How Did the COVID-19 Pandemic Affect Children with OCD?

What you need to know

• The proportion of children and adolescents seeking treatment for OCD increased during the COVID-19 pandemic.
• Many young people with OCD experienced worsening symptoms during the pandemic.
• More patients required and were offered treatment during the pandemic compared to previous years.
• Cognitive Behavioral Therapy (CBT) remained the most common treatment, with a slight increase in medication use.

Understanding OCD in Children and Adolescents

Obsessive-Compulsive Disorder (OCD) is a mental health condition characterized by persistent, intrusive thoughts (obsessions) and repetitive behaviors or mental acts (compulsions). For children and adolescents, OCD can significantly impact their daily lives, affecting school performance, social relationships, and overall well-being.

Common obsessions in young people with OCD include fears of contamination, concerns about symmetry or order, and worries about harming others. Compulsions often involve excessive cleaning, checking, or arranging objects. These symptoms can be distressing and time-consuming, interfering with normal activities and development.

The COVID-19 Pandemic and OCD

The COVID-19 pandemic has brought unprecedented challenges to people worldwide, particularly affecting mental health. For individuals with OCD, especially those with contamination-related fears, the pandemic has presented unique difficulties.

Public health measures to combat the spread of the virus, such as frequent handwashing and social distancing, closely resemble OCD-like behaviors. This similarity has raised concerns about the potential exacerbation of OCD symptoms in children and adolescents during the pandemic.

Key Findings of the Study

This research aimed to investigate how the COVID-19 pandemic affected children and adolescents with OCD in terms of treatment-seeking behavior, symptom severity, and treatment approaches. The study analyzed data from a Child and Adolescent Mental Health Service (CAMHS) in London, comparing information from before and during the pandemic.

Increased Proportion of OCD Cases

One of the most striking findings was the significant increase in the proportion of OCD cases among all CAMHS referrals during the pandemic. In 2020, 5.62% of assessments were related to OCD, compared to only 1.30% in 2018 and 2.27% in 2019. This increase occurred despite an overall decrease in the total number of CAMHS referrals during the pandemic.

This rise in OCD-related cases could be due to several factors:

1. The pandemic may have triggered OCD symptoms in children who were predisposed to the condition.
2. Existing mild or subclinical OCD cases may have worsened, leading to formal diagnosis and treatment-seeking.
3. The pandemic’s focus on hygiene and contamination fears may have made OCD symptoms more noticeable to families and healthcare providers.

Symptom Severity and Worsening

Interestingly, the study found no significant difference in initial symptom severity between pre-pandemic and pandemic cases, as measured by the Health of the Nation Outcome Scale for Children and Adolescents (HoNOSCA). However, clinicians reported that a higher percentage of patients assessed during the pandemic (69.2%) showed symptom worsening over time compared to those assessed before the pandemic (46.7%).

This discrepancy between initial severity and subsequent worsening could be explained by:

1. The prolonged stress and uncertainty of the pandemic.
2. Increased exposure to triggers related to contamination fears.
3. Disruptions in daily routines and support systems due to lockdowns and social distancing measures.

Changes in Treatment Approaches

The study also revealed significant changes in how OCD cases were managed during the pandemic:

1. More patients required and were offered treatment: Before the pandemic, 37.5% of patients were discharged without treatment after initial assessment. During the pandemic, all patients assessed were offered treatment.

2. Cognitive Behavioral Therapy (CBT) remained the primary treatment: CBT, which helps patients recognize and change unhelpful thought patterns and behaviors, continued to be the most common treatment offered both before and during the pandemic.

3. Slight increase in medication use: There was a small increase in the use of combined CBT and medication therapy during the pandemic (38.5% of patients) compared to pre-pandemic levels (30% of patients).

These changes in treatment approaches may reflect:

1. A higher level of distress and impairment in patients seeking help during the pandemic.
2. Increased awareness and motivation for treatment among families due to the pandemic’s mental health impact.
3. Adaptations in healthcare delivery, such as the use of telehealth services, which may have made treatment more accessible.

Implications for Families and Caregivers

For families and caregivers of children and adolescents with OCD, these findings highlight several important points:

1. Increased vigilance: Be aware that the pandemic may exacerbate OCD symptoms, even if they were previously well-controlled.

2. Seek help early: Don’t hesitate to reach out for professional help if you notice worsening symptoms or new OCD-like behaviors in your child.

3. Expect treatment availability: Mental health services have adapted to provide care during the pandemic, often through remote options like telehealth.

4. Support CBT practices: Cognitive Behavioral Therapy remains a cornerstone of OCD treatment. Support your child in practicing CBT techniques at home.

5. Be open to medication options: In some cases, a combination of CBT and medication may be recommended for more effective symptom management.

Conclusions

• The COVID-19 pandemic has been associated with an increase in children and adolescents seeking treatment for OCD.
• Many young people with OCD experienced worsening symptoms during the pandemic, highlighting the need for ongoing support and monitoring.
• Mental health services have adapted to meet the increased demand, offering treatment to all assessed cases and maintaining CBT as the primary intervention.
• Future pandemics or health crises may similarly impact individuals with OCD, emphasizing the importance of preparedness in mental health services.

While this study provides valuable insights, it’s important to note its limitations, such as the small sample size and reliance on clinical service data. Further research is needed to fully understand the long-term impacts of the pandemic on children and adolescents with OCD. Nevertheless, these findings underscore the importance of continued support and accessible mental health services for young people with OCD, especially during times of widespread stress and uncertainty.