Published online September 28, 2009
PEDIATRICS Vol. 124 No. 4 October 2009, pp. 1085-1093 (doi:10.1542/peds.2009-0015)
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ARTICLE

Predictors of Early Adult Outcomes in Pediatric-Onset Obsessive-Compulsive Disorder

Michael H. Bloch, MD, MSa, Brittany G. Craiglow, BAa, Angeli Landeros-Weisenberger, MDa, Philip A. Dombrowski, BAa, Kaitlyn E. Panza, BAa, Bradley S. Peterson, MDb,c and James F. Leckman, MDa

a Yale Child Study Center, Yale University School of Medicine, New Haven, Connecticut
b Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York
c Department of Psychiatry, New York State Psychiatric Institute, New York, New York

OBJECTIVE: The aim of this study was to determine the childhood clinical predictors of early adult outcomes in pediatric-onset obsessive-compulsive disorder (OCD) and to assess whether dimensional subtypes of OCD and the presence of comorbid tic symptoms influence long-term outcomes.

METHODS: We conducted a longitudinal cohort study in which 45 of 62 eligible children with OCD were reassessed an average of 9 years later, in early adulthood. Main outcome measures included expert-rated, obsessive-compulsive (OC) symptom severity and time to remission of OC symptoms. Baseline clinical characteristics were evaluated in terms of their influence on OCD severity in adulthood and time to remission of OC symptoms.

RESULTS: Forty-four percent of subjects were determined to have subclinical OC symptoms at the follow-up evaluation. The absence of a comorbid tic disorder and the presence of prominent hoarding symptoms were associated with the persistence of OCD symptoms. Female gender, earlier age at childhood assessment, later age of OCD onset, more-severe childhood OCD symptoms, and comorbid oppositional defiant disorder also were associated with persistence of OCD symptoms into adulthood.

CONCLUSIONS: These results confirm that a significant proportion of treated children with OCD experience remission by adulthood. The presence of comorbid tics heralds a positive outcome, whereas primary hoarding symptoms are associated with persistent OCD.

Key Words: obsessive-compulsive disorder • longitudinal study • compulsive hoarding • tic disorder

Abbreviations: OCD—obsessive-compulsive disorder • TS—Tourette syndrome • ADHD—attention-deficit/hyperactivity disorder • Y-BOCS—Yale-Brown Obsessive Compulsive Scale • ODD—oppositional defiant disorder • SSRI—selective serotonin reuptake inhibitor • CTD—chronic tic disorder • OC—obsessive-compulsive

Accepted May 28, 2009.


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