Distinguishing Between OCD and GAD in Children

As many parents of children with obsessive-compulsive disorder (OCD) will tell you, getting the right diagnosis is half the battle. Getting the right treatment is the other half.

It’s true that OCD can be tough to diagnose, especially in children. Rituals are an important part of a healthy childhood, and it’s often difficult to know when they should be a cause for concern. This article can help you sort out “normal” rituals from behaviors that should raise a red flag.

Even if you and your healthcare providers recognize that your child is dealing with anxiety issues, it’s not always easy to differentiate between OCD and Generalized Anxiety Disorder (GAD). Both can be characterized by rumination, increased vigilance, and an intolerance of uncertainty. Experts in OCD and anxiety disorders should be able to distinguish between the two, but for others it can be quite difficult. To make matters even more confusing, the two disorders can also occur together.

A study published online in October 2018 in Depression Anxiety aims to make it easier to properly diagnose these two disorders. The study looked at participants’ abilities in certain cognitive domains to determine if this information might be helpful in diagnosing OCD and GAD.

The children involved in the study had either been diagnosed with OCD, GAD, or neither (control group). None were diagnosed with both OCD and GAD. The breakdown included 28 study participants diagnosed with OCD only, 34 diagnosed with GAD only, and 65 diagnosed with neither. This last group of children were the typically-developing controls (TDC). Cambridge Neuropsychological Automated Battery (CANTAB) tests were administered to compare the following cognitive performances:

  • Working memory
  • Visuospatial memory
  • Planning ability and efficiency
  • Cognitive flexibility

The results were interesting. The participants with obsessive-compulsive disorder required more turns overall to complete multi-step problems than the other two groups, while those with Generalized Anxiety Disorder were more likely to make reversal errors than those with OCD or the control group. Those with GAD also took longer to identify visual patterns.

Although those with OCD and those with GAD demonstrated significantly worse cognitive functioning compared with the control group, the children’s cognitive impairments and difficulties with specific skills depended on which disorder they’d been diagnosed with. Children with generalized anxiety disorder struggled more with mental flexibility and visual processing, and those with obsessive-compulsive disorder displayed poorer planning abilities.

These results show promise in helping to diagnose OCD and GAD in children. More research is needed, however. For future research, the study authors suggested the use of parent-reporting forms as well as self-reporting forms. Neuroimaging and other types of assessments measuring the same cognitive skills examined in the study discussed here would be helpful as well.

One of the reasons I find this research so interesting is the fact that, as many of us know, the earlier obsessive-compulsive disorder is diagnosed, the sooner it can be properly treated — before it becomes deeply entrenched. The same is true for Generalized Anxiety Disorder — the sooner the better. The more we can differentiate between these two disorders, the better chance we have for more timely diagnoses.