Characterizing symptom presentations in children and adolescents with obsessive-compulsive disorder

Pediatric obsessive-compulsive disorder (OCD) is characterized by significant heterogeneity in symptom presentation, complicating assessment and treatment planning. This study presents item-level data on the frequency of specific OCD symptoms using the updated Children's Yale-Brown Obsessive Compulsive Scale-II (CY-BOCS-II), which includes expanded content and greater emphasis on avoidance behaviors. Participants included 101 children and adolescents (54% male; M = 12.81 years, SD = 2.81, range = 7-17) with a primary OCD diagnosis recruited from two specialty clinics. Analyses examined the current presence or absence of 58 individual symptoms, and item-level frequency comparisons were conducted between children (≤12 years) and adolescents (≥13 years). Youth endorsed an average of 17 total symptoms, with reassurance seeking, "just right" behaviors, and need for symmetry/exactness among the most common. Most youth (77.2%) reported experiencing symptoms in at least three dimensions. Adolescents endorsed significantly more symptoms than children, and ritualized avoidance behaviors were reported by 31.7% of the sample. Findings highlight the value of item-level assessment for characterizing the full range of pediatric OCD symptoms, guiding personalized treatment, and improving diagnostic accuracy.