Challenges in child and adolescent obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) occurs at a population rate of about 1% in children and adolescents, yet there tend to be delays in diagnosis and in accessing evidence-based treatments. The characteristic symptoms of intrusive repetitive thought (obsessions) and time consuming, disruptive rituals (compulsions) can lead to significant distress and impairments in social, educational and emotional development. Increased awareness by the general public of this disorder, and the fact that children often tend to be secretive about the symptoms, may assist earlier recognition. Careful assessment is needed to exclude alternative diagnoses, identify co-morbid conditions, and to define the symptom profile. General practitioners and child mental health professionals need to be aware of the specific, effective treatments, and have appropriately trained staff available to deliver them. Families need clear and accurate explanations about OCD and its treatments. Children and adolescents with OCD should be offered cognitive behaviour therapy as a first line treatment. Selective serotonin reuptake inhibitors are also effective (either alone or in combination with cognitive behavioural therapy). Children and young people receiving these treatments should have at least a 70% chance of obtaining a good remission.