What is the best screening tool for Obsessive-Compulsive Disorder (OCD) in children?

The Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) is the Best OCD Screening Tool for Children

The Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) is the most reliable and valid screening instrument for obsessive-compulsive disorder in children. 1

Evidence Supporting CY-BOCS

• The CY-BOCS is a semi-structured measure specifically designed to assess obsessive-compulsive symptom severity in children and adolescents with OCD 1
• It demonstrates high internal consistency (0.87 for the 10 items) and excellent interrater reliability with intraclass correlations of 0.84 for the total score 1
• The CY-BOCS shows strong convergent validity with self-reported obsessive-compulsive symptoms (r = 0.62) and good discriminant validity when compared to measures of depression (r = 0.34) and anxiety (r = 0.37) 1
• The 10-item CY-BOCS total score provides a reliable and valid assessment of symptom severity in early childhood OCD, even in children as young as 5-8 years of age 2

Key Features and Clinical Application

• The CY-BOCS measures OCD symptom severity independent of the specific content of obsessions or compulsions, making it applicable across various OCD presentations 3
• It effectively captures time spent on obsessions, distress levels, and interference with daily functioning, which are key determinants of clinical significance 3
• The scale helps differentiate OCD from normal concerns by quantifying the obsessional quality, time consumption, and functional impairment of symptoms 3
• Regular administration during treatment allows for objective tracking of symptom changes, with decreases in scores indicating treatment response 3

Age-Specific Considerations

• For children aged 8-17 years, the standard CY-BOCS demonstrates excellent reliability and validity 1
• For younger children (5-8 years), the 10-item CY-BOCS total score remains reliable and valid, though the Obsessions subscale alone should be used with caution in this age group 2
• The reliability and validity of the CY-BOCS appear to be influenced by the age of the child and the integration of data from parental and patient sources 1

Alternative Formats

• Child-report (CY-BOCS-CR) and parent-report (CY-BOCS-PR) versions have been developed with satisfactory reliability and validity 4
• These alternative formats can be easily administered to patients and parents when clinician administration is not feasible 4
• The psychometric properties of the child-report version may be lower in children with comorbid externalizing behavior problems 4

Dimensional Assessment

• A briefer, interview-only version of the Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS) has demonstrated high internal consistency and moderate to strong correlations with alternative measures of OCD severity 5
• This version is sensitive to treatment effects and may be more practical for routine clinical care 5

Factor Structure and Potential Limitations

• Research has identified two potential factor structures for the CY-BOCS: obsessions/compulsions or severity/disturbance 6
• Items assessing resistance to obsessions and compulsions may provide less reliable evaluations in children with OCD 6
• Family accommodation assessment should accompany CY-BOCS administration, as family members may inadvertently reinforce symptoms through reassurance-giving 3

Clinical Implementation

• The CY-BOCS should be administered by clinicians trained in recognizing the nuanced presentation of OCD in children to ensure accurate scoring and interpretation 3
• For treatment monitoring, clinicians should establish clear symptom reduction targets (typically a 35% or greater reduction is considered clinically meaningful) 3
• The American Academy of Child and Adolescent Psychiatry recommends using standardized assessment tools like the CY-BOCS to guide treatment decisions for pediatric OCD 7