How Can We Identify Different Types of OCD Symptoms in Children and Teens?

What you need to know

• Obsessive-compulsive disorder (OCD) in children and teens tends to involve three main types of symptoms: contamination/cleaning, symmetry/ordering, and disturbing thoughts/checking.
• The Obsessive-Compulsive Inventory-Child Version (OCI-CV) questionnaire can help identify these different symptom types in youth with OCD.
• The OCI-CV washing scale is very good at detecting contamination/cleaning symptoms, while the ordering and obsessing scales are moderately good at detecting symmetry/ordering and disturbing thoughts/checking symptoms.

Understanding OCD symptom types in youth

Obsessive-compulsive disorder (OCD) affects 1-2% of children and teenagers. It can cause significant distress and impairment if not properly treated. One challenge in treating OCD is that it can look very different from person to person. Some kids with OCD might be very worried about germs and wash their hands excessively. Others might need to arrange objects in a certain way or have disturbing thoughts they can’t get out of their head.

Research has shown that OCD symptoms in youth tend to cluster into three main types:

1. Contamination/cleaning: Excessive fears about germs, dirt, or contamination, leading to repetitive cleaning or washing behaviors.
2. Symmetry/ordering: Needing things to be arranged in a particular way or feeling that things must be “just right.”
3. Disturbing thoughts/checking: Intrusive, unwanted thoughts (often about harm or taboo topics) and repeatedly checking to prevent bad things from happening.

Understanding which symptom type(s) a child has is important for providing the most effective treatment. However, it can be challenging for doctors and therapists to quickly and accurately identify these symptom types, especially when time with patients is limited.

The OCI-CV: A tool for assessing OCD symptoms

The Obsessive-Compulsive Inventory-Child Version (OCI-CV) is a questionnaire designed to measure OCD symptoms in children and teens. It asks young people to rate how often they experience 21 different OCD-related thoughts and behaviors. The OCI-CV provides scores on six different scales:

1. Doubting/Checking
2. Obsessing
3. Hoarding
4. Washing
5. Ordering
6. Neutralizing

While these scales don’t perfectly match the three main symptom types identified by researchers, they cover similar territory. The question is: How well can the OCI-CV identify children with clinically significant symptoms in each of the three main OCD symptom types?

What the researchers did

To answer this question, researchers studied 197 children and teens with OCD from Sweden and Spain. All participants:

1. Completed the OCI-CV questionnaire
2. Were interviewed by a clinician using a comprehensive OCD assessment tool called the Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS)

The DY-BOCS allowed the researchers to determine which children had clinically significant symptoms in each of the three main OCD symptom types. They then compared these results to the participants’ OCI-CV scores to see how well the questionnaire could identify the different symptom types.

What the researchers found

Contamination/Cleaning Symptoms

The OCI-CV washing scale was excellent at identifying children with clinically significant contamination/cleaning symptoms:

• A score of 3 or higher on this scale correctly identified 79% of children with significant contamination/cleaning symptoms.
• This scale was 76% sensitive (ability to correctly identify those with the symptom) and 82% specific (ability to correctly identify those without the symptom).

Symmetry/Ordering Symptoms

The OCI-CV ordering scale was moderately good at identifying children with clinically significant symmetry/ordering symptoms:

• A score of 3 or higher on this scale correctly identified 70% of children with significant symmetry/ordering symptoms.
• This scale was 69% sensitive and 71% specific.

Disturbing Thoughts/Checking Symptoms

The OCI-CV obsessing scale was moderately good at identifying children with clinically significant disturbing thoughts/checking symptoms:

• A score of 4 or higher on this scale correctly identified 67% of children with significant disturbing thoughts/checking symptoms.
• This scale was 75% sensitive and 65% specific.

Other findings

• The doubting/checking, hoarding, and neutralizing scales of the OCI-CV were not as useful for identifying specific symptom types.
• The results were similar for both the Swedish and Spanish samples, suggesting these findings might apply across different cultures.

Why this matters

This research provides clinicians and researchers with a practical way to use the OCI-CV to identify different types of OCD symptoms in children and teens. This is important for several reasons:

1. Quick assessment: The OCI-CV is a brief questionnaire that can be completed quickly, making it useful in busy clinical settings.

2. Tailored treatment: Knowing a child’s primary symptom type can help clinicians choose the most appropriate treatment strategies. For example, exposure therapy for a child with contamination fears might look very different from exposure therapy for a child with disturbing thoughts.

3. Research applications: Researchers studying OCD can use these cutoff scores to group participants by symptom type, allowing for more specific investigations into the causes and treatments of different OCD presentations.

4. Tracking progress: The OCI-CV could be used to monitor changes in specific symptom types over the course of treatment.

Limitations and future directions

It’s important to note some limitations of this study:

• The research only included children who already had an OCD diagnosis. The OCI-CV might not work as well for identifying symptom types in the general population or in children with other mental health conditions.
• The study relied on clinical interviews (the DY-BOCS) as the “gold standard” for determining symptom types. While this is currently the best available method, it’s not perfect.
• The research was conducted in only two countries (Sweden and Spain). More studies are needed to see if these findings apply equally well in other cultures and languages.

Future research could:

• Test these OCI-CV cutoff scores in larger, more diverse samples of youth with OCD.
• Investigate whether using the OCI-CV to identify symptom types leads to better treatment outcomes.
• Explore whether combining the OCI-CV with other assessment tools could improve the accuracy of symptom type identification.

Conclusions

• The OCI-CV washing scale is very good at identifying contamination/cleaning symptoms in youth with OCD.
• The OCI-CV ordering and obsessing scales are moderately good at identifying symmetry/ordering and disturbing thoughts/checking symptoms, respectively.
• Using specific cutoff scores on these OCI-CV scales can help clinicians and researchers quickly identify different OCD symptom types in children and teens.
• This information can potentially lead to more personalized and effective OCD treatments for young people.