background   Obsessive-compulsive disorder is relatively infrequent in children and adolescents. However, the disorder can be extremely disabling, interfering with every level and type of functioning and with family life.
aim   Although little research has been done into the aetiology and treatment of obsessive-compulsive disorder in children and adolescents, the results are relevant for clinicians. Therefore, an overview is given of recent research into the epidemiology, aetiology and treatment of obsessive-compulsive disorder in children and adolescents.
method   We compiled this article on the basis of a literature search for which we used PubMed (1995-2004), PsychLit and the Cochrane Library.
results   The incidence of obsessive-compulsive disorder in children up to 18 years is between 0.06% and 2%. Familial factors and heredity are important factors in the aetiology. So far, very few research is done into the applicability of the psychological and biological models to the disorder in children. Both in adults and in children hyperactivity has been identified in the cortico-striatal-thalamic circuit. Evidence-based treatment consists of cognitive-behavioural therapy with or without medication (selective serotonin reuptake inhibitors or clomipramine). A mean improvement of about 60% with cognitive-behavioural therapy; selective serotonin reuptake inhibitors have a significant but slight effect compared to placebos. The combination of cognitive-behavioural therapy and a selective serotonin reuptake inhibitor has a slight effect but this effect is significantly larger that that of cognitive-behavioural therapy alone. There is a substantial number of non-responders (15-40%).
conclusion Cognitive-behavioural therapy and pharmacotherapy (such as selective serotonin reuptake inhibitors) are effective in the treatment of obsessive-compulsive disorder in children and adolescents. Research needs to be done into the treatment of non-responders. Investigations into explanatory models are important for the development of improved treatment strategies. So far, however, such investigations have yielded very little useful information.