Early onset OCD refers to the subtype of OCD that emerges in childhood, typically before age 10 or 11 years old (Rosario-Campos et al., 2001). Some researchers have hypothesized that early-onset OCD constitutes a distinct subtype of the disorder compared to cases with later adolescent or adult-onset (Delorme et al., 1999).

Proposed distinguishing features of early-onset OCD have included heightened symptom severity (Rosario-Campos et al., 2001), differences in gender ratio (Geller et al., 2001), increased rates of comorbid disorders like tic disorders (Diniz et al., 2004), and poorer response to treatments (Rosario-Campos et al., 2001).

However, findings have been mixed regarding whether early-onset OCD can be reliably differentiated as a separate subtype versus later-onset OCD (Nakatani et al., 2011).

More research is still needed to clarify if the age of onset delineates a clinically meaningful OCD subtype with unique characteristics.

Kenyon, K. M., & Eaton, W. O. (2015). Age at child obsessive-compulsive disorder onset and its relation to gender, symptom severity, and family functioning. Archives of Scientific Psychology, 3(1), 150–158. https://doi.org/10.1037/arc0000022

Key Points

The study examined the validity of subtyping early onset OCD as a distinct subtype compared to later onset OCD.
No evidence was found to support differentiating early and later onset OCD as separate subtypes based on symptom severity or gender differences.
Earlier OCD onset was not associated with worse symptoms. Males did not show earlier onset or more severe symptoms than females.
Poorer family functioning was significantly associated with greater OCD symptom severity in children.
The role of family functioning in OCD development and severity merits further research using longitudinal designs.

Rationale

Prior research disagreed on whether early onset OCD before age 10-11 constitutes a distinct subtype with unique features like symptom severity and gender ratio (Rosario-Campos et al., 2001; Geller et al., 2001; Lomax et al., 2009).
Most prior studies recruited clinical samples from specialty clinics, limiting generalizability (Mancebo et al., 2008).
This study aimed to test the early onset OCD subtype hypothesis using an online survey to access a more heterogeneous, non-clinic sample across English-speaking countries.

Method

129 parents of children ages 3-16 with OCD symptoms completed an online survey assessing OCD severity, age of onset, family functioning, and demographics.
OCD severity was measured using ten questions derived from the Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS).
Age of onset was determined by the mean age at which symptoms were first noticed and began causing problems.
Family functioning was assessed on a 3-item scale developed by the authors.

Sample

Children’s age range: 3.1-16 years old (mean age 9.3 years)
49% male, 51% female
Parents were predominantly biological mothers
Primarily from US, UK and Canada

Statistical Analysis

Multiple regression analysis tested the predictive relationship between age of onset, gender, family variables, and OCD symptom severity.

Results

Earlier age of OCD onset did not predict worse symptom severity.
Males and females showed no differences in age of onset, symptom severity, or sample distribution.
Poorer family functioning strongly predicted higher OCD severity in children (p < .0001).

Insight

The lack of support for differentiating early vs later onset OCD challenges prior subtype classification attempts based primarily on clinical samples.
Accessing a non-clinic sample through online recruitment provides a more diverse, generalizable picture of OCD in children.
The strong link between family dysfunction and higher OCD severity warrants further research on causal direction using longitudinal data.

Strengths

Heterogeneous non-clinic sample improves generalizability
Participants from English-speaking countries worldwide
Use of validated measures tailored for online survey

Limitations

The correlational design prohibits determining causality
Exclusive reliance on parent reports
Possible sample bias in online recruitment targeting OCD searches

Implications

Subtyping childhood OCD based on age of onset or gender differences does not appear clinically useful based on these findings.
Family dysfunction could potentially contribute to the worsening of OCD symptoms over time, suggesting a need for early screening and intervention focused on the family system.
Family therapy and psychoeducation should be components of treatment plans for pediatric OCD. Helping families understand OCD and learn skills for appropriately supporting the child while avoiding accommodating compulsive rituals may improve child outcomes.
Longitudinal research tracking the emergence of OCD pre- and post-onset is needed to elucidate family factors predicting symptom trajectories.

References

Primary reference

Kenyon, K. M., & Eaton, W. O. (2015). Age at child obsessive-compulsive disorder onset and its relation to gender, symptom severity, and family functioning. Archives of Scientific Psychology, 3(1), 150–158. https://doi.org/10.1037/arc0000022

Other references

Delorme, R., Golmard, J. L., Chabane, N., Millet, B., Krebs, M. O., Mouren-Simeoni, M. C., & Leboyer, M. (1999). Admixture analysis of age at onset in obsessive-compulsive disorder. Psychological medicine, 29(1), 237-243.

Diniz, J. B., Rosario-Campos, M. C., Shavitt, R. G., Curi, M., Hounie, A. G., Brotto, S. A., & Miguel, E. C. (2004). Impact of age at onset and duration of illness on the expression of comorbidities in obsessive-compulsive disorder. Journal of Clinical Psychiatry, 65, 22-27.

Geller, D. A., Biederman, J., Faraone, S. V., Bellordre, C. A., Kim, G. S., Hagermoser, L., … & Coffey, B. J. (2001). Disentangling chronological age from age of onset in children and adolescents with obsessive—compulsive disorder. The International Journal of Neuropsychopharmacology, 4(2), 169-178.

Mancebo, M. C., Garcia, A. M., Pinto, A., Freeman, J. B., Przeworski, A., Stout, R., … & Rasmussen, S. A. (2008). Juvenile-onset OCD: Clinical features in children, adolescents and adults. Acta Psychiatrica Scandinavica, 118(2), 149-159.

Nakatani, E., Krebs, G., Micali, N., Turner, C., Heyman, I., & Mataix-Cols, D. (2011). Children with very early onset obsessive-compulsive disorder: clinical features and treatment outcome. Journal of Child Psychology and Psychiatry, 52(12), 1261-1268.

Rosario-Campos, M. C., Leckman, J. F., Mercadante, M. T., Shavitt, R. G., da Silva Prado, H., Sada, P., … & Miguel, E. C. (2001). Adults with early-onset obsessive–compulsive disorder. American Journal of Psychiatry, 158(11), 1899-1903.

Scahill, L., Riddle, M. A., McSwiggin-Hardin, M., Ort, S. I., King, R. A., Goodman, W. K., … & Leckman, J. F. (1997). Children’s Yale-Brown obsessive compulsive scale: reliability and validity. Journal of the American Academy of Child & Adolescent Psychiatry, 36(6), 844-852.

Keep Learning

How might family dynamics before and after OCD onset interact to influence symptom trajectories over time?
Would family-based prevention programs be feasible and effective for children at high risk of developing OCD?
How might access to non-clinic samples shape our understanding of OCD subtypes based on phenotypic expression?

Difference Between Early and Late-Onset OCD: Gender, Symptom Severity, and Family Functioning