Preparation for Child Psych PRITE and Boards
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Introduction

Epidemiology

OCD in children and adolescents often goes unrecognized and undiagnosed due to its idiosyncratic, not always obvious nature.

  • Point prevalence of pediatric OCD is 0.25% (British study 5-15 y.o., Heyman I, IntRevPsych 2003);
  • Overall pediatric prevalence rate is 1-2% (USA studies, Apter A, JAACAP 1996)
  • Incidence of OCD peaks during two developmental periods, pre-adolescents, and young adults (mean 20 y.o.). (Geller D, March J, Practice Parameter, JAACAP 2012)

Genetic and non-genetic factors

  • OCD has a significant familial/genetic component with higher concordance rates in monozygotic twins vs. dizygotic twins.
  • Environmental triggers and immunological cross-reactions, particularly to Strep infection had been implicated. Specifically, in PANDAS - Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus, is attributed to immune response to Group A Strep, which can cause cross-reactivity and inflammation of basal ganglia. This can produce (the somewhat controversial) syntrome of PANDAS, which involves tics, OCD, and hyperactivity.

Diagnosis

Presentation

  • Children may have compulsions without obsessions.
  • Most common obsessions in children and adolescents involve aggressive and catastrophic worries (e.g death of parent); these become less common in adults. (Geller DA, J Nerv Men D/o 2001)
  • Contamination worries are common throughout the developmental spectrum.
  • Sexual and religious obsessions are common in adolescents.
  • Most common compulsions in children involve cleaning, repeating, checking, and ordering rituals.

Treatment