Obsessive compulsive disorder evident as early as age four

Oct 1 2008

Researchers in the U.S. say children as young as four can develop full-blown obsessive compulsive disorder (OCD).

The researchers from the Bradley Hasbro Children's Research Center have found that quite young children often exhibit many of the same OCD characteristics seen in older kids.

The study is the largest yet of young children with OCD, an anxiety disorder characterized by recurrent, unwanted thoughts (obsessions) and/or repetitive behaviours (compulsions).

Common repetitive behaviours include handwashing, counting, checking, or cleaning, which are often performed with the hope of preventing obsessive thoughts or making them go away - however these so-called "rituals," only provide 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.

Lead author Dr Abbe Garcia, director of the Bradley Hasbro Children's Research Center (BHCRC) Pediatric Anxiety Research Clinic, says there have been very few studies focusing on early childhood OCD, even though it is know that OCD left untreated, can significantly disrupt a child's growth and development and can worsen as the child gets older.

Dr Garcia says this is why a better understanding of OCD in very young children is needed, as early diagnosis and intervention are critical in reducing the severity of symptoms and improving the quality of life.

The researchers 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% had been previously treated with medication and 24% had received some form of psychotherapy for OCD; 20% had a family history of OCD and almost 22% of the children had an additional diagnosis of attention deficit hyperactivity disorder (ADHD) ; 20% were also diagnosed with generalized anxiety disorder (GAD).

Among the children common obsessions included fear of contamination and aggressive/catastrophic fears (involving death or harm to themselves or loved ones) and three-quarters had multiple obsessions.

Nearly all of the children suffered from multiple compulsive behaviours, with an average of four compulsions per child - washing, checking and repeating were the most commonly reported compulsions.

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

Dr Garcia says 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.

However, Dr 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.

Dr Garcia says their 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.

The study is published online by the Journal of Psychopathology and Behavioral Assessment.