OCD Assessment Scale for a 14-Year-Old Male
For a 14-year-old male with OCD, use the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS) or its updated version, the CY-BOCS-II. 1, 2
Primary Recommendation: CY-BOCS or CY-BOCS-II
The CY-BOCS is the gold-standard instrument for assessing OCD symptom severity in children and adolescents aged 8-18 years, making it the appropriate choice for this 14-year-old patient. 3, 4, 5
Key Features of the CY-BOCS:
- Scoring range: 0-40 points total, with 10 items each rated 0 (no symptoms) to 4 (extreme symptoms) 1, 2
- Two subscales: Obsessions (0-20 points) and Compulsions (0-20 points) 1
- Severity classification:
Psychometric Properties:
The CY-BOCS demonstrates excellent reliability and validity in adolescents:
- Internal consistency: α = 0.87 for the 10-item scale 4
- Interrater reliability: Intraclass correlation of 0.84 for total scores 4
- Convergent validity: Strong correlation (r = 0.62) with self-report OCD measures 4
The newer CY-BOCS-II shows even stronger psychometric properties with internal consistency of α = 0.75-0.88 and excellent inter-rater reliability (ICC = 0.86-0.92). 7
Administration Format Options
You can use either clinician-rated or self-report formats, depending on clinical context:
- Clinician-rated CY-BOCS: The traditional gold-standard format 4, 5
- Child self-report (CY-BOCS-CR): Demonstrates satisfactory reliability and validity for ages 8-17 years 8
- Parent-report (CY-BOCS-PR): Also shows satisfactory psychometric properties 8
For a 14-year-old, all three formats are appropriate, though the clinician-rated version remains the most validated. 8, 4
Critical Assessment Considerations
What the Scale Measures:
The CY-BOCS quantifies severity based on three parameters:
- Time spent on obsessions and compulsions 1, 2
- Distress levels experienced 1
- Functional interference in daily activities 1
Important Clinical Pitfalls to Avoid:
Avoidance behaviors can artificially lower scores: Patients who extensively avoid OCD triggers may spend less time on active rituals, leading to underestimation of true symptom severity despite significant functional impairment. 1, 2
Family accommodation must be assessed separately: Family members may provide reassurance or participate in rituals, which affects the accuracy of interference ratings on the CY-BOCS. 1, 2 This should be evaluated alongside the CY-BOCS administration, not as part of it.
Integration of multiple informants: Reliability can be influenced by discrepancies between parent and child reports, particularly in this age group. 4 The clinician must use clinical judgment to reconcile different perspectives.
Practical Administration Notes
- The CY-BOCS requires clinician training to recognize nuanced OCD presentations and ensure accurate scoring 2
- The scale is content-independent, meaning it measures severity regardless of specific obsession/compulsion themes, but thorough clinical assessment of symptom content must accompany administration 2
- For treatment monitoring, a ≥35% reduction from baseline CY-BOCS scores indicates clinically meaningful improvement 2