Childhood obsessive compulsive disorder.

Childhood obsessive compulsive disorder has recently been recognized as being more common than previously believed, supporting epidemiologic studies in adults that found rates far higher than clinical studies have suggested. Clinically, presentation is generally similar to that for adult patients, but compulsions may occur in the absence of obsessions although both obsessions and compulsions are common. Symptoms typically change over time, but almost all subjects at some time experienced excess washing as one of their symptoms. There is an increased rate of obsessive compulsive disorder and of motor tics in the relatives of children with obsessive compulsive disorder. As with Tourette's disorder, partial voluntary control of symptoms is usual. Prospective follow-up studies show continued disability from obsessive compulsive disorder and continued comorbidity with affective disorders. Obsessive compulsive symptoms are selectively associated with several childhood onset neurologic disorders such as Tourette's disorder and Sydenham's chorea, both presumed to be basal ganglia disorders. The implication of this association is that there may be hard-wired complex behaviors subsumed by basal ganglia frontal cortical pathways that are inappropriately released in obsessive compulsive disorder.