What is the Children’s Yale‑Brown Obsessive‑Compulsive Scale, second edition (CY‑BOCS‑II), how is it scored, what do the total scores indicate, and what treatment is recommended based on the score?

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CY-BOCS-II Rating Scale Overview

The Children's Yale-Brown Obsessive-Compulsive Scale, Second Edition (CY-BOCS-II) is a 10-item clinician-rated instrument that quantifies OCD symptom severity in youth aged 5-18 years, with scores ranging from 0-40, and treatment recommendations based on severity thresholds: mild OCD (8-15) warrants cognitive-behavioral therapy, moderate OCD (16-23) requires CBT with consideration of medication, severe OCD (24-31) necessitates combined CBT and pharmacotherapy, and treatment-refractory OCD (≥28) indicates need for intensified or alternative therapeutic strategies. 1, 2

Scale Structure and Administration

  • The CY-BOCS-II contains 10 items total: 5 items assessing obsessions and 5 items assessing compulsions, with each item rated from 0 (no symptoms) to 4 (extreme symptoms). 1, 2

  • The scale was modified from the original CY-BOCS by removing one item and adding a new item (item 4), allowing clinicians to generate both original CY-BOCS and CY-BOCS-II scores in a single administration through back-coding. 1

  • The instrument quantifies severity across three key parameters: (a) time spent on obsessions/compulsions, (b) level of distress experienced, and (c) degree of functional interference in daily activities. 1, 2

  • The CY-BOCS-II demonstrates excellent psychometric properties with internal consistency (α = 0.75-0.88), inter-rater reliability (ICC = 0.86-0.92), and test-retest reliability (ICC = 0.95-0.98). 3

Scoring Interpretation

Severity Classification:

  • 0-7 points = Subclinical symptoms (no significant OCD pathology) 1, 2

  • 8-15 points = Mild OCD (noticeable symptoms with minimal functional impairment) 1, 2

  • 16-23 points = Moderate OCD (clear symptoms with moderate functional impairment) 1, 2

  • 24-31 points = Severe OCD (marked symptoms with substantial functional impairment) 1, 2

  • ≥28 points = Treatment-refractory OCD threshold (indicates severe, resistant disease requiring intensified intervention) 1, 2

Critical Assessment Pitfalls

  • Extensive avoidance behaviors can artificially lower CY-BOCS-II scores because patients who avoid triggering situations spend less observable time on active obsessions/compulsions despite severe functional impairment, leading to underestimation of true severity. 1, 2

  • Failure to evaluate family accommodation (such as parental reassurance-giving or participation in rituals) will bias interference ratings downward and cause underestimation of symptom severity. 1, 2

  • Clinicians must apply professional judgment when using this content-independent scale to correctly categorize obsessive-compulsive symptoms and differentiate them from other intrusive-thought disorders (e.g., generalized anxiety, PTSD intrusions, autism-related repetitive behaviors). 1

Treatment Recommendations Based on Score

Mild OCD (8-15):

  • Initiate cognitive-behavioral therapy with exposure and response prevention (ERP) as first-line treatment. 2

Moderate OCD (16-23):

  • Begin CBT with ERP as primary intervention. 2
  • Consider adding selective serotonin reuptake inhibitor (SSRI) pharmacotherapy if CBT alone produces insufficient response after 8-12 weeks. 4

Severe OCD (24-31):

  • Implement combined treatment with both CBT/ERP and SSRI pharmacotherapy from the outset. 4
  • For autism spectrum disorder patients with comorbid OCD, pharmacotherapy may target compulsive-like behaviors when CY-BOCS scores indicate moderate-to-severe symptoms. 4

Treatment-Refractory OCD (≥28):

  • A score of ≥28 identifies severe, treatment-refractory OCD in youth aged 8-18 years, indicating the need for intensified or alternative therapeutic strategies. 1, 2
  • Consider augmentation strategies, intensive outpatient or residential OCD programs, or alternative medication trials beyond first-line SSRIs. 1, 2

Treatment Response Monitoring

  • A clinically meaningful treatment response is defined as ≥35% reduction from baseline CY-BOCS-II scores. 1

  • The CY-BOCS-II is sensitive to change and can effectively track symptom reduction across various treatment modalities, including internet-based telepsychiatry interventions. 1

  • Serial administration allows objective monitoring of treatment efficacy and guides decisions about treatment intensification or modification. 3, 5

References

1
Guideline

Updated Guidance for the Children’s Yale‑Brown Obsessive‑Compulsive Scale (CY‑BOCS‑II)

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

2
Guideline

CY-BOCS Score Interpretation Guidelines

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

3
Research

Development and Psychometric Evaluation of the Children's Yale-Brown Obsessive-Compulsive Scale Second Edition.

Journal of the American Academy of Child and Adolescent Psychiatry, 2019

4
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

5
Research

Children's Yale-Brown Obsessive Compulsive Scale: reliability and validity.

Journal of the American Academy of Child and Adolescent Psychiatry, 1997

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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