1. Running head: YOUTH WITH OCD 1
Youth with Obsessive-Compulsive Disorder:
Predictors and Effects of Long-Term Development
Gabriella Zaso
Moravian College

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Abstract
Is the long-term development of youth with OCD possibly at risk? Research resulted in
the findings of three main themes that can potentially effect development: concerns with the
quality of life, environmental influences, and how predictors can be found. Youth with OCD can
be affected long term depending on gender, treatment, personal evaluation regarding quality of
life, and environmental influences. With these findings and with future research, youth with
OCD can potentially decrease their risk of more severe symptom development as well as further
diagnoses of comorbid disorders.
Keywords: obsessive-compulsive disorder (OCD), development, youth, influences,
predictors, symptoms

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Youth with Obsessive-Compulsive Disorder:
Predictors and Effects of Long-Term Development
Are youth with obsessive-compulsive disorder (OCD) who are receiving treatment going
to be affected long-term developmentally? The following articles will dive into the factors that
will ultimately predict certain outcomes regarding OCD. With genetic and environmental
influences playing a major role in the development or the decline in symptoms of OCD and the
possibility and likelihood of comorbid disorders developing further in someone's life, it is
important to understand aspects and measures that can potentially predict future diagnoses
leading to greater chances of early intervention for treatment and resulting in a less debilitating
disorder later on in one's life. The articles below provide a brief summary of research in relation
to OCD and the long-term developmental effects.
Ivarsson and Valderhaug (2006) delve into symptom patterns in youth with OCD; they
examined the existence of diagnosable varieties of certain symptom patterns in children and
adolescents who have been diagnosed, using criteria from the DSM-V, with OCD. Participants in
this study included 213 children and adolescents who were advised treatment. Ivarsson and
Valderhaug (2006) excluded participants if they were diagnosed with mental retardation,
anorexia, developmental, or psychotic disorders (Ivarsson & Valderhaug, 2006). Participants and
their parents completed an interview that provided researchers with the information needed
regarding the child or adolescents’ OCD diagnosis; also known as the Yale-Brown Obsessive-
Compulsive Scale (YBOCS; Baer, 1994: Leckman et al., 1997 as cited in Ivarsson & Valderhaug
2006). This helped to determine the intensity of past and present OCD symptoms.
In regards to symptoms alone, Ivarsson and Valderhaug (2006) established that OCD
symptoms are very diverse. With that being said, Ivarsson and Valderhaug’s (2006) study

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concluded that OCD can be categorized into five different domains; contamination/cleaning,
superstitions, mental rituals/touching/ordering, obsessions/checking/confessing, and somatic
concerns.
In relation, Caluwé and De Clercq (2015) researched obsessive-compulsive (OC)
symptoms and affliction compared to age and age differences. They did so by studying the
children’s self-reports on how they relate to their general condition and/or distress in their daily
lives. Caluwé and De Clercq (2015) hypothesized that by exploring youth’s self-assessments of
their symptoms and the impairment that accompanies them compared to their father’s ratings of
degree of their quality of life, associations between father and child could be determined. Sample
One of the participants included 462 participants between eight and eleven years old who were
recruited from primary schools. Sample Two contained 265 participants between the ages of ten
and seventeen who were recruited from primary and secondary schools. Also participating were
129 fathers.
In both samples, the children completed a five-point Likert-type scale: the Youth
Obsessive-Compulsive Symptom Scale (YOCSS; Caluwé & De Clercq, 2014 as cited in Caluwé
& De Clercq, 2015), which included questions regarding their symptoms and impairments
associated with their diagnosis of OCD. The participants were also given the Screen For Child
Anxiety-Related Emotional Disorders (SCARED; Birmaher, Khetarpal, Brent, Cully, Balach,
Kaufman, & Neer, 1997 as cited in Caluwé & De Clercq, 2015) to assess comorbid problems.
The fathers filled out the Pediatric Quality of Life Inventory (PedsQL; Koot & Bastiaansen, 1998
as cited in Caluwé & De Clercq, 2015). The author’s results concluded that not all, but certain
symptoms and impairments affect the quality of life of children including emotional, social, and
academic areas of life.

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Krebs, Waszczuk, Zavos, Bolton, and Eley (2015) aimed to examine and research how
consistent obsessive-compulsive behaviors (OCB) are in children and youth over the course of
12 years. In addition, Krebs and colleagues investigated how genetics and the environment
influence OCBand how these influenced behaviors changed or developed over time. Krebs,
Waszczuk, Zavos, Bolton, and Eley (2015) hypothesized that OCB are highly affected by
genetics and the environment in relation to the development of symptoms and/or other disorders;
these effects convert through aging.
Participants were from the Twins Early Development Study (TEDS; Trouton, Spinath, &
Plomin, 2002 as cited in Krebs, Waszczuk, Zavos, Bolton, & Eley, 2015). The twins checked-in
and were evaluated at ages four, seven, nine, and sixteen; 3,224 participants completed all four
check-ins. The Anxiety-Related Behavior Questionnaire (ARBQ; Eley, Bolton, O’Connor,
Perrin, Smith, & Plomin, 2003 as cited in Krebs, Waszczuk, Zavos, Bolton, & Eley, 2015) was
used to evaluate the level of severity of the OCB. Only at check-in ages of seven and sixteen, the
Principal Component Analysis (PCA) further looked into factors from the ARBQ (Eley et al.,
2003; Hallet, Ronald, Rijsdijk, & Eley, 2009 as cited in Krebs, Waszczuk, Zavos, Bolton, &
Eley, 2015).
With careful analysis of the scores from the ARBQ and the PCA, Krebs, Waszczuk,
Zavos, Bolton, and Eley (2015) concluded that OCB remained consistent over time. However,
environmental influences were found to be not as affecting as hypothesized but were by large
specific to age.
Lensi, Cassano, Correddu, Ravagli, and Kunovac (1996) continued investigating the
hypothesis by Capstick and Seldrup (1997; as cited in Lensi, Cassano, Correddu, Ravagli, &
Kunovac 1996) stating that perinatal trauma may show a difference in genders regarding OCD

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development; over time, males will have decreased mental functioning while females will be
more likely to develop depression along with their OCD diagnosis. For this study, the 263
participants were split into two groups by gender. The participants were asked to fill out a
specialized OCD questionnaire (OCD-Q) which included information regarding the participants’
demographics, family history, other mental illnesses, and their own current disorder. The
completed OCD-Q was evaluated closely by one of the two present psychiatrists.
Lensi and colleagues (1996) found that more males who experienced trauma around their
time of birth also showed premature signs and symptoms of OCD. They were also more likely to
have certain OCD relation obsessions such as sex, exactness, and symmetry as well as strange
rituals. Women showed the symptoms of OCD at an older age than males; yet, they did have an
increased likelihood of panic attacks after being diagnosed with OCD. In addition to that,
woman's obsessions were also rated as being more aggressive than males.
Pietrefesa, Schofield, Whiteside, Sochting, and Coles (2010) aimed to add to prior
research with their study on thinking patterns between mothers with OCD and their biological
children with OCD; how genetics and the environment can influence OCD behaviors. Pietrefesa
and researchers (2010) hypothesized that there would be a positive significant relation between
mother and child regarding their “beliefs related to responsibility and threat”, and the
priority/concern of controlling thoughts (Pietrefesa, Schofield, Whiteside, Sochting, & Coles,
2010, p. 189). Twenty-eight children diagnosed with OCD between the ages of nine and
seventeen years old participated as well as their biological mothers.
Pietrefesa, Schofield, Whiteside, Sochting, and Coles (2010) had the children evaluated
and treated at either the Binghamton Anxiety Clinic, The Mayo Clinic, or at Richmond Health
Services (Pietrefesa, Schofield, Whiteside, Sochting, & Coles, 2010, p. 189). The diagnoses were

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concluded by trained and qualified clinicians after the children were interviewed; their parents
were present. Their mothers filled out a Likert-type rating scale: the 44-Item Obsessive Beliefs
Questionnaire (OBQ-44; Obsessive Compulsive Cognitions Working Group, 2005 as cited in
Pietrefesa, Schofield, Whiteside, Sochting, & Coles 2010). The youth answered a similar
questionnaire, but the children’s version. The children were also instructed to fill out and answer
a childrens version of the Leyton Obsessional Inventory (LOI-CV; Berg Whitaker, Davies, &
Flament, 1998 as cited in Pietrefesa, Schofield, Whiteside, Sochting, & Coles 2010) to determine
how severe the participants’ symptoms were. The author’s research findings suggested that
responsibility and threat estimation beliefs as well as importance and control of thought beliefs
were significantly and positively related to symptom prevalence and affliction of OCD. Not
statistically significant, but showing a trend towards significant was perfectionism and
uncertainty beliefs relating to distress. As for the children, their beliefs relating to responsibility
and threat estimation related to their mothers beliefs significantly and positively. However,
perfectionism and uncertainty, as well as importance and control of thoughts were not significant
(Pietrefesa, Schofield, Whiteside, Sochting, & Coles 2010).
In summary, the researchers concluded significance between beliefs in responsibility
which predicts the damage of threat in youth with OCD and their biological mothers.
Grant, Mancebo, Eisen, and Rasmussen (2010) investigated the ubiquity of coexistent
impulse-control disorders (IDC) in children and adolescents who also have OCD using three
hypothesis; children and adolescents who have OCD will also be more likely to have an IDC;
having ICD and OCD together is likely to lead to poor social skills and a higher probability of
psychiatric hospitalization; their final hypothesis being ICDs are more likely to be prevalent with
other co-occurring diagnosis. Since IDC is believed to be associated with OCD, Grant and

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colleagues (2010) researched the relation of ICDs in children and adolescents with OCD. Grant
and colleagues’ main purpose was to use their findings to conclude if ICDs should have their
own separate diagnostic category from OCD due to the functional changes that occur when the
disorder is present, or should it be that IDCs are placed in the same category as OCD?
Seventy children and adolescents with OCD participated. The requirements to participate
were as follows: between the ages of six and eighteen and treatment-seeking individuals.
Individuals with any kind of mental disorder were excluded (Grant, Mancebo, Eisen, &
Rasmussen 2010). Participants were evaluated; they were given a clinical interview by a
professional, they were also given rater-administered assessments and filled out questionnaires.
Demographics and previous or current treatment for each participant was also obtained via
Butler Hospital OCD Database (Grant, Mancebo, Eisen, & Rasmussen 2010). By using the
Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS; Scahill, Riddle, McSeiggin-
Hardin, Ort, King, Goodman, 1997 as cited in Grant, Mancebo, Eisen, and Rasmussen 2010),
researchers were able to determine the severity of OCD for each participant.
Grant, Mancebo, Eisen, and Rasmussen (2010) analyzed ICD prevalence in individuals
with OCD. The authors concluded that youth with OCD and ICD were likely to have a tic
disorder in addition to ICD and OCD. Participants with tic disorders were also found to have
grooming disorders as well. Grant and colleagues (2010) hypotheses regarding people who have
IDC and OCD together are more likely to be hospitalized was not backed by their results;
however, results did find that OCD, in people who also have ICD, can grow to become more
debilitating.
Nadeau, Lewin, Arnold, Crawford, Murphy, and Storch (2013) aimed to examine what
can predict functional impairment in children diagnosed with OCD. By finding the predictors,

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therapists would then be able to intervene sooner with treatment to aid in increased success.
Nadeau and researchers (2013) hypothesized how occupational impedance reports of parents and
children with OCD would be related to OCD symptoms, severity, anxiety, depression,
interpersonal problems, and overall subjective wellbeing (Nadeau, Lewin, Arnold, Crawford,
Murphy, & Storch, 2013, p. 433).
Twenty-two females and forty-three males, all seeking treatment, participated in this
experiment; all of which have a current diagnosis of OCD. First, a trained and qualified clinician
conducted the CY-BOCS (Scahill et al., 1997 as cited in Nadeau et al., 2013). Following the CY-
BOCS, a Child Behavior Checklist (CBCL; Achenbach & Rescorla, 2001 as cited in Nadeau et
al., 2013) was completed by the parents if the child was too young, which indicated their/their
child's symptom-occurrence over the last half-year. Next, the children completed a children’s-
version of the OCD impact scale (COIS-R; Piacentini, Peris, Bergman, Chang, & Jaffer, 2007 as
cited in Nadeau et al., 2013) which assessed the symptoms of OCD from the last month. The
participants also completed a self-report regarding their depression over the last two weeks; the
Childrens Depression Inventory 2 (CDI 2:SR; Kovacs, 2010 as cited in Nadeau et al., 2013) was
used. The Multidimensional Anxiety Scale for Children (MASC; March, Parker, Sullivan,
Stallings, & Conners, 1997 as cited in Nadeau et al., 2013) was completed by the participants
regarding their current symptoms and the intensity of the symptoms. To determine the overall
happiness of the participants’ lives, Nadeau and colleagues (2013) used the Student’s Life
Satisfaction Scale (SLSS; Huebner, 1991 as cited in Nadeau et al., 2013). Finally, the Positive
and Negative Affect Scale for Children (PANAS; Laurent, Catanzaro, Joiner, Rudolf, Potter,
Lambert, et al., 1999 as cited in Nadeau et al., 2013) was completed by participants to evaluate
how positively and/or negatively they were affected over the last 30 days.

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The author’s conclusions from all of the evaluations and self-assessments found that
parent-rated impairment was correlated to symptoms and their severity. On the other hand,
Nadeau and colleagues found that child-rated impairment was not correlated to OCD symptoms,
but mainly anxiety symptoms. Overall well-being was negatively in concordance with
parent/child impairment.
Due to a lack of research on exposure and how it can predict the outcome of treatment,
Kircanski and Peris (2015) hypothesized that the degree of distress during exposure and response
prevention (ERP) tasks, in between ERP sessions, and the degree of stress after ERP sessions,
would not predict the results of treatment. Also hypothesized, was that the length of the session
and how many prevention exercises were accomplished would not determine/impact the clients
end result. In addition, what would predict a better outcome for the clients was hypothesized that
ERP tasks focus or aim towards treating multiple OC symptoms.
Youth, ages eight to seventeen years old diagnosed with OCD who are seeking treatment,
and their immediate relatives, participated in this study. All youth were provided with 12
individual hour-long sessions of ERP. The following were requirements for the participants as
indicated by Kircanski and Peris (2015): diagnosed with OCD, a score at or above 15 on the CY-
BOCS, highly distressed, no failed therapy for anxiety or OCD within the past two recent years,
English speaking, and no other psychiatric illness.
To begin, the participants were interviewed using the Anxiety Disorders Interview
Schedule (ADIS-C/P; Silverman & Albano, 1996 as cited in Kircanski & Peris, 2015) which
evaluates what is mentally causing the current distress. The CY-BOCS was also used in this
study (Scahill et al., 1997 as cited in Kircanski & Peris, 2015) to measure the intensity of the
symptoms. The Clinical Global Impression-Severity Scale (CGI-S; NIMH, 1985 as cited in

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Kircanski & Peris, 2015) was implemented to assess the participants overall mental illness
severity. The Clinical Global Impression-Improvement Scale (CGI-I; NIMH, 1985 as cited in
Kircanski & Peris, 2015) was administered to evaluate the level of improvement from the initial
diagnosis, and the Childrens Global Assessment Scale (CGAS; Shaffer, Gould, Brasic,
Ambrosini, Fisher, Bird, et al., 1983 as cited in Kircanski & Peris, 2015) rates how well the
participant functions on a daily basis from the past 30 days. Finally, to measure their level of
fear, the participants were asked to complete the Subjective Units of Distress Scale (SUDS;
Wolpe 1973 as cited in Kircanski & Peris, 2015).
The authors concluded that the level of leading distress did not foreshadow future
outcomes if the distress measure decreased over sessions; Kircanski and Peris (2015) found that
a better prediction originates from the symptoms declining through therapy. With that being said,
ERP tasks that focus on multiple symptoms are likely to result in positive outcomes.
Within and including all of the articles, there were three major themes; concerns with the
quality of life, environmental influences, and how predictors can be found. Ivarsson and
Valderhaug (2006), Caluwé and De Clercq (2015), and Grant, Mancebo, Eisen, and Rasmussen
(2010) concentrated mainly on how symptoms can be severe, or become so severe that they
eventually decrease the quality of one's life. By focusing on the development of symptoms, these
researchers were able to conclude how OCD symptoms can affect a child’s emotional, social,
and academic lives and predict future disorders that are likely to occur if untreated.
Krebs, Waszczuk, Zavos, Bolton, and Eley (2015), Lensi, Cassano, Correddu, Ravagli,
and Kunovac (1996), and Pietrefesa, Schofield, Whiteside, Sochting, and Coles (2010) centered
on environmental influences and the effects they can have on the individual with OCD. The close
attention on problems before or around the time of birth leading to obsessive-compulsive

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behaviors over time and genetics were able to break down OCD on a more biological level to aid
in further prediction-focused research such as the studies done by Nadeau, Lewin, Arnold,
Crawford, Murphy, and Storch (2013) and Kircanski and Peris (2015).
Nadeau and colleagues (2013) and Kircanski and Peris (2015), researched the predictors
of functional impairment and the outcome of treatment which can better help therapists,
researchers, and/or clinicians understand what can potentially be causing the symptoms to
worsen, advance, or find their client being diagnosed with another related disorder. With the bulk
of the research on quality of life, influences, and predictors, the opportunity for early
intervention and therapy heightens which greatly affects long-term development in individuals
diagnosed with OCD.
In many of the present articles, a larger sample size was a major suggestion. In addition
to sample size, other limitations regarding participants may have affected the outcomes of the
studies. Many of the participants were recruited from hospitals, or were treatment seeking which
resulted in abnormal or different participants than that of the general public; the subject pool is
most likely a more severe representation of the actual OCD population. Adding to the limitation
of population, Nadeau, Lewin, Arnold, Crawford, Murphy, and Storch’s (2013) participants were
mainly from upper-middle class families. Different class families have different environmental
influences or obstacles that can trigger anxiety. Future research should include participants from
all economic classes to obtain a more broad range of influence possibilities.
Further limitations include self-assessment concerns; since the participants who were
seeking treatment or simply participating in the study were knowledgeable that they had OCD, it
is likely that they downplayed their symptoms and ratings during surveys, assessments, and
interviews. For example, in Grant and colleague’s (2010) research, the ICD diagnoses were

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solely based on the subject with no outside input (i.e. from parents, guardians, or other medical
professionals) which can cause the diagnosis to appear less severe than it is since participants
who self-report are likely to be embarrassed of their disorder and/or symptoms causing them to
make their symptoms and disorder seem less harsh. Similar to Grant and colleague’s (2010)
research, Lensi, Cassano, Correddu, Ravagli, and Kunovac’s (1996) research relied solely on
self-assessment as well. On the opposite spectrum, Krebs, Waszczuk, Zavos, Bolton, and Eley
(2015) only retrieved parent reports and not self-reports from the children. However, this could
be due to the fact that the children may have been too young at the time of the study. Perhaps in
future research, information should be obtained via clinical records, doctor records, and even
family interviews or assessments to ensure that the most truthful and valuable information is
obtained. Overall, more research is needed to be done on therapy that can slow down the
advancement or development of OCD and on influences that can virtually predict the future
diagnosis of an individual with OCD. This research can benefit clinicians, therapists, and
individuals suffering with, or potentially at risk of developing OCD.
According to prior research, even if they are receiving treatment, youth with OCD can be
affected long term depending on gender, treatment, personal evaluation regarding quality of life,
and environmental influences. With all of these factors taken into account and with future
research, early intervention can be made possible which would result in an early decrease in
symptoms, severity of the disorder, and the potential development of comorbid disorders.

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