**6. Parent-child interactions**

of depressive cognitions can provide information on whether depressive thoughts center on impairment or quality of life issues related to OCD. Additionally, obtaining a timeline of symptoms (such as whether depression preceded OCD or began afterward) can assist with

While OCD has frequently been described as a debilitating and chronic illness whose symptoms wax and wane over time, less is known about the course of the disorder for children and adolescents specifically. In fact, research demonstrates potential differences regarding the course of illness between pediatric and adult populations. A study that compared pediatric and adult treatment-seeking individuals with OCD over a 3-year time period found that children had a significantly higher remission rate (53%) compared to adults (34%) [36]. Better psychosocial functioning as well as engaging in treatment earlier in the course of illness was related to shorter time to remission for children with OCD. These findings suggest a better prognosis for pediatric OCD and additionally emphasize the importance of early recognition

Additionally, clinical presentation of OCD may vary across the life span between children, adolescents, and adults. Youth diagnosed with OCD at an earlier age tend to have higher rates of ADHD and anxiety disorders [1, 37]. As children with OCD age into adolescence, they are more likely to experience mood disorders such as depression [1, 16, 37]. These developmental trends are exemplified by a study that investigated differences in clinical presentation between 46 children, 55 adolescents, and 60 adults with OCD. Results revealed that ADHD and tic disorder rates were inversely related to age such that the children had the highest prevalence followed by adolescents and then adults [37]. Conversely, adults had the highest rates of depression followed by adolescents and then children with the lowest rates of depression [37]. Similarly, another study that examined the prevalence of comorbidity in pediatric OCD demonstrated adolescents had a six times greater likelihood of having a co-occurring

OCD pathogenesis involves neuroanatomy, biochemical, genetic, and environmental factors. Brain structures that are associated with obsessive compulsive disorder include the orbitofrontal cortex, striatum, thalamus, and the basal ganglia, which are all involved in the cortical-striatal circuit [38]. MRI and fMRI scans have demonstrated structural abnormalities for individuals with OCD. Biochemical factors that have been identified to play a role include neurotransmitters like serotonin [38, 39], and in fact, serotonin changes have been shown to change purely with an intensive exposure and response prevention treatment [40]. Genetic factors also appear to have a strong influence on the development of early-onset OCD. Children

identifying if depression is reactionary to OCD or a distinct condition.

**4. Course of the disorder**

72 Anxiety Disorders - From Childhood to Adulthood

and intervention for children with OCD [36].

depressive disorder compared to younger children [16].

**5. Etiology**

Children's OCD symptoms affect and are affected by family dynamics and the family environment. As children are heavily reliant on their parents for activities of daily living and general well-being, parents often bear the brunt of their child's OCD severity and impairment. Extensive research demonstrates the importance of accounting for family factors in the treatment of pediatric OCD [45–48]. In fact, family-based therapy has demonstrated effectiveness and is highly encouraged, especially in the case of younger children [45, 49].

A parent of a child with OCD is faced with many challenges on a daily basis. Children may delay family activities due to involvement in rituals or may refuse to partake in activities or gatherings altogether due to their OCD symptoms. When children become distressed by their obsessions and compulsions, it is typically family members who deal with the resulting temper tantrums, crying, reassurance seeking, or avoidance of situations and activities. Children may request or demand their parents adjust their behavior to assist with rituals or prevent feared negative consequences related to obsessional fears (e.g., expecting a parent to hand-wash excessively after a parent touches something the child considers dirty). Parents are faced with difficult questions such as how to cope effectively with their children's emotional distress, whether to assist in rituals or provide reassurance, and how to respond when children avoid or refuse to participate in activities. In addition, parents often have to deal with the poor interpersonal relations these children exhibit [50].
