title: Structure and clinical correlates of obsessive-compulsive symptoms in a large sample of children and adolescents: a factor analytic study across five nations.
abstract: The underlying structure of obsessive-compulsive disorder (OCD) remains to be confirmed in child and adolescent populations. In this paper we report the first factor analytic study of individual OCD items from Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS). OCD symptoms were assessed using the CY-BOCS symptom checklist in a sample of 854 patients with OCD (7-18 years of age) recruited from clinics in five countries. Pooled data were subjected to exploratory and confirmatory factor analysis (CFA) to identify the optimal factor structure. Various models were tested for age and gender subgroups. Also, the invariance of the solution across age and gender was tested and associations with demographic and clinical factors were explored. A three-factor model provided the best-fit solution. It consisted of the following factors: (1) harm/sexual, (2) symmetry/hoarding, (3) contamination/cleaning. The factor structure was invariant for age and gender across subgroups. Factor one was significantly correlated with anxiety, and factor two with depression and anxiety. Factor three was negatively correlated with tic disorder and attention-deficit/hyperactivity disorder (ADHD). Females had higher scores on factor two than males. The OCD symptom structure in children and adolescents is consistent across age and gender and similar to results from recent child and adolescents although hoarding may not be a separate factor. Our three-factor structure is almost identical to that seen in early studies on adults. Common mental disorders had specific patterns of associations with the different factors.
authors.affiliation: Center for Child and Adolescent Psychiatry, Aarhus University Hospital Risskov, Risskov, Denmark. davmar@rm.dk.
authors.forename: D R M A
authors.initials: DR
authors.lastname: Højgaard
authors.affiliation: Department of Public Health and Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark.
authors.forename: E L
authors.initials: EL
authors.lastname: Mortensen
authors.affiliation: The Center for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP), Oslo, Norway.
authors.forename: T
authors.initials: T
authors.lastname: Ivarsson
authors.affiliation: Center for Child and Adolescent Psychiatry, Aarhus University Hospital Risskov, Risskov, Denmark.
authors.forename: K
authors.initials: K
authors.lastname: Hybel
authors.affiliation: The Center for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP), Oslo, Norway.
authors.forename: G
authors.initials: G
authors.lastname: Skarphedinsson
authors.affiliation: Center for Child and Adolescent Psychiatry, Aarhus University Hospital Risskov, Risskov, Denmark.
authors.forename: J B
authors.initials: JB
authors.lastname: Nissen
authors.affiliation: Regional Centre for Child and Youth Mental Health and Child Welfare, Central Norway, Trondheim, Norway.|Department of Child and Adolescent Psychiatry, Hospital of Aalesund, Aalesund, Norway.
authors.forename: R
authors.initials: R
authors.lastname: Valderhaug
authors.affiliation: The Center for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP), Oslo, Norway.
authors.forename: K
authors.initials: K
authors.lastname: Dahl
authors.affiliation: Regional Centre for Child and Youth Mental Health and Child Welfare, Central Norway, Trondheim, Norway.|Department of Child and Adolescent Psychiatry, St. Olavs Hospital, Trondheim, Norway.
authors.forename: B
authors.initials: B
authors.lastname: Weidle
authors.affiliation: The Center for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP), Oslo, Norway.|Department of Child and Adolescent Psychiatry, Division of Mental Health and Addiction, Vestre Viken Hospital, Drammen, Norway.
authors.forename: N C
authors.initials: NC
authors.lastname: Torp
authors.affiliation: John Hopkins Children's Center, Baltimore, USA.
authors.forename: M
authors.initials: M
authors.lastname: Grados
authors.affiliation: Department of Pediatrics, University of South Florida College of Medicine, Tampa, FL, USA.|Department of Psychiatry and Behavioral Neurosciences, University of South Florida, St. Petersburg, FL, USA.
authors.forename: A B
authors.initials: AB
authors.lastname: Lewin
authors.affiliation: Department of Child and Adolescent Psychiatry, Queen Silvia's Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: K H
authors.initials: KH
authors.lastname: Melin
authors.affiliation: Department of Pediatrics, University of South Florida College of Medicine, Tampa, FL, USA.|Department of Psychiatry and Behavioral Neurosciences, University of South Florida, St. Petersburg, FL, USA.|Department of Psychology, University of South Florida, St. Petersburg, FL, USA.
authors.forename: E A
authors.initials: EA
authors.lastname: Storch
authors.affiliation: Department of Child and Adolescent Psychiatry, Academic Medical Center, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands.|Academic Center for Child and Adolescent Psychiatry, de Bascule, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands.
authors.forename: L H
authors.initials: LH
authors.lastname: Wolters
authors.affiliation: Department of Pediatrics, University of South Florida College of Medicine, Tampa, FL, USA.|Department of Psychiatry and Behavioral Neurosciences, University of South Florida, St. Petersburg, FL, USA.
authors.forename: T K
authors.initials: TK
authors.lastname: Murphy
authors.affiliation: Department of Psychology, University of Southampton, Southampton, UK.
authors.forename: E J S
authors.initials: EJ
authors.lastname: Sonuga-Barke
authors.affiliation: Center for Child and Adolescent Psychiatry, Aarhus University Hospital Risskov, Risskov, Denmark.
authors.forename: P H
authors.initials: PH
authors.lastname: Thomsen
mesh_terms: D000293:Adolescent; D001007:Anxiety / Q000453:epidemiology / Q000523:psychology*; D001008:Anxiety Disorders / Q000453:epidemiology / Q000523:psychology*; D002648:Child; D015897:Comorbidity; D003431:Cross-Cultural Comparison; D005163:Factor Analysis, Statistical; D005260:Female; D060845:Hoarding / Q000453:epidemiology / Q000523:psychology; D006801:Humans; D008297:Male; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D010552:Personality Assessment / Q000706:statistics & numerical data*; D011569:Psychiatric Status Rating Scales; D012725:Sexual Behavior / Q000208:ethnology / Q000523:psychology*; D055815:Young Adult
keywords: CY-BOCS; Children and adolescents; Comorbidity; Factor analysis; OCD symptom patterns; Obsessive–compulsive disorder