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Advances in Obsessive–Compulsive Disorders in Children: Epidemiology, Diagnosis and Treatment
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Advances in Obsessive–Compulsive Disorders in Children: Epidemiology, Diagnosis and Treatment

A special issue of Children (ISSN 2227-9067). This special issue belongs to the section "Pediatric Mental Health".

Deadline for manuscript submissions: 15 July 2025 | Viewed by 5294

Special Issue Editors

Dr. Emily Bilek

E-Mail Website
Guest Editor
Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
Interests: anxiety disorders; obsessive–compulsive and related disorders; transdiagnostic treatments; cognitive behavioral therapies; school-based mental health implementation
Dr. Emily M. Becker-Haimes

E-Mail Website
Guest Editor
Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, 3rd floor, Philadelphia, PA 19104, USA
Interests: implementation science; youth mental health; evidence-based practice; anxiety and related disorders; exposure therapy

Special Issue Information

Dear Colleagues,

We invite authors to contribute to our Special Issue, focused on collating recent advances in the epidemiology, diagnosis, and treatment of youth obsessive–compulsive and related disorders. This Special Issue offers a unique platform to showcase your research exploring the prevalence, risk factors, and diagnostic innovations shaping our understanding of youth OCD. We encourage you to share your insights into novel therapeutic approaches, including psychosocial and pharmacological treatments, in order to address the mental health needs of youth suffering from obsessive–compulsive and related disorders. By submitting your work, you will contribute to providing a comprehensive overview of the latest developments in the field and help shape the future of youth OCD research and treatment. Research conducted in partnership with individuals with lived experience is especially encouraged. Join us in making a difference in the lives of young individuals struggling with obsessive and compulsive disorders by submitting an abstract for consideration to this Special Issue.

Submission deadlines: Initial abstracts (250 word maximum) are requested by October 1st, 2024. Invitations for full manuscripts will be made by November 1st, 2024. The deadline for full manuscript submissions is March 1, 2025. Invitation to submit a manuscript does not guarantee publication; all manuscripts will undergo peer review.

Dr. Emily Bilek
Dr. Emily M. Becker-Haimes
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Children is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • pediatric anxiety
  • pediatric OCD
  • assessment
  • diagnosis
  • treatment
  • evidence-based practice

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Further information on MDPI's Special Issue policies can be found here.

Published Papers (6 papers)

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Research

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29 pages, 4317 KiB  
Article
Are the Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents as Effective for OCD as for Anxiety and Depression?
by Lauren Milgram, Madison E. Bigler, Elizabeth R. Halliday, Kiara R. Timpano and Jill Ehrenreich-May
Children 2025, 12(4), 529; https://doi.org/10.3390/children12040529 - 21 Apr 2025
Viewed by 381
Abstract
Background: Obsessive–compulsive disorder (OCD) in youth commonly co-occurs with other affective disorders (e.g., anxiety, depression). Exposure and response prevention (ERP) is the front-line treatment for OCD but may require significant adaptation to treat co-occurring symptoms or complex comorbidity patterns. Preliminary evidence suggests [...] Read more.
Background: Obsessive–compulsive disorder (OCD) in youth commonly co-occurs with other affective disorders (e.g., anxiety, depression). Exposure and response prevention (ERP) is the front-line treatment for OCD but may require significant adaptation to treat co-occurring symptoms or complex comorbidity patterns. Preliminary evidence suggests that the Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents (UP-C/A) are effective in reducing OCD symptoms. Still, it is not yet known if the UP-C/A are comparably effective to treat OCD as they are for anxiety and depression, the disorders for which there is the most robust empirical support. Methods: This study compared trajectories of OCD, anxiety, and depression symptom change among 388 youth who received UP-C/A treatment (M = 15 sessions) at a university-based research clinic. We also examined whether youth with (n = 60) and without (n = 328) an OCD diagnosis demonstrated comparable improvements in anxiety, depression, and transdiagnostic treatment targets (i.e., anxiety sensitivity, cognitive flexibility, and distress tolerance). Results: OCD symptoms improved at a slower rate than anxiety and depression symptoms during the first half of UP-C/A treatment but at a comparable rate to anxiety and depression symptoms during the second half of treatment. Youth with and without OCD exhibited comparable improvements in anxiety, depression, anxiety sensitivity, cognitive flexibility, and distress tolerance across the treatment course. Conclusions: Findings support the efficacy of UP-C/A treatment for co-occurring OCD and affective disorders but suggest that initiating exposure earlier in the treatment course may confer additional benefits. Full article
(This article belongs to the Special Issue Advances in Obsessive–Compulsive Disorders in Children: Epidemiology, Diagnosis and Treatment)
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21 pages, 617 KiB  
Article
McLean OCD Institute for Children and Adolescents: Overview, Rationale, and Description of Symptomatology and Functional Impairment
by Alyssa L. Faro, Rebecca A. Wolenski, Chun W. Lee, Perihan Esra Guvenek-Cokol, Daniel P. Dickstein and Maria G Fraire
Children 2025, 12(4), 505; https://doi.org/10.3390/children12040505 - 15 Apr 2025
Viewed by 352
Abstract
Background/Objectives: Residential treatment represents an important level of care for adolescents with severe and/or treatment-refractory obsessive–compulsive disorder (OCD). Despite accumulating evidence supporting the treatment efficacy and cost-effectiveness of insurance-based intensive OCD treatment in residential settings, few data exist that characterize the population of [...] Read more.
Background/Objectives: Residential treatment represents an important level of care for adolescents with severe and/or treatment-refractory obsessive–compulsive disorder (OCD). Despite accumulating evidence supporting the treatment efficacy and cost-effectiveness of insurance-based intensive OCD treatment in residential settings, few data exist that characterize the population of adolescent patients utilizing this level of care. As a result, residential treatment may be poorly understood by patients, their families, and referring providers, which may delay appropriate treatment for adolescents with OCD. Here, we characterize the patient population at an intensive residential treatment center (RTC) and partial hospitalization program (PHP) for adolescents (Mage = 15.23) with a primary diagnosis of OCD. Methods: We examine quantitative data collected from 168 adolescents admitted to the McLean OCD Institute for Children and Adolescents for the treatment of primary OCD or a related disorder over a three-year period. We also conduct analyses on a subset of patients (n = 120) who participated in the Child and Adolescent Routine Evaluation (CARE) Initiative (McLean Child Division-Wide Measurement-Based Care Program) to further characterize this patient population with a lens toward additional comorbidities and factors impacting prognosis. Results: The current paper describes the severity of symptom presentation, comorbidities, psychotropic medication profiles, and disruption to personal and family functioning. Analyses also include the prevalence of OCD subtypes and co-occurrence among varied presentations. Conclusions: In addition to identifying common clinical presentations in an RTC/PHP, this paper further aims to detail best practices and clinical rationale guiding a specialty RTC/PHP to inform families, providers, and payors about the individuals that most benefit from this level of care. Full article
(This article belongs to the Special Issue Advances in Obsessive–Compulsive Disorders in Children: Epidemiology, Diagnosis and Treatment)
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18 pages, 286 KiB  
Article
Australian Clinicians’ Capabilities, Opportunities, and Motivations in Implementing Exposure and Response Prevention for Youth with Obsessive-Compulsive Disorder: An Exploratory Study
by Jason I. Racz, Iain E. Perkes, Andrea Bialocerkowski, Katelyn M. Dyason, Jessica R. Grisham, Matthew L. McKenzie and Lara J. Farrell
Children 2025, 12(2), 156; https://doi.org/10.3390/children12020156 - 28 Jan 2025
Viewed by 644
Abstract
Objectives: Informed by implementation science, this exploratory study examined the capabilities, opportunities, and motivations of Australian mental health clinicians (N = 38) associated with the implementation of exposure and response prevention (ERP) for youth (i.e., children and adolescents) with obsessive-compulsive disorder (OCD). [...] Read more.
Objectives: Informed by implementation science, this exploratory study examined the capabilities, opportunities, and motivations of Australian mental health clinicians (N = 38) associated with the implementation of exposure and response prevention (ERP) for youth (i.e., children and adolescents) with obsessive-compulsive disorder (OCD). It also explored how the capabilities and motivations of mental health clinicians untrained in ERP for youth (i.e., typical clinicians; n = 25) differed from clinicians experienced in the use of ERP for youth (i.e., experienced clinicians; n = 13). Methods: Questionnaires were administered to the entire sample alongside observational role-plays, which assessed observed adherence and competence delivering ERP against published best-practice standards among available participants. Results: In the whole sample, the reported time dedicated to implementing ERP was associated with a range of factors relating to capabilities, opportunities, and motivations to implement ERP. Experienced clinicians had greater knowledge, adherence, competence, and self-reported confidence using ERP and fewer negative beliefs about ERP relative to typical clinicians. They also intended to dedicate greater time to implementing within-session ERP for youth and reported greater within- and between-session time spent doing so compared to typical clinicians. The time intended to dedicate to implementing between-sessions ERP did not significantly differ between the clinician groups. Conclusions: In summary, compared to typical clinicians, experienced clinicians appeared to possess greater levels of capabilities and motivations to implement ERP for youth with OCD. Future research examining barriers and facilitators of ERP implementation in community settings and identifying effective strategies to improve it would benefit service provision and, ultimately, outcomes for youth. Full article
(This article belongs to the Special Issue Advances in Obsessive–Compulsive Disorders in Children: Epidemiology, Diagnosis and Treatment)
14 pages, 710 KiB  
Article
The Flip Side of the Coin: Giftedness in Pediatric Acute-Onset Neuropsychiatric Syndrome
by Denise Calaprice, Ryan Terreri, Christopher Whitty, Ryan Whitty and Janice Tona
Children 2024, 11(12), 1524; https://doi.org/10.3390/children11121524 - 16 Dec 2024
Viewed by 2348
Abstract
Background/Objectives: Individuals with Pediatric Acute-onset Neuropsychiatric Syndrome (PANS), an immune-modulated disorder, experience exacerbation-related neuropsychiatric symptoms, functional impairments, and high rates of developmental diagnosis. The literature describes links between giftedness and mental illness, and giftedness and autoimmune disorders. We sought to explore rates of [...] Read more.
Background/Objectives: Individuals with Pediatric Acute-onset Neuropsychiatric Syndrome (PANS), an immune-modulated disorder, experience exacerbation-related neuropsychiatric symptoms, functional impairments, and high rates of developmental diagnosis. The literature describes links between giftedness and mental illness, and giftedness and autoimmune disorders. We sought to explore rates of giftedness among children with PANS as perceived by their caregivers, and to examine whether giftedness was related to PANS symptom severity, persistence, or duration. Methods: Data were extracted from a larger, 146-item survey, with 680 respondents meeting inclusion criteria of being a parent/guardian of a child with PANS and answering questions regarding perceived giftedness in empathy, social skills, verbal ability, reading, memory, math, creativity, or “other.” Results: In all, 604 respondents indicated some type of giftedness; the categories of giftedness were each endorsed by 30–57% of respondents. We found no significant associations between giftedness and severity of worst symptoms, persistence of symptoms, or length of time since symptom onset, once Bonferonni corrections were applied. Significantly more females than males were identified as gifted in creativity, but no other sex-related differences were seen. Thematic analysis of optional comments revealed three themes: (1) Elaboration on Types of Giftedness; (2) Objective Basis for Perceptions of Giftedness; and (3) Impact of PANS on Giftedness. Conclusions: The rate of giftedness reported by parents of PANS subjects in this study is much higher than would be expected in the general population, even when adjusting generously for potential overestimation. This study of the “flip side” of PANS should serve as impetus for future studies regarding giftedness in this population; a robust finding of exceptionally high rates of giftedness would have implications for diagnosis, interpretation of symptoms (for example, perfectionism and social challenges) and disease management. Full article
(This article belongs to the Special Issue Advances in Obsessive–Compulsive Disorders in Children: Epidemiology, Diagnosis and Treatment)
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Review

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14 pages, 476 KiB  
Review
From Doubt to Direction: Untangling Pediatric Scrupulosity
by Rachel E. Mathews and Shivali Sarawgi
Children 2025, 12(4), 528; https://doi.org/10.3390/children12040528 - 21 Apr 2025
Viewed by 231
Abstract
Background: Up to 33% of individuals with obsessive-compulsive disorder (OCD) have scrupulosity symptoms, although less is known regarding the prevalence rates in youth, specifically. Scrupulosity translates to “fearing sin where there is none” and describes pathological guilt and distress related to religion [...] Read more.
Background: Up to 33% of individuals with obsessive-compulsive disorder (OCD) have scrupulosity symptoms, although less is known regarding the prevalence rates in youth, specifically. Scrupulosity translates to “fearing sin where there is none” and describes pathological guilt and distress related to religion and morality. Disentangling scrupulosity from true religious beliefs and actions may be difficult in youth for a number of reasons, including the nature of youth as a time of developing independent identities and values, expected ritualistic behavior (e.g., confession, ritualistic cleansing), scrupulosity being reinforced in some religious communities, and the discomfort or inexperience of clinicians with both these symptoms and various belief systems. The literature suggests limited knowledge of scrupulosity among mental health providers, including pediatric clinicians, and apprehension to discuss or target scrupulous beliefs and behaviors. Apprehension may be enhanced for providers working with youth populations, particularly given broader misconceptions about the efficacy and safety of gold-standard interventions. Objectives: This narrative review with practice guidelines examines the existing literature related to pediatric scrupulosity and its challenges and describes evidence-based treatments for scrupulosity in pediatric populations. Recommendations for clinical practice and research are discussed. Full article
(This article belongs to the Special Issue Advances in Obsessive–Compulsive Disorders in Children: Epidemiology, Diagnosis and Treatment)
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17 pages, 1103 KiB  
Review
Emotion Regulation in Pediatric Obsessive-Compulsive Disorder and Related Interventions: A Scoping Review
by Shivali Sarawgi and Rachel E. Mathews
Children 2025, 12(4), 400; https://doi.org/10.3390/children12040400 - 21 Mar 2025
Viewed by 405
Abstract
Background/Objectives: Maladaptive emotion regulation (ER) and emotion dysregulation (ED) have long been associated with obsessive-compulsive disorder (OCD) as etiological and maintaining factors. Despite building interest in the field along with ancillary research into “rage OCD” (likely an example of ED), targeting the relationship [...] Read more.
Background/Objectives: Maladaptive emotion regulation (ER) and emotion dysregulation (ED) have long been associated with obsessive-compulsive disorder (OCD) as etiological and maintaining factors. Despite building interest in the field along with ancillary research into “rage OCD” (likely an example of ED), targeting the relationship between OCD and ER/ED has been understudied in pediatric OCD populations. The aim of this review was to elucidate the current state of the literature regarding ER/ED, its relationship to pediatric OCD, and related interventions. Methods: A scoping review examined how ER/ED are related to OCD, particularly in pediatric populations, and the efficacy of interventions to affect ER/ED for youth, with a focus on youth diagnosed with OCD. Results: A total of 182 publications were reviewed. While not always consistent, a majority of studies found a significant relationship between measures of ER or ED and OCD broadly, as well as with specific OCD symptom dimensions. A number of previously existing interventions, adaptations of those interventions, and newly presented interventions were found to affect ER/ED in youth; however, few studies have effectively targeted ER/ED for pediatric OCD, specifically. As such, the mechanism of change is not well understood. Conclusions: Findings from this review suggest that the increasing focus on ER/ED in pediatric OCD is warranted and in need of continued research. ER/ED can be effectively changed by interventions in youth, but the role ER/ED-change plays in pediatric OCD symptom improvement remains unclear. Implications for future study are examined. Full article
(This article belongs to the Special Issue Advances in Obsessive–Compulsive Disorders in Children: Epidemiology, Diagnosis and Treatment)
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