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Understanding the Course of Childhood OCD

by Clark R. Goldstein, PhD and Dana Galler-Hodkin

 Understanding the Course of Childhood OCD - AboutOurKids.org

Approximately half of OCD cases begin in childhood, with only about 5% to 10% of OCD suffers enjoying a spontaneous and permanent remission. Oftentimes when a child or teenager is diagnosed with OCD, the patient and their families will ask questions such as what is the natural course of this illness if left untreated, what are the best treatments and what factors might impact whether or not treatment will work for them.

Most of the time, patients diagnosed with OCD need professional help. Currently, we know that a form of cognitive behavior therapy (CBT) that involves something called exposure and response prevention (ERP) often in combination with medication, such as Serotonin Reuptake Inhibitors, are the best treatments we have to help OCD sufferers.

Success in Treatment

Studies have found that those with high motivation to get better tend to experience more success in treatment than those who do not have motivation for treatment, and that completing treatment leads to better long-term outcomes, especially for those diagnosed after the age of fifteen.

Additional studies also suggest that children that have less severe OCD tend to do better in treatment, and that the shorter time a child goes between first displaying symptoms of OCD and receiving treatment might reduce the chances of having OCD down the road after treatment. This may be particularly important because those with OCD tend to wait longer to seek treatment than those with any other kind of anxiety or mood disorder.

Though many parents may have a natural instinct to try and accommodate their child’s behaviors, lower levels of family accommodation (meaning lower levels of family members helping a person with OCD to ritualize) have also been found to bode well for a better outcome in treatment. Also, families that function better together might provide environments for OCD treatment to be more effective. Additionally, in one study, those with a family history of OCD did not do nearly as well in CBT treatment alone compared to those without an OCD family history, suggesting that those with a family history of OCD might do best with both a combination of CBT and medication.

Presence of Tic Disorders

It is not clear how having an additional tic disorder may impact the prognosis. Tic-related OCD tends to occur more often in males and has an earlier age of onset compared with OCD without tics and one study done indicated that tic-related OCD subjects had a tendency to have somewhat severe OCD than individuals with non-tic related OCD.

Some research has indicated that children and teens suffering from OCD who also have a tic disorder might not respond as well to medication treatment alone as those without tics, and seem to do best with both CBT and medication.

Presence of Behavioral Problems

A child who has more behavioral problems may also not benefit as much from treatment as children without such difficulties. However, others have found only that children and teenagers with behavior problems might not gain as much benefit from medication than those who do not. A later age of onset might also lead to a better prognosis. Also, having better insight into one’s OCD often leads to better outcome in the short and long-term.

Seeking Treatment

Interventional treatments such as cognitive behavioral therapy (CBT) has been recommended as the treatment of choice for OCD and systematic reviews have shown these interventions to be highly effective in reducing OCD symptoms. What can you do to help yourself or your child who might have OCD? Seeking an evaluation as soon as possible from a qualified CBT clinician is likely the most helpful thing that you can do. Unfortunately, due to less public awareness of OCD, difficulty finding therapists who can effectively treat OCD, and tendencies to hide symptoms before seeking help, the average time between having OCD and getting help is 14 to 17 years. And, given that delaying treatment might reduce the chances that treatment will be as effective, it may be particularly important to get help promptly. Helpful advice on selecting a therapist can be found in the OCF’s “What You Need to Know About OCD Guide,” which is available free of charge on-line.

If CBT and/or a medication evaluation is recommended, don’t put it off and commit to completing the treatment. If the treatment is recommended for your child, a good CBT clinician should work with you to help you decrease your family accommodation of OCD. If your child has OCD, and there is a family history of OCD, strongly consider a combined medication and CBT approach since having a family history of OCD may reduce the effectiveness of CBT treatment alone. Be aware that other factors outside of your control, such as symptom severity and how much insight you or your child initially has into how realistic his or her obsessions are, may impact the course and effectiveness of treatment. Also, be aware that having other stressors, such as behavioral difficulties and/or depression, may also complicate, and possibly, lengthen the course of treatment. Other treatments might be needed prior to or in conjunction with CBT to treat OCD. So, getting the evaluation and treatment process started promptly, persevering with treatment, and being patient with the process should help you and your child get the most out of treatment.

For more helpful information on OCD, please visit…

Care at the CSC: OCD Overview

OCD Foundation

KidsHealth

American Association of Child and Adolescent Psychiatrists: Facts for Families on OCD in Children and Adolescents

Mass General: OCD Info

References

Department of Psychiatry at UF

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