Developmental Considerations in Obsessive Compulsive Disorder: Comparing Pediatric and Adult-Onset Cases

Abstract

There appear to be two peaks of incidence of Obsessive Compulsive Disorder (OCD), one with a pre-adolescent onset and another in early adulthood. As new cases are added, the cumulative prevalence of OCD increases, but the great majority of cases have an onset in youth. The notion that early onset OCD represents a unique developmental subtype of the disorder has been considered by many researchers based on several specific age-related factors. Ascertainment and early intervention in affected youth is critical to abbreviate the functional impairments associated with untreated illness. In this paper we review the clinical, familial and translational biomarker correlates seen in early onset OCD that support the notion of a developmental subtype and discuss implications for research and treatment aimed at this cohort. The importance of cognitive, academic and social development tasks of childhood and adolescence, illness-specific and familial factors, and immune-mediated inflammatory factors are discussed, with their implications for management.

Inhibitory control in obsessive compulsive disorder: A systematic review and activation likelihood estimation meta-analysis of functional magnetic resonance imaging studies

“…Heterogeneity driven by differences in sample characteristics may also have contributed to inconsistencies across experiments. Marked differences exist between pediatric OCD and adult OCD ( Geller et al, 2021 ), and impairments of inhibitory control may manifest only later in the trajectory of the disorder ( Marzuki et al, 2020 ). Although we were not able to assess the effects of age or disease duration on our findings, a post-hoc sub-group analyses restricted to experiments on adults suggested that the results of our meta -analyses were not notably affected by data from the 3 pediatric samples.…”

Cognitive behavior therapy for obsessive compulsive disorder in youth: a narrative review

“…OCD frequently emerges early in childhood, is more common in females, and occurs across socioeconomic classes as well as across countries at a prevalence of approximately 3% (Stein et al, 2019). Data from several studies suggest that pre-adolescent onset OCD is less severe and more likely to result in remission than adult onset (Geller et al, 2021. Some studies suggest that OCD symptoms can persist for decades, although others have suggested that remissions can occur.…”

Impaired differential learning of fear versus safety signs in obsessive‐compulsive disorder

“…Notably, this study investigated pediatric OCD, and former research has indicated developmental discontinuity between pediatric and adult OCD. For example, children with OCD tend to show higher rates of Tourette's disorder and separation anxiety than patients with adult-onset OCD (Geller et al, 2001(Geller et al, , 2021. Given this age-dependent variability, conclusions drawn from studies with pediatric OCD may not necessarily applicable to adults.…”