Date of Award

9-21-2009

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

First Advisor

James Leckman, MD

Abstract

This study was conducted in order to determine childhood clinical predictors of early adult outcome in pediatric-onset obsessive-compulsive disorder (OCD). We specifically hypothesized that OCD symptom dimensions and comorbid tic disorders would be associated with persistence of obsessive-compulsive (OC) symptoms into early adulthood. The study followed a longitudinal cohort design in which 45 of 61 eligible children with OCD were reassessed in early adulthood an average of 9 years following a baseline childhood assessment. Main outcome measures included expert-rated OC symptom severity and time to remission of OC symptoms. Baseline clinical characteristics were evaluated in terms of their impact on early adulthood OC symptom severity and time to remission of OC symptoms. Forty-four percent of subjects were determined to have subclinical OC symptoms at follow-up. Absence of a comorbid tic disorder and presence of prominent hoarding symptoms were associated with OC symptom persistence. In our best-fitting multivariate Cox Proportional Hazard model female gender, younger age at childhood baseline assessment, older age of OCD onset, more severe childhood OC symptoms, and comorbid oppositional defiant disorder were also independently associated with persistence of OC symptoms into early adulthood. Our results suggest that a significant proportion of patients with pediatric-onset OCD will remit by early adulthood. The presence of comorbid tics was associated with a favorable outcome, while primary hoarding symptoms were associated with persistent OCD.

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