Long-term outcome of pediatric obsessive-compulsive disorder: a meta-analysis and quantitative review of the literature.
Stewart SE, Geller DA, Jenike M, Pauls D, Shaw D, Mullin B and Faraone SV;
Commented by , 28 Jul 2004
Aims of the study
To review the current literature on the long-term outcome of obsessive-compulsive disorder (OCD) with an onset during childhood or adolescence.
Method
Two databases (Medline and Psychlit) were searched for long-term follow-up studies of OCD, with an onset during childhood or adolescence. The primary outcome measure was "percent full OCD at follow-up" and the secondary outcome measure "percent of any (i.e. either full or sub threshold) OCD at follow-up".
Results
The search did not find any previous systematic review or meta-analysis on the long-term outcome of pediatric or adolescent OCD. It identified 16 outcome studies in all (11 retrospective, 5 prospective), including a total of 521 subjects. The 16 studies varied in length of follow-up (from 1 to 15 .6 years), study design, diagnostic criteria, and psychometric measures. Potential predictors (e.g. comorbid disorders) and mediators (e.g. treatment interventions) of outcome were reported in only 11 studies, and varied across studies.
The overall pooled rates at follow-up were 0.41 for persistent full OCD and 0.60 for any OCD. Poor initial treatment response, and comorbid tic or mood disorder, were identified as predictors of poor outcome.
Discussion
OCD is a prevalent disorder in children and adolescents. It is associated with high morbidity and functional impairment in this age group, and may interfere with normal development, educational achievement and professional orientation. As such, it is of utmost importance not only for clinicians, caretakers, and health care providers, but also for individuals with OCD themselves, to have precise empirical data concerning the natural course, response to treatment, and long-term outcome of the disorder.
According to DSM-IV-TR, "OCD may begin in childhood, although it usually begins in adolescence or early adulthood", and "the majority of individuals with OCD have a chronic waxing and waning course". The results of the meta-analysis performed by Stewart and all suggests that OCD with onset in childhood or adolescence may in fact be less persistent and pervasive over time than assumed in DSM-IV-TR, since less than half of the subjects followed over the years still had full OCD as adults.
The meta-analysis and review of the literature has a number of limitations. As pointed out by the authors themselves, follow-up studies of pediatric OCD are scarce. In addition, several candidate predictor variables were reported so inconsistently as to make conclusions regarding their importance difficult.
In spite of these limitations, the results of the investigation represent a major contribution to the current knowledge on the long-term outcome of pediatric OCD. In particular, they suggest that a significant proportion of children and adolescents will recover from their OCD before reaching adulthood, either spontaneously or in response to pharmaceutical and/or psychotherapeutical treatment.
Additional well-designed prospective investigations are however needed to elucidate the natural course, treatment reponse over time, and overall long-term outcome of OCD in children and adolescents.