20 Feb The Benefits of Standardized Screening in Identification of Obsessive-Compulsive Disorder in Youth
Screening, early detection, and intervention are effective weapons against the life-long consequences of serious mental illness. Obsessive Compulsive Disorder, or OCD, is one of the most common psychiatric illnesses to manifest during childhood or adolescence, with the mean
age of onset being ten years. The American Academy of Pediatrics reports that OCD afflicts up to 3% of children and adolescents and is one of the more common psychiatric disorders to present before age 18.
Despite these facts, OCD is underdiagnosed and undertreated. Research reported by the Journal of Neural Transmission in 2008 found that treatment for OCD started on average at age 13, about two years after the onset of the symptoms presented. Unmanaged symptoms of OCD worsen with age and the beginning of puberty, often developing into a life-long chronic condition. Early identification, therefore, is essential to promote positive treatment outcomes. Psychologists and school-based mental health professionals hold the opportunity to screen for OCD symptoms when they may be first presenting themselves.
Parents can hesitate or avoid seeking help for their child when they are displaying obsessions or compulsions. Commonly, parents minimize the behaviors and symptoms observed. Yale Medicine cites that, at times, families engage in enabling behavior. Described as family accommodation, this refers to family members’ participation in or facilitation of the child’s rituals and avoidance of OCD. Family accommodation is attributed to an effort to support their child, allowing them to engage in these ritualistic behaviors as it reduces anxiety and emotional distress.
Research published in 2020 in the Journal of Translational Pediatrics identified the complexities in a diagnostic differential related to accurate and early determination of OCD as the primary cause of the symptoms. These include the possible differential of autism, other serious mental illnesses such as schizophrenia, rigid response to symptoms of ADHD, or compulsive tics. Children often lack the insight and communicative skills to accurately describe their behaviors’ reasons. These complications to accurately diagnose OCD can delay identification and result in inadequate treatment interventions.
In addition, the same study cites that comorbid mental disorders can be present in as many as 70% of cases. The presence of comorbid illness may be attributed to very young children experiencing behavioral manifestations of obsessions and compulsions, which they cannot understand. The response to this may include heightened emotional distress and the development of secondary depressive symptoms. Parents note these secondary symptoms and seek treatment as a result.
Externalizing disorders also appear more common in combination with OCD, such as ADHD. Another study reported in the Journal of Neural Transmission found that children with ADHD developed OCD at an earlier age and experienced greater severity of symptoms than OCD patients without ADHD. Such comorbidity may complicate the presentation of symptoms of OCD. Studies have also shown that comorbid diagnoses impact the severity and treatment response of youth with OCD.
Accurate and rapid identification of psychiatric illness in children or adolescents is the primary step in ensuring the most appropriate course of clinical care to ameliorate symptoms and minimize functional deficits that may occur secondary to severe illness. Standardized screening and assessment for mental illness in all children and adolescents in school systems would support more immediate identification of mental illness. While this initiative requires continued advocacy to become common in schools, the screening for OCD for all youth seeking mental health services will help to identify comorbid illnesses or the presence of OCD.
The ability for an in-depth and comprehensive diagnostic assessment can be a challenge with children. Rapid, brief screenings can help professionals quickly rule out the presence of symptoms consistent with pediatric OCD. Considerable advancements have occurred in OCD screenings for youth, including the Obsessive-Compulsive Inventory-Child Version 5 (OCI-CV-5) and the Children’s Yale-Brown Obsessive–Compulsive Scale (CY-BOCS).
The efficacy of the OCI-CV-5 in screening for OCD was recently studied and reported in the Journal of Affective Disorders in 2022. The researchers found that the OCI-CV-5 was effective as a self-report screening in identifying OCD in youth based on the measure’s sensitivity, specificity, and validity.
The CY-BOCS was adapted for children from the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), which is the gold standard in OCD screenings. The CY-BOCS is a semi-structured interview that assesses the presence and severity of OCD in children. Research conducted in 2016 and reported in the Journal for Central Nervous System Disease found the CY-BOCS effective in screening for OCD. The researchers found that the severity score has excellent to fair internal consistency, excellent interrater reliability, and good short-term test-retest reliability.
Improvements in standardized screening and subsequent assessment will improve accurate diagnostic practices and identification of OCD. Research identifies the benefit of practitioners who assess youth to include a pediatric OCD screening in their clinical formulation to help ensure efficacious treatment outcomes.