Childhood obsessive-compulsive disorder in the NIMH MECA study: Parent versus child identification of cases

Because as many as 50% of obsessive-compulsive disorder (OCD) cases have ha d onset by age 15, interest in its detection in childhood is strong. Clinic al experience indicates that children often try to keep their OCD secret an d that parental report may give marked underestimates. The authors examined the prevalence of childhood OCD in the NIMH Methods for the Epidemiology o f Child and Adolescent Mental Disorders (MECA) Study, a four-site community survey which allowed comparison of both parent and child report of the chi ld's OCD and related symptoms and disorders. OCD cases, based on structured interviews (DISC-2.3 with DSM-III-X criteria) with 1,285 caretaker-child p airs, were identified separately for parent and child (aged 9 through 17) i nformants from the MECA database. Cases were then examined for demographic characteristics, for obsessive-compulsive symptoms and other diagnoses repo rted in cases "missed" by one reporter, and for comorbid disorders. Of a to tal of 35 (2.7%) identified cases, four (0.3%) were identified by the paren t and 32 (2.5%) were identified by the child, with only one overlapping cas e. In general, when OCD cases were "missed" by one reporter, that reporter did not substitute another disorder. These findings support clinical data t hat children with OCD often hide their illness and underscore the importanc e of child interviews for its detection. (C) 2000 Elsevier Science Ltd. All rights reserved.