Avoidance in pediatric obsessive-compulsive disorder: Symptom phenomenology and clinical correlates

Avoidance and family accommodation are common in pediatric obsessive-compulsive disorder (OCD). While family accommodation has received considerable investigation, avoidance in pediatric OCD has been comparatively understudied. Despite this, avoidance can mask overall symptom severity, hinder accurate diagnosis, and impede treatment effectiveness. This study characterized avoidance behaviors and their clinical correlates in 101 treatment-seeking children and adolescents (54% male; ages 7 to 17) diagnosed with OCD. Avoidance was measured using the Children's Yale-Brown Obsessive Compulsive Scale-II (CY-BOCS-II), and both youth self- and parent-report were used to assess depression, anxiety, family accommodation, and functional impairment. Avoidance behaviors were highly prevalent, with 76% of participants endorsing avoidance in at least one domain. Youth with avoidance demonstrated significantly higher OCD symptom severity, greater self-reported mood symptoms, increased family accommodation, and more functional impairment. Preliminary mediation analyses highlight that avoidance has a significant indirect effect on the relationship between OCD symptom severity and parent-reported functional impairment. Findings underscore the importance of assessing avoidance in youth with OCD to accurately capture its impact on functional impairment and guide targeted intervention.