Preschool-onset OCD: A review of literature and clinical experience

Area of Science:

• Child and Adolescent Psychiatry
• Neurodevelopmental Disorders
• Pediatric Mental Health

Background:

• Obsessive-compulsive disorder (OCD) can manifest in very young children, with onset as early as 2-3 years old.
• Preschool-onset OCD (≤ 5 years) poses distinct diagnostic and therapeutic challenges compared to older individuals.
• Existing literature on early-onset OCD is limited, particularly regarding its course, treatment, and long-term outcomes.

Purpose of the Study:

• To review existing literature on preschool-onset OCD.
• To present clinical data on preschool-onset OCD from a tertiary care center in India.
• To explore the phenomenology, comorbidity, and treatment characteristics of early-onset OCD.

Main Methods:

• A qualitative review of published literature on preschool-onset OCD.
• Analysis of clinical records from a child and adolescent psychiatry center in India for cases of preschool-onset OCD (age of onset ≤ 5 years).

Main Results:

• Preschool-onset OCD is phenomenologically similar to OCD in older individuals but shows high rates of comorbidity and family history.
• At the study center, preschool-onset OCD had a 3% prevalence, with a male predominance (69%) and high comorbidity (62%).
• Treatment seeking was often delayed, follow-up rates were poor, pharmacological treatments were frequently used, and adequate treatment led to high remission rates.

Conclusions:

• Preschool-onset OCD requires specialized attention due to its unique challenges and high comorbidity.
• Despite delayed treatment seeking and follow-up issues, adequate intervention for preschool-onset OCD can achieve high remission rates.
• Further research is needed to understand the long-term course and optimal management strategies for this vulnerable population.