Predictors of functional impairment in pediatric obsessive-compulsive disorder Eric A. Storch a,b,c, *, Michael J. Larson d , Jordana Muroff e , Nicole Caporino c , Daniel Geller f , Jeannette M. Reid a , Jessica Morgan a , Patrice Jordan a , Tanya K. Murphy a,b a Department of Pediatrics, University of South Florida, United States b Department of Psychiatry, University of South Florida, United States c Department of Psychology, University of South Florida, United States d Department of Psychology, Brigham Young University, United States e School of Social Work, Boston University, United States f Department of Pediatric Psychopharmacology, Massachusetts General Hospital, United States Obsessive-compulsive disorder (OCD) is an anxiety disorder that is characterized by presence of obsessions and/or compulsions that are distressing and potentially disabling to the affected individual (American Psychiatric Association [APA], 2000). Al- though a considerable body of research exists on the nature of obsessive-compulsive symptoms and the overall phenomenology of OCD, only recently has attention been given to functional impairment and quality of life among those with OCD. Most of these studies have examined functional impairment in adult samples, with findings extrapolated to inform upon pediatric OCD patients. However, children differ from adults in a number of important ways, including position within a family system; domains of impairment (e.g., school versus work); and clinical characteristics (e.g., presence of insight is not necessary among youth with OCD, but comprises a diagnostic criterion for adults; Freeman et al., 2003). Accordingly, we sought to directly examine variables theoretically associated with OCD-related functional impairment among affected youth. As noted, the majority of research examining functional impairment in OCD has utilized adult participants. Not surpris- ingly, adults with OCD exhibit greater levels of functional impairment relative to the general United States population. Those with OCD report significantly more work-related impair- ments (e.g., higher unemployment rate, lower socio-economic status; Huppert, Simpson, Nissenson, Liebowitz, & Foa, 2009; Karno, Golding, Sorenson, & Burnam, 1988); disruption of social and marital relationships (Huppert et al., 2009; Karno et al., 1988; Koran, Thienemann, & Davenport, 1996); and physical health concerns (as evidenced by greater frequency/extent of medical utilization and hospitalization; Barlow, 2002). Further, adults with OCD report quality of life levels comparable to those found in association with schizophrenia (Stengler-Wenzke et al., 2006) and depression (Bobes et al., 2001), and significantly lower than reported by healthy controls (Bobes et al., 2001; Rodriguez- Salgado et al., 2006; Stengler-Wenzke et al., 2006). In adults with OCD, quality of life is strongly related to degree of functional Journal of Anxiety Disorders 24 (2010) 275–283 ARTICLE INFO Article history: Received 10 September 2009 Received in revised form 10 December 2009 Accepted 10 December 2009 Keywords: Obsessive-compulsive disorder Children Impairment Disability Treatment Anxiety ABSTRACT The current study examined factors associated with obsessive-compulsive disorder (OCD) related functional impairment among 99 youth with OCD. A trained evaluator administered the Children’s Yale- Brown Obsessive-Compulsive Scale, items assessing family accommodation, and a version of the Brown Assessment of Beliefs Scale that was modified for children. Youth completed the Child Obsessive- Compulsive Impact Scale-Child Version, Obsessive-Compulsive Inventory-Child Version, Multidimen- sional Anxiety Scale for Children, and Children’s Depression Inventory-Short Form. The child’s parent completed the Child Obsessive-Compulsive Impact Scale-Parent Version. Results indicated that OCD symptom severity, depressive symptoms, and family accommodation were directly related to impairment, while insight was inversely related to functional impairment. Insight, family accommoda- tion, and depressive symptoms predicted parent- and/or child-rated functional impairment above and beyond OCD symptom severity. Among symptom dimensions, contamination/cleaning and aggressive/ checking symptoms were the only dimensions significantly associated with impairment. Assessment and treatment implications are discussed; specifically, we highlight how the variables of interest may impact clinical presentation and treatment course. ß 2009 Elsevier Ltd. All rights reserved. * Corresponding author at: Department of Pediatrics, University of South Florida, 800 6th Street South 4th Floor, St. Petersburg, FL 33701, United States. Tel.: +1 727 767 8230; fax: +1 727 767 7786. E-mail address: estorch@health.usf.edu (E.A. Storch). Contents lists available at ScienceDirect Journal of Anxiety Disorders 0887-6185/$ – see front matter ß 2009 Elsevier Ltd. All rights reserved. doi:10.1016/j.janxdis.2009.12.004