What Role Does Doubting and Checking Play in Childhood OCD Symptoms?

What you need to know

• Doubting and checking behaviors play a central role in childhood OCD symptoms across different countries and clinical/non-clinical settings
• Other common OCD symptom dimensions like washing, ordering, and obsessing are influenced by doubting/checking behaviors
• The network of OCD symptoms is more interconnected in non-clinical samples compared to clinical samples
• Understanding the central role of doubt may help improve assessment and treatment of childhood OCD

What is OCD and how does it manifest in children?

Obsessive-compulsive disorder (OCD) is a mental health condition characterized by recurring, intrusive thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) that a person feels compelled to perform to relieve anxiety. In children, OCD symptoms can take many forms, but researchers have identified several common “symptom dimensions”:

• Doubting/checking: Constantly doubting whether something was done correctly and checking repeatedly
• Obsessing: Intrusive unpleasant thoughts, often about harm coming to oneself or others
• Washing: Excessive hand washing or cleaning due to contamination fears
• Ordering: Needing to arrange objects in a particular way
• Hoarding: Difficulty discarding objects and excessive acquisition of items
• Neutralizing: Mental acts like counting or repeating words to counteract anxious thoughts

While children with OCD often experience symptoms across multiple dimensions, it has been unclear how these different symptom types relate to and influence each other. This study aimed to map out the network of relationships between OCD symptom dimensions in children.

How was the study conducted?

The researchers analyzed data from two large groups:

1. 6,991 unselected schoolchildren from Chile, Italy, Spain and Turkey
2. 704 children diagnosed with OCD from clinics in Italy, Spain, Sweden and the USA

All participants completed the Obsessive-Compulsive Inventory - Child Version (OCI-CV), a questionnaire that assesses the different OCD symptom dimensions. The researchers then used network analysis, an advanced statistical technique, to examine how the different symptom dimensions were interconnected.

What were the key findings?

Doubting/checking is central across samples

In both the school-based and clinic-based samples, doubting and checking behaviors emerged as the most central and influential symptom dimension. This means that doubting/checking had the strongest connections to all other symptom types.

The centrality of doubting/checking was consistent across:

• Different countries
• Boys and girls
• Younger children and adolescents
• Clinical and non-clinical samples
• OCD patients with and without tic disorders

This suggests that doubting and checking behaviors play a key role in childhood OCD symptoms regardless of demographic factors or clinical status.

More interconnected symptoms in non-clinical samples

Interestingly, the network of OCD symptoms was more densely interconnected in the school-based samples compared to the clinic samples. This means the different symptom dimensions influenced each other more strongly in children without an OCD diagnosis.

In the clinical OCD sample, washing symptoms were less connected to other symptom types. The researchers suggest this could mean contamination-related OCD may function somewhat differently than other symptom types in diagnosed cases.

Age and gender differences in non-clinical samples

In the school-based samples, some network differences were observed between younger children and adolescents and between boys and girls. The symptom networks became more interconnected with age. However, these age and gender differences were not found in the clinical OCD sample.

What are the implications of these findings?

The central role of doubting and checking in childhood OCD symptoms has several potential implications:

1. Assessment: Clinicians should pay close attention to doubting and checking behaviors when evaluating children for possible OCD, as these may be key indicators.

2. Treatment targets: Addressing doubting and checking symptoms may help reduce other OCD symptoms. Existing therapies like cognitive-behavioral therapy could potentially be enhanced by focusing more on these central symptoms.

3. Early intervention: Doubting and checking behaviors could potentially serve as early warning signs to identify children at risk of developing more severe OCD symptoms.

4. Theoretical models: The findings support longstanding theories about the importance of doubt and uncertainty in driving OCD symptoms. Further research into the cognitive and neural basis of pathological doubt in OCD may be warranted.

5. Developmental considerations: The increasing interconnectedness of symptoms with age in non-clinical samples may provide clues about how OCD develops over time in childhood and adolescence.

Conclusions

• Doubting and checking behaviors appear to be central, interconnected symptoms in childhood OCD across diverse samples
• This symptom dimension may be an important target for assessment, treatment, and early intervention efforts
• More research is needed to understand how doubt and uncertainty drive OCD symptoms in children
• The development of OCD symptoms with age and potential differences in contamination-related OCD require further study

While this research provides valuable new insights into the structure of OCD symptoms in youth, it’s important to note that the findings are based on a single self-report measure at one point in time. Longitudinal studies tracking symptom networks over time will be crucial to confirm these results and clarify how OCD develops in children. Nevertheless, this study highlights the key role of doubt in childhood OCD and opens up promising new directions for improving our understanding and treatment of this challenging condition.