Functional impairment in children and adolescents with obsessive-compulsive disorder

Although obsessive-compulsive disorder (OCD) is a chronic and oftentimes debilitating disorder, the specific impact of this illness on the psychosocial functioning of affected youngsters has not been systematically described. A total of 151 clinic-referred youngsters (mean age 11.8 years, 57% male, 83% Caucasian) with primary Diagnostic and Statistical Manual of Mental Disorders (fourth edition) OCD and a primary caretaker completed a checklist designed to assess the impact of OCD on school, social, and family functioning. The two most common OCD-related problems were concentrating on schoolwork and doing homework. Consistent with the heterogeneous nature of OCD, subjects exhibited a broad range of specific impairments. However, almost 90% of youngsters reported at least one significant OCD-related dysfunction, and close to half reported significant OCD-related problems at school, home, and socially. Parents were more likely to report significant impairments in home and school functioning than children. However, few systematic gender or age effects were noted. Impairment ratings were significantly correlated with clinician-generated measures of OCD severity. These results provide the most specific description to date of the adverse impact of OCD on child psychosocial functioning. Given the adverse developmental consequences of psychosocial dysfunction, treatment studies need to carefully track and address OCD-specific functional impairments in affected youngsters.