Childhood Obsessive-Compulsive Disorder

Abstract

1. Barry Sarvet, MD 1. Division of Child and Adolescent Psychiatry, Baystate Health System, Springfield, MA. * Abbreviations: CBT: : cognitive behavioral therapy DSM-IV-TR: : Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition , Text Revision ERP: : exposure and response prevention GABHS: : group A β-hemolytic Streptococcus OCD: : obsessive-compulsive disorder PANDAS: : pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection PCP: : primary care provider SCARED: : Screen for Anxiety Related Emotional Disorders SSRI: : selective serotonin reuptake inhibitor Obsessive-compulsive disorder (OCD) affects up to 3% of children and adolescents, with nearly 75% of these experiencing comorbid diagnoses. Physicians need to familiarize themselves with the diagnostic criteria and basic screening tests, including the Pediatric Symptom Checklist and the Screen for Anxiety Related Emotional Disorders, as well as the principles of effective treatment, including Cognitive Behaviorial Therapy and pharmacologic agents. After completing this article, readers should be able to: 1. Know the definition of obsessive-compulsive disorder (OCD) and be familiar with its signs and symptoms. 2. Understand the biological and environmental contributions to the development of OCD. 3. Be aware of the comorbidities associated with OCD. 4. Know the therapies available for treating OCD, both cognitive and pharmacologic. 5. Understand the role of the primary care physician in the management of OCD. Joseph is an 11-year-old boy whose mother has brought him to the pediatrician for a concern about his hands. The skin is dry, cracked, and erythematous. Joseph is wearing gloves in the office and is unhappy about being there. He does not want to show his hands to the doctor. No other area of skin is affected. The condition has worsened gradually over several months. Joseph’s mother has noticed that he washes his hands often and consumes large quantities of hand sanitizer gel throughout the day. Joseph vehemently denies this behavior. In addition, there is a several-year history of frequent hand-washing, increasing in severity over the past several months, and avoidance of touching door knobs, handles, playing cards, books, and toys that are not his own. He wears gloves everywhere he goes outside of his house. Joseph worries about germs and getting sick, and he avoids …