Pre-schoolers can develop full-blown OCD

A new study by researchers at the Bradley Hasbro Children's Research Center has found that children as young as four can develop full-blown obsessive compulsive disorder (OCD) and often exhibit many of the same OCD characteristics typically seen in older kids.

The study, published online by the Journal of Psychopathology and Behavioral Assessment, is the largest sample of young children with OCD published to date.

"There have been very few studies focusing on early childhood OCD, even though we know that OCD, if left untreated, can significantly disrupt a child's growth and development and can worsen as the child gets older," says lead author Abbe Garcia, PhD, director of the Bradley Hasbro Children's Research Center (BHCRC) Pediatric Anxiety Research Clinic. "That's why we need to understand more about OCD in very young children, since early diagnosis and intervention are critical to reducing the severity of symptoms and improving quality of life."

OCD is an anxiety disorder characterized by recurrent, unwanted thoughts (obsessions) and/or repetitive behaviors (compulsions). Repetitive behaviors such as handwashing, counting, checking, or cleaning are often performed with the hope of preventing obsessive thoughts or making them go away. Performing these so-called "rituals," however, provides only temporary relief, and not performing them markedly increases anxiety. According to the American Academy of Child and Adolescent Psychiatry, as many as 1 in 200 children and adolescents struggle with OCD.

Garcia and colleagues studied 58 children with OCD between the ages of four and eight, including 23 boys and 35 girls. All children underwent a series of clinical psychological assessments. Approximately 19 percent had been previously treated with medication and 24 percent had received some form of previous psychotherapy for OCD. Twenty percent reported a first-degree family history of OCD. Nearly 22 percent of children had an additional diagnosis of attention deficit hyperactivity disorder (ADHD) and about 20 percent were also diagnosed with generalized anxiety disorder (GAD).

Common obsessions among children in the study included fear of contamination and aggressive/catastrophic fears (involving death or harm to themselves or loved ones), and three-quarters reported having multiple obsessions. Nearly all of the children suffered from multiple compulsive behaviors, with an average of four compulsions per child. Washing, checking and repeating were the most commonly reported compulsions.

A data analysis revealed a number of parallels between young children with OCD and reported samples of their older peers in terms of symptoms and severity. For example, both groups appear to have similar types of obsessions and compulsions, multiple psychiatric diagnoses, and high rates of OCD family history.

"These similarities suggest this is a study sample involving full-blown OCD, as opposed to children who are either in the beginning phases of the illness or only have a partial OCD diagnosis," says Garcia, who is also an assistant professor of psychiatry (research) at The Warren Alpert Medical School of Brown University.

However, Garcia says they also discovered some important differences between younger and older children with OCD. Although anxiety disorders seem to be a common comorbid diagnosis in both groups, younger children were less likely to have depression, compared to older children. Also, while many experts believe boys are more likely to present with juvenile OCD, the findings from the current study actually indicate a lower boy to girl ratio.

"Our findings offer the first glimpse at the features and variables that emerge during early childhood onset OCD and will hopefully lead to further studies focusing on assessment and treatment of this age group," Garcia says.

The study was supported in part by a grant from the National Institutes of Mental Health.

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Garcia AM, Freeman JB, Himle MB, et al. Phenomenology of Early Childhood Onset Obsessive Compulsive Disorder. J Psychopathol Behav Assess. 2008;doi:10.1007/s10862-008-9094-0 [Abstract]