When Should Medication Be Considered For Children With OCD?

Medication treatment should only be considered when children are experiencing significant OCD impairment or distress. Also when cognitive-behavioral therapy is unavailable or only partially effective.

Each of the seven available anti-OCD medications is discussed separately on this web page. The following are some general principles that apply to them all:

• Anti-OCD medications work because they affect the brain chemical serotonin. Serotonin is used by certain nerve cells in the brain to communicate with other brain cells. These nerve cells (called neurons) release serotonin, which then affects neighboring cells. After the serotonin is released, the serotonin is taken back up into the cell so that it can be used again. Each of the anti-OCD drugs interferes with serotonin being recycled once it has been released. This allows serotonin to spend more time outside of the cell, where it continues to affect neighboring cells. How or why this reduces obsessions and compulsions is still unknown.
• The best dose of anti-OCD medication should be determined on an individual, case-by-case basis. It is always best to use the smallest amount of medicine that effectively treats the child's OCD.  Most children metabolize medications quite rapidly, and relieving the child's OCD symptoms often necessitates the use of higher, adult-sized doses.
• Anti-OCD medications control symptoms, but do not "cure" the disorder. This means that the positive effects of an anti-OCD medication occur as long as the drug is being taken. That some symptoms often remain, but with lower severity.

  When the child stops taking the anti-OCD medication, symptoms usually return. At this point, there is no known cure for OCD.

• Each of the anti-OCD medications is also an antidepressant. With clomipramine (Anafranil ®), it was discovered that certain antidepressant medications  helped control OCD symptoms. Not all antidepressant medications have anti-OCD effects, only those that strongly affect serotonin.
• Cognitive-behavioral therapy, if available, should  be considered in addition to medication. This type of therapy (see discussion later in this booklet) is a safe and effective treatment for OCD. Medication alone is usually not as effective, nor are the benefits as long-lasting as medication plus cognitive-behavior therapy. Sometimes, finding a behavior therapist who treats childhood OCD is challenging. For this reason, many children with OCD are treated solely with medications.
• All anti-OCD medications work slowly. Medication is often considered when the child's OCD is severe. Both the child and family are in distress. These drugs are not "quick fixes." It takes two to three months to see improvement in the OCD!  Recent studies show that ongoing improvement of OCD continues between twelve weeks and one year after starting medication.
• No two children respond to anti-OCD medication in  the same way. An occasional child will not respond to any medication. It is common for children to respond individually to each of the anti-OCD medications. Some work well for a particular child, and some not at all. The occurrence of side effects  varies greatly. It is impossible to pick which medication will work best for a particular child. It is important to understand that if the first medication does not improve OCD, another one should be tried. The child may need a trial of each of the seven available anti-OCD medications to find the one that works best. The drug clomipramine is likely to cause bothersome side effects. Physicians often reserve prescribing it until several of the other anti-OCD drugs have been tried and failed.

  This is not a hard and fast rule. There are valid reasons why a doctor may choose to prescribe it first. An individual child's response to these medications, as well as the occurrence of side effects, varies greatly from drug to drug.

• Not all the anti-OCD drugs have the Food and Drug Administration (FDA) approval for use in children and adolescents. Presently, four anti-OCD medications have been approved by the FDA for use in children. They are clomipramine (Anafranil ®), fluoxetine (Prozac ®), fluvoxamine (Luvox ®) and sertraline (Zoloft ®). The FDA grants this approval when large studies have been completed using pediatric patients. These large studies are very expensive and difficult to accomplish. They have not been conducted with all the anti-OCD medications. Doctors still prescribe any of the seven available medications to children of any age they deem appropriate. Most physicians prefer to use medication the FDA has specifically approved for use in children.

Let's take a closer look at each of the anti-OCD medications. Because each drug has two names, the first listed is the chemical name; the second, in (parentheses) is the brand name. Common pronunciation is in [brackets]. Each drug's customary dosing range for childhood OCD follows the drug names.

Clomipramine

Clomipramine [Clo-MIP'-raw-meen]
— (Anafranil ®) [An-AF'-rah-nil]
Customary dose range: 25 to 250 milligrams/day.

Clomipramine was the first anti-OCD medication to become widely available. It is the medication that has been most studied in children with OCD. Prior to its release in the United States, it was available for many years in Europe. It has the most long-term data of any of the drugs used to treat childhood OCD. Clomipramine affects the brain chemical serotonin. It also affects additional brain chemicals such as norepinephrine, histamine, acetylcholine, and dopamine. The effects on serotonin appear to be the most important in helping those with OCD. Clomipramine's effect on other brain chemicals may help to reduce OCD symptoms in particular children.

What Are Clomipramine'S Side Effects?

Clomipramine has a number of side effects, and most children will experience a few. The most common are sleepiness, dry mouth, or constipation. If children become excessively sleepy on clomipramine, the doctor will typically lower the dose. Often, the child's body adapts to this side effect and the sleepiness will lessen. Dry mouth can occur because clomipramine reduces the amount of saliva produced. A dry mouth is uncomfortable, but not medically dangerous. It, too, often diminishs in severity over time. If it doesn't, chewing sugarless gum to stimulate saliva production should make the child more comfortable. Dry mouth  becomes a problem if the child has orthodontic braces. The combination of reduced saliva production and braces leads to an increased rate of tooth decay. If clomipramine is started in a child with braces, the child's dentist should be informed. This is so they can watch more closely for tooth decay and try to prevent or correct it.

Parents can  prevent constipation from becoming a problem by being aware of the child's bowel habits. This is particularly true for younger children, who do not complain until several days have gone by without a bowel movement. A high-fiber diet, plenty of fluids, and regular exercise helps to prevent constipation. If constipation is a problem, parents should talk with the child's doctor. They may prescribe a stool-softening agent.

Clomipramine can cause irregular heartbeats, especially in children who have pre-existing heart abnormalities. Prior to starting a child on clomipramine, physicians should ask that the child have an electrocardiogram (ECG).  This is to ensure that the child's heart is beating normally. An ECG is a simple and painless test in which the heart's electrical activity is measured. The child's physician should order an ECG from time to time during clomipramine treatment. Especaily if a child is on a higher than usual dose, or if a child is experiencing heart-related side effects. The risk of clomipramine-related heart problems is very small, so most physicians believe that routinely obtaining ECGs is unnecessary.

Fluoxetine

Fluoxetine [Flu-OX-a-teen]
— (Prozac ®) / PRO-zak]
Customary dose range: 5 to 60 milligrams/day.

Fluoxetine was the first selective serotonin-reuptake inhibitor (SRIs) to be available in the United States. Drugs in this class of medications only affect the brain chemical serotonin. Although it is not specifically approved for use in treating childhood OCD, this drug is often prescribed to children with OCD. This is usually produces few side effects and many physicians are very comfortable prescribing it. It is also available in a liquid preparation. Sertraline has FDA approval for use in childhood OCD.

What Are Fluoxetine's Side Effects?

Most children take fluoxetine without experiencing any side effects. Occasionally, children develop an upset stomach, a rash, a headache, jitteriness, or insomnia. Fluoxetine can lead to changes in some children's behavior. Called behavioral side effects (BSEs),  are impulsive, silly, or defiant and aggressive behaviors (see description later in this guide). BSEs may be related to the dose of medication that the child is taking, as well as the child's age.

Fluvoxamine

Fluvoxamine [Flu-VOX-a-meen]
— (Luvox ®) [LU-vox]
Customary dose range: 25 to 250 milligrams/day.

Fluvoxamine is another of the selective SRI medications, similar to citalopram, escitalopram, fluoxetine, paroxetine, and sertraline. It acts specifically on serotonin, and has very limited effects on any of the other brain neurochemicals.

Fluvoxamine was the first selective SRI to receive FDA approval for use in children (down to age 8). This drug was available in Canada and Europe for many years prior to becoming available for use in the United States. Fluvoxamine has a long track record of safety for children.

What Are Fluvoxamine's Side Effects?

Most children can take fluvoxamine without  bothersome side effects. Still side effects can occur. The side effects reported in a recent study of childhood OCD include sleepiness insomnia, tremor, nervousness, and upset stomach. Fluvoxamine can lead to BSEs (see description later in this guide).

Sertraline

Sertraline [SIR-traw-leen]
— (Zoloft ®) [ZO-loft]
Customary dose range: 50 to 150 milligrams/day.

Sertraline is also a selective SRI medication, similar in many ways to citalopram, escitalopram, fluoxetine, fluvoxamine, and paroxetine. Sertraline acts specifically on serotonin, and has little if any effects on other brain chemicals. Sertraline has been used in studies specifically designed to research its safety and effectiveness in children with OCD. Sertraline has FDA approval for use in childhood OCD.

What Are Sertraline's Side Effects?

Most children take sertraline without experiencing side effects. However, side effects can occur. These are nervousness, upset stomach, or insomnia.

Fluvoxamine can lead to BSEs (see description later in this guide).

Paroxetine

Paroxetine [Paw-ROX-uh-teen]
— (Paxil ®) [PACKS-il]
Customary dose range: 10 to 30 milligrams/day.

Paroxetine is another selective SRI medications, similar to citalopram, escitalopram, fluoxetine, fluvoxamine, and sertraline.

Paroxetine has been effective for OCD in adults, but it has not been systematically studied in children with the disorder.

What Are Paroxetine's Side Effects?

There is scant information about paroxetine's side effects in childhood OCD. In adults with OCD, paroxetine's side effects are similar to those of the other selective SRIs. This drug may be more likely to lead to dizziness and unsteadiness if the drug is abruptly stopped, which may be due to the drug's short half-life.

Citalopram

Citalopram [CIT-TAL-O-PRAM]
— (Celexa ®) [CELL-X-A]
Customary dose range: 20 to 60 milligrams/day.

Based on clinical research performed mainly in Europe, Celexa has proven to be useful for many psychiatric conditions. This includes depression (major depression, post-stroke dep, bipolar depression, etc), OCD, and panic disorder. In open label trials, Celexa showed promise in treating disorders such as social phobia, trichotillomania, and premenstrual dysphoric disorder. Many new research initiatives will occur. Celexa only has an FDA approved indication for depression. Celexa is available in liquid form.

Based on European and now US anecdotal responses and clinical trial information, Celexa is very well tolerated. Side effects of  nausea, dry mouth, somnolence, and ejaculatory delay are documented as commonly observed. The FDA determined definition of a commonly observed side effect is an incidence of greater than 5%. These side effects, from clinical experience, are normally mild and transient. They dissipate usually  after several weeks.

Drug Interactions: Due to low protein binding and minimal to no activity at the cytochrome P-450 enzyme system there is little potential for clinically significant drug interactions.

What Are Citalopram's Side Effects?

The most frequent side effects reported with Citalopram (Celexa) are nausea, dry mouth, drowsiness, insomnia, increased sweating, tremor, diarrhea and problems with ejaculation. People taking Citalopram (Celexa) generally do not suffer from insomnia, agitation, nervousness, or anxiety. There have been no reports of any significant change in weight when taking this drug.

There have been a few European studies of citalopram in pediatric/adolescent populations, that demonstrate effectiveness for obsessive-compulsive disorder.

Important Note: Forest Laboratories does not make any claims to the effectiveness or safety of using Celexa to treat OCD as this medication is not indicated by the FDA to treat any OCD condition.

Escitalopram

Escitalopram [EEE-CIT-TAL-O-PRAM]
— (Lexapro ®) [LEX-A-PRO]
Customary dose range: 10 to 20 milligrams/day.

Lexapro is the most recently developed selective serotonin reuptake inhibitor. It is very closely related to Celexa, which is made up of a mixture of "mirror image" molecules. Lexapro consists of only one (the "s" form) of these Celexa molecules and has similar effectiveness and side effects. Lexapro has been found to be effective in social phobia, generalized anxiety disorder, panic disorder and anxiety symptoms associated with major depression. No studies have been published on the use of Lexapro for obsessive-compulsive disorder, or on use in children.

What Are Escitalopram's Side Effects?

Side effects of Lexapro are similar to those reported for the other selective serotonin reuptake inhibitors (described above).

Is It Possible To Treat Childhood OCD Without Using Medication?

Sometimes. Drugs are not the only treatment for OCD. Cognitive-behavioral therapy (CBT), has been shown to be effective. The cognitive-therapy component of CBT helps by challenging the catastrophic thinking and exaggerated sense of responsibility often seen in children with OCD.  A child may believe that taking his temperature many times per day prevents him and others from getting sick and dying. Cognitive therapy helps him to challenge the faulty assumptions behind this compulsion.

The behavioral component of CBT exposes the child to real-life things that  typically leads to a compulsive ritual.  A child who repeatedly takes his temperature would be encouraged to be around people he thinks are ill then the child is encouraged to refrain from taking his temperature. By being exposed to "ill" people, and not taking his temperature, the child learns from experience that the feared outcome of becoming sick and dying doesn't occur.

Children who don't respond adequately to cognitive-behavioral therapy alone, may find a combination of cognitive-behavioral therapy and medication helpful.

Are There Delayed Side Effects From Anti-OCD Medication?

Probably not, although no one knows for certain. There is no reason to expect long-term problems to develop. Most of these medications haven't been around long enough to answer this question with complete assurance. Clomipramine has been in use the longest (about 30 years). It has delayed side effects reported of gradual weight gain in some individuals. Fluoxetine and fluvoxamine have been in widespread use for more than 10 years primarily in Europe and Canada. The delayed problems have not been reported. Sertraline, paroxetine, citalopram and escitalopram have not been available as long. The delayed side effects have not been reported with these medications either.

Which Anti-OCD Medication Should Be Tried First?

A child's response to each of the anti-OCD medications varies. Some children will respond to all of them, some will respond to only one, and some respond to none at all. Side effects vary from child to child, there is no "best" drug to start with. The decision of which drug to use first is made on a case-by-case basis. There are some considerations that guide physician decision-making regarding the selection of medication. These include:

• Whether there was a positive response to a particular drug by other family members.
• The presence of other problems besides OCD (i.e., clomipramine may help a child with insomnia get to sleep).
• The potential for side effects (i.e., clomipramine's potential to cause constipation).
• The physician's prior successes or experience with a particular drug.
• Concerns about the child attempting suicide via an overdose.
• The cost or availability of the drug (i.e., some health-care providers only allow their pharmacies to dispense a particular anti-OCD drug).
• The FDA approval status of the drug (presently favors clomipramine, fluoxetine, fluvoxamine, and sertraline)

What Should Be Done If The First Medication Tried Doesn't Seem To Work?

When this happens, several things should be considered:

• Has enough time passed? All anti-OCD medications take time to work. If the child has been taking the medication less than 8 weeks, the best course may be simply to do nothing but wait until at least 12 weeks have passed that is assuming that the child has been taking an adequate dose.
• Is the child actually taking the medication? A common saying among physicians is, "Half of the patients take half of the medication, half of the time." An anti-OCD medication will not work if it is not taken. This is a problem for adolescents who may be busy distracted, or ambivalent about taking medication.
• Is the dose appropriate? The best dose of anti-OCD medication varies widely from child to child. If there has been no benefit and no side effects a dose increase may help. Childhood OCD uses the same doses of medication used to treat adult OCD. However, "going low and slow" in regard to drug treatment is always a prudent maxim to follow.
• Is a cognitive-behavioral therapy program in place? A few children will feel better but continue to perform their OCD compulsions out of habit. It is as though they are better, but don't know it. The behavioral-therapy component of cognitive-behavioral therapy helps  the child experience the fact that they are better. It helps them to realize that they need not perform these rituals.

Sometimes, after all of the above considerations have been explored, the first medication chosen does not work. A trial of one of the other anti-OCD medications is often a reasonable choice.  This process may need to be repeated once or twice before a satisfactory anti-OCD response is achieved.

Is It Important To Obtain Blood Levels Of anti-OCD Drugs?

Sometimes blood levels are useful. Clomipramine is unique among anti-OCD medications in that excessively high blood levels can be medically dangerous. Due to the danger of seizures or heart problems, many physicians obtain blood levels to ensure that the dose being used is resulting in blood levels that fall within a safe range. This ensures a margin of safety for children taking higher than usual doses of this medication.

Blood levels of other anti-OCD medications are only used in special circumstances.  If there is a suspicion that a teenager is not taking the medication, obtaining a blood level of the drug definitively answers this question. Blood levels are helpful when drug combinations being used, have unusual side effects.

What If My Child Won't Swallow Pills?

One approach would be to use the liquid preparation of fluoxetine or citalopram. It is also possible to have the pharmacist compound fluvoxamine.

Liquids are dispensed in small amounts the child can tolerate. This avoids the discomfort of taking pills. An alternative approach would be to crush a tablet between two spoons, or pull apart and empty a gelatin capsule. They can  be added to a spoonful of apple sauce or jelly.

Can Very Young Children (Under The Age Of 6) Take These Medications?

It is difficult to make the diagnosis of OCD in very young children. Because of this medications are rarely considered for this age group. OCD can be diagnosed in a very young child, and medication may be recommended. There is little information in the medical literature regarding the use of anti-OCD medications in preschool children. It should only be considered in situations where the child is experiencing significant disability and/or distress. These situations, warrant a second medical opinion. This is often helpful.

What Are Behavioral Side Effects (BSEs)?

These side effects occur with any of the anti-OCD drugs. They are characterized by a significant change in the child's behavior. Some parents have described their child as being "too happy" or "giddy." Some have said their child became "mouthy," impertinent, or provocative while taking an anti-OCD medication. Increased aggressiveness has been described. Some degree of BSE  probably occurs in 50 percent of children treated with anti-OCD medication. Most of the time, these side effects are mild and require no specific treatment. Occasionally they can be severe.

High anti-OCD medication doses or the age of the child may be contributing factors, so starting low and going slow when administering medication should always be a consideration.

If a marked behavioral change occurs that seems "out of character," BSEs should be considered. When treating BSEs, reducing the dose is usually the first step. If that is not helpful, switching to an alternative medication is another option. There is probably an increased likelihood that the new drug will cause BSEs. Sometimes, adding a medication to control the BSEs (such as lithium) may be the best alternative. This is only done if the OCD symptoms are much improved by the anti-OCD drug.

Will My Child Have To Take These Medications Forever?

Perhaps OCD is a chronic condition and anti-OCD medications do not typically "cure" it the child. They may need to take medication indefinitely. This is because when medication is withdrawn, the OCD symptoms usually return to their pre-drug level of severity.

Many physicians advocate that anti-OCD treatment should continue for at least one year.  After a year of treatment, often during summer vacation or at another time the dose of the drug can be slowly lowered to see if it is still being helpful. If OCD symptoms return, the dose is raised again. Lowering the dose on a yearly basis benefits the child in several ways:

• Assures the doctor, child, and parents that the drug is still needed.
• Adjusts the dose of medication to the lowest effective level.
• Prevents needless medication taking (occasionally OCD does go away).
• Allows the child the opportunity to see if cognitive-behavioral therapy techniques (without medication) will be effective if OCD symptoms recur.
• Minimizes the child's exposure to anti-OCD drugs.

The anti-OCD Drug Has Helped A Little, but My Child Still Has OCD Symptoms. What Should Be Done?

Perhaps nothing. These medications can take up to 12 weeks to become effective, and waiting is the best option. It is important to understand that these medications do not completely eliminate OCD symptoms. They reduce them to a manageable level.  These residual OCD symptoms are effectively controlled with cognitive-behavior therapy.

Do The SSRIS Have Withdrawal Effects?

On rare occasions, yes. Withdrawal adverse effects have been reported with nearly all the anti-OCD drugs. Especially when they are abruptly discontinued. This side effect seems to occur most often with paroxetine, the anti-OCD drug with the shortest half-life. Withdrawal symptoms are dizziness or unsteadiness, although unusual neurological symptoms have been reported on rare occasions.

Fluoxetine is the only SRI that has not been linked to adverse withdrawal effects. This is because this drug's long half-life makes it self-tapering. Even if the drug is stopped abruptly, the blood levels fall gradually over weeks to months.

Are These Drugs Dangerous In Overdose?

Yes, although clomipramine is the most dangerous. Any medication overdose should be viewed as a medical emergency. The child should be taken to an emergency room without delay. With proper treatment, complete recovery is the rule, although clomipramine overdoses can result in seizures, cardiac arrest, and even death. To avoid overdose, medications should always be kept safely out of the reach of small children, and an adult should always supervise the medication taken  by a child.

Combining Other Drugs With SRIS Prescription Drug

As many as 40 to 60 percent of those treated with one anti-OCD drug will have residual symptoms. In some instances, these remaining symptoms can be severe, despite trying several of the available medications along with cognitive-behavioral therapy. Drug combinations are sometimes tried called augmentation. The use of such medication combinations is only modestly researched in the treatment of adult OCD. There is essentially no research on this practice for the treatment of childhood OCD. When augmentation strategies are used in the treatment of childhood OCD, they are based primarily on the clinical experience of the child's doctor, and on applying to childhood OCD what is known about the treatment of treatment- resistant OCD in adults.

The use of medication augmentation is the exception rather than the rule. There are a number of circumstances in which this becomes a consideration. These include:

• An unsatisfactory response to numerous single-drug treatments.
• The presence of significant symptoms that are due to other disorder(s) in addition to OCD.
• Treating the bothersome side effects from an anti-OCD medication While it is impossible to list all the possible medication combinations, a few of the more commonly used are listed below:
  • Adding clonazepam (Klonopin®) or buspirone (BuSpar®) to treat severe anxiety.
  • Adding methylphenidate (Ritalin®) to treat symptoms of ADHD.
  • Adding a major tranquilizer, such as Haloperidol (Haldol®), to treat tic symptoms, Tourette's syndrome, or psychosis.
  • Adding lithium carbonate to treat severe mood instability.
  • Combining clomipramine with an SRI to achieve a synergistic drug effect at lower than usual doses of each In addition to the drug augmentation strategies used to treat OCD, medication combinations are often necessary when treating additional illnesses children develop such as rashes, the flu, ear infections, etc.

Combining anti-OCD medication with a drug used to treat a childhood illness is called adjunctive medication treatment. Sometimes these drugs can interact with anti-OCD drugs.

It is usually OK to treat children with OCD that have an occasional headache with acetaminophen (Tylenol®). Other medications may contain ingredients that interact adversely with anti-OCD drugs. A complete list of medications that can interact with anti-OCD medications is impossible to list in a pamphlet of this size. It is always best to consult with the doctor or pharmacist before combining medications. The following is a list of some of the common ingredients found in many medications that are known to interact with anti-OCD medications:

• Caffeine (Interaction primarily with Fluvoxamine [Luvox®]: Probably OK with other anti-OCD medications), and can lead to sweating, nervousness, trembling, and insomnia.
• Dextromethorphan: Can lead to extreme anxiety, chest, and abdominal discomfort.
• Phenylpropanolamine: Can lead to extreme nervousness.

It is important to be aware that combining medications of any kind including over-the-counter ones can complicate the treatment of OCD.

If unanticipated side effects occur, it can be difficult to determine which of the medications is the culprit. All of the physicians involved in the health care of the child should be made aware of all the medications the child is taking. This includes psychiatric medications, but also asthma medications, antibiotics, over-the-counter cough medicines, anti-acne medications, and all others.

OCD symptoms are often a significant problem for children treated with single anti-OCD medications. Because the symptoms of comorbid psychiatric disorders or additional illnesses can be significant problems, drug combinations are sometimes required when treating children with OCD. The use of medication combinations is not well researched in children.  It is difficult to make specific recommendations on the use of medication combinations.  The decision to use them should be determined on a case-by-case basis in collaboration with a physician familiar with the treatment of childhood OCD.

Acknowledgment

This information was compiled by J. Jay Fruehling, M.A., Information Specialist and The Child Psychopharmacology Information Service University of Wisconsin-Madison, Department of Psychiatry [http://www.psychiatry.wisc.edu] It was edited by Hugh F. Johnston, M.D., University of Wisconsin, Madison and John S. March, M.D., Duke University, Durham, North Carolina. It was revised by S. Evelyn Stewart, M.D., Department of Children and Adolescents' Psychiatry, Massachusetts General Hospital. It was funded in part by donations from the Daphne Seybold Culpepper Memorial Fund, Ticking Hearts, Mr. and Mrs. Irwin Lancer, The Andrade family, Meryl and Christoper Lewis, Annoymous, Robert Selig, and Stephen Josephson, Ph.D.

This information was commissioned by the Obsessive-Compulsive Foundation (OCF). It is as a service for children with Obsessive-Compulsive Disorder (OCD) and for those who care for them. Its purpose is to provide concise information about the drug treatment of childhood OCD, and to deliver answers to many of the frequently asked questions about this treatment.

The views expressed represent the opinions of the author.  The opinions are based on the medical literature as well as the clinical experience of Drs. March and Johnston. Each child is unique and because OCD can manifest itself in many different ways,. Therefore it is difficult to make blanket recommendations regarding the medication treatment of childhood OCD.

The goal of this information is to provide drug treatment information and recommendations. It is not a blueprint for treatment. This information is best utilized in fostering effective communication and collaboration with a doctor familiar with the diagnosis and treatment of childhood OCD.