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Obsessive compulsive disorder in children and adolescents, CONCLUSION -…

- - - - Challenges may face*
        
        Embarrassment and concealment: Young people with OCD may hide their symptoms due to shame or fear of judgment.
        
        Lack of insight: They may not recognize their behaviors as unusual or excessive.
        
        Difficulty differentiating: Normal developmental rituals can be mistaken for OCD symptoms.
        
        Heterogeneity: OCD symptoms vary greatly between individuals, making diagnosis complex.
    - - eg:.Short OCD Screener
        
        Do you wash or clean a lot?
        
        Do you check things a lot?
        
        Is there any thought that keeps bothering you that you would like to get rid of but cannot?
        
        Do your daily activities take a long time to finish? (eg, getting ready for school)
        
        Are you concerned about putting things in a special order or are you very upset by mess?
        
        Do these problems trouble you?
      - Short OCD Screener (SOCS): This questionnaire is effective in identifying most cases.
        
        Further assessment: If positive on SOCS, detailed history, developmental history, and separate interview are crucial.
        
        Separate interview: This allows young people to disclose sensitive thoughts and feelings privatel
  - - - Differentiating from Autism Spectrum Disorder (ASD): Look for obsessions, anxiety relief from compulsions, and egodystonic (unwanted) behavior to distinguish from ASD-related stereotyped behaviors.
      - Differentiating from tic disorders: Check for intentionality, complexity (compulsions are more elaborate), and anxiety relief in OCD compared to involuntary and simpler tics.
      - Differentiating from psychosis: Consider insight into irrationality, presence of other OCD symptoms, and absence of other psychotic features like hallucinations.
      - Prevalence of OCD is elevated in individuals with ASD.
        
        OCD treatments are effective in children with tics and OCD.
        
        Transformation obsessions and aggressive obsessions can be mistaken for delusions.
        
        Comorbidity with ASD and tic disorders is common
- - - - Cognitive Behavioral Therapy (CBT) with Exposure and Response Prevention (E/RP):
      - Considered the first-line treatment for mild to moderate cases.
      - Short-term, typically 12-20 weekly sessions.
      - Involves gradually confronting feared situations and resisting compulsions.
      - Effective for children as young as 3 years old.
      - 40%-65% reduction in symptoms, with gains maintained up to 18 months.
- - - - Trying different SSRI medications or clomipramine (tricyclic drug).
        
        Augmenting SSRI with a low dose of a dopamine antagonist (mixed evidence).
        
        High-quality exposure-based CBT is generally preferred over risperidone augmentation.
    - - What are the specific modified treatment approaches for different comorbidities?
        
        What are the risks and benefits of using dopamine antagonists to augment SSRI treatment?
        
        What are the emerging treatment options for treatment-resistant OCD?
        
        Where can I find resources for young people and families struggling with OCD?