title: [Severe early-childhood obsessive-compulsive disorder--case report on a 4-year-old girl].
abstract: OBJECTIVE
  OCD is seldom diagnosed in children younger than six years of age. The present report deals with the diagnosis and therapy of OCD at a very early onset in childhood.
  
  
  METHODS
  Reported is the case of a 4-year-old girl who was affected by severe compulsive behaviour, with marked impairment of her familial and extra-domestic social activities, including an inability to attend kindergarten.
  
  
  RESULTS
  The girl was affected to an extreme extent by compulsive symptoms pertaining to symmetry and order, and suffered from severe psychological strain. Her symptoms improved markedly following behaviour therapy in an inpatient setting. Adjuvant medication was not necessary. Her parents were counselled intensively and included in the therapeutic process. She was able to return to her family, resuming activities appropriate for a child her age, and to attend kindergarten.
  
  
  CONCLUSIONS
  OCD can develop in a child as early as at the age of four. For diagnostic procedure in cases of "very early onset", OCD criteria described by ICD-10 and DSM-IV can be applied. Behaviour therapy was effective even in this case of early manifestation of OCD. Particularly important is the inclusion of the parents in the therapeutic process.
authors.affiliation: Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie der Universität Würzburg. renner@kjp.uni-wuerzburg.de
authors.forename: Renner
authors.initials: R
authors.lastname: Tobias
authors.forename: Susanne
authors.initials: S
authors.lastname: Walitza
mesh_terms: D001521:Behavior Therapy; D002675:Child, Preschool; D003131:Combined Modality Therapy; D004493:Education; D005196:Family Therapy; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D007389:Internal-External Control; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy; D010287:Parent-Child Relations; D016896:Treatment Outcome