Obsessive compulsive disorder (OCD) is often seen in pediatric patients, either alone or alongside other mental health conditions, such as anxiety.
While we have become more comfortable with using assessment tools and treatment options for some of these other mental health conditions, there has been little guidance for assessment and treatment of children with OCD. Thus, it is likely that many of these children go undiagnosed and untreated.
This week, Pediatrics is early releasing companion articles by an investigator team at Brown University: “Brief Assessment Tools for Obsessive Compulsive Disorders in Children: A Systematic Review” by Gaelen Adam, PhD, and colleagues (10.1542/peds.2024-068993) and “Treatment of Obsessive-Compulsive Disorder in Children and Youth: A Meta-Analysis,” by Dale Steele, MD, and colleagues (10.1542/peds.2024-068992).
When you read the articles, you will be impressed with the breadth and depth of the literature reviews.
For assessment tools, while the authors note that there may be others that are equally sensitive and specific, there are not sufficient data for any tools except for the 8-question version of the Child Behavior Checklist-Obsessive Compulsive (CBCL-OCD) subscale, which has adequate sensitivity and specificity to refer a child to a specialist for further assessment.
However, there are 2 big caveats to using the CBCL-OCD:
- In all of the studies, the CBCL-OCD was not administered in isolation but as part of the entire CBCL, which is a tool with 120 questions. Thus, it is not yet clear if the CBCL-OCD will be equally sensitive and specific as a stand-alone assessment tool.
- There are few studies in which the CBCL-OCD was used with youth who are from families who are minoritized and/or of low educational status.
The authors found that effective treatments for OCD include:
- Exposure and response prevention therapy (ERP), delivered either in-person or via telehealth: Patients are gradually exposed to situations that trigger their obsessive-compulsive behaviors and encouraged to resist performing these behaviors.
- Selective serotonin reuptake inhibitors (SSRIs): these medications, which include fluoxetine and sertraline, increase serotonin levels in the brain and are often used to treat patients with depression, anxiety, and other mental health conditions.
- Clomipramine is a tricyclic antidepressant and also increases serotonin levels in the brain.
Again, the caveat with OCD treatment is that most of the studies were conducted in children who were largely from families who were white and highly educated.
In an invited commentary, Drs. Isheeta Zalpuri, Morgan Matzke, and Shashank Joshi from Stanford University note that the CBCL-OCS is not free, and this may be a barrier to use (10.1542/peds.2024-069121). They add that it will be important to include patients who are minoritized and/or with few financial resources to be sure that these treatments are effective for these patients.
Overall, I learned a lot from reading these articles and commentary. And when my patients with OCD cannot access timely mental health support, it gives me much more confidence in starting medications while they’re waiting.
