The obsessive-compulsive disorder has only recently been recognized as a specific pathological entity in children, despite the fact that the first descriptions of pediatric manifestations date back to the beginning of this century (P. Janet, 1903) with further reports having been published regularly since that time. The first assessment of the complete epidemiologic, clinical and functional repercussions of the obsessive-compulsive disorder was reported by the Pediatric Psychiatric Group of the NIMH (Pr Judith Rapoport); of their various publications, one is well known in France : The Child who Couldn't Stop Washing (17). Among possible reasons for this delayed recognition are the special conditions for diagnosis and the frequent underestimation of its importance by the family, and sometimes by doctors. This underassessment could be due to confusion between the normal developmental rituals which are frequently seen between the ages of 3 and 5 years, and which do not cause any particular handicaps, and a more severe symptomatology which interferes with normal academic and social adaptation, presenting a substantially worse long-term prognosis. Having recognized the disorder, questions have arisen as to its possible linkage with the form seen in adults. There are numerous convergent arguments suggesting a certain long-term persistence of this disorder throughout development and later life : 1) the relative stability of the incidence and prevalence of the disorder; 2) phenomenologic and developmental similarities; 3) most recently, comparable efficacy of treatments for pediatric and adult obsessive-compulsive disorder, whether by the behavioral modification approaches or by pharmacologic treatment, notably with the serotonine re-uptake inhibitors (clomipramine, fluoxetine, fluvoxamine). There are certain particular aspects which should be noted: 1) Diagnostic problems specific for children The perception of the morbid nature of the manifestations in children can vary widely, in part as a function of the stage in development. The awareness of the disorder frequently leads to a feeling of shame, of << being abnormal >> and an attempt to hide the resultant suffering. Non-recognition of the disorder can account for the high frequency of non-specific behavioral manifestations (sometimes the main symptom) such as agitation or aggressiveness. In view of these difficulties, if is important that obsessive-compulsive symptomatology be carefully evaluated, and symptomatic inventories or evaluation scales can be quite useful. 2) Concurrent psychiatric disorders The obsessive-compulsive disorder is frequently seen in conjunction with other psychiatric manifestations such as anxiety which is present in the more specifically pediatric disorders, such as separation anxiety. Specificity of this clustering is still open to discussion, and there may be difficulty in differentiating between true comorbidity and the direct effects of the obsessive-compulsive disorder in the child. There is a particular correlation with chronic motor tics and Gilles de la Tourette syndrome in this age group. Prospective epidemiologic studies and the observation of familial clustering suggest that this correlation is not due to chance alone, and indeed, if is necessary to address the problem of a possible continuum between tic, compulsion and obsession in view of the existence of borderline forms. It is possible that subgroups differing in terms of disease progression and treatment response could be differentiated by the presence or absence of tics. Similarly, although current reports support a different treatment approach to obsessive-compulsive disorder and Gilles de la Tourette syndrome, there is data suggesting the existence of common neurobiological disorders in both of these syndromes. The most recent data will require confirmation in well-conducted therapeutic trials.
