive compulsive disorder (OCD) often first begins in childhood or adolescence, the diagnosis is frequently made late, which delays treatment. Prompt identification and treatment of OCD is important because the disorder is often associated with severe impairment and family difficulties.

Obsessive compulsive disorder is an anxiety disorder

Obsessive compulsive disorder is characterized by recurrent, unwanted thoughts (obsessions) and/or repetitive actions and behaviors (compulsions). The disorder affects 1 to 3 percent of children and teens and is accompanied by other mental conditions in nearly three-quarters of patients. More than 70 percent of patients, for example, also suffer with attention deficit hyperactivity disorder (ADHD).

In the current study, investigators reviewed the literature on the diagnosis and treatment of obsessive compulsive disorder in children and teens. Among their findings was that treatment was started at an average age of 13 years, which is an average of two years after signs of the disease appeared.

The most common conditions that accompany obsessive compulsive disorder (comorbid conditions) are anxiety disorders, tic disorders, ADHD, and personality disorders. The more severe the OCD, the more likely an individual is to have one or more comorbid disorders.

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Up to 87 percent of children and teens with obsessive compulsive disorder practice compulsive washing. Other practices include compulsive checking or counting. Such behaviors are performed because the individual is trying to prevent obsessive thoughts or is trying to make them go away.

Individuals close to the patients, especially parents, frequently unintentionally help perpetuate the compulsive behaviors. For example, parents may allow their child to compulsively wash his or her hands or they may repeatedly answer questions of children who have a checking compulsion.

Of the studies conducted thus far, the investigators found that patients who develop obsessive compulsive disorder at a young age have the most difficulties in social integration, relationships, and age-appropriate development of independence from the family. For the best outcomes and quality of life, early initiation of treatment as well as continuation of treatment are necessary.

The investigators’ findings highlight the importance of diagnosing and treating obsessive compulsive disorder early in children and teens. Given OCD develops into a chronic form in more than 40 percent of patients, aggressive treatment is recommended.

Review of the literature reveals that it may be best for patients to undergo an initial phase of intensive treatment involving cognitive behavioral therapy or behavioral therapy followed by behavioral therapeutic intervention, alone or combined with a selective serotonin reuptake inhibitor, such as fluoxetine (Prozac), sertraline (Zoloft), or paroxetine (Paxil).

SOURCE:
Walitza S et al. Deutsches Arzteblatt International 2011; 108:173-79

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