The International Journal of Neuropsychopharmacology

Special Section

Disentangling chronological age from age of onset in children and adolescents with obsessive–compulsive disorder

Daniel A.  Geller  a1 a2 a3 c1, Joseph  Biederman  a2 a3 a4, Stephen V.  Faraone  a3, Christine A.  Bellordre  a2, Grace S.  Kim  a2, Lisa  Hagermoser  a2, Kathleen  Cradock  a2, Jean  Frazier  a2 a3 and Barbara J.  Coffey  a2 a3
a1 Obsessive Compulsive Disorder Clinic, McLean Hospital, Belmont, MA, USA
a2 Pediatric Psychopharmacology Clinic, McLean Hospital, Belmont, MA, USA
a3 Harvard Medical School, Boston, MA, USA
a4 Massachusetts General Hospital, Fruit Street, Boston, MA, USA


Although paediatric obsessive–compulsive disorder (OCD) is increasingly recognized as a putative developmental subtype of the disorder, it remains uncertain as to whether additional subtyping by age at onset in childhood or adolescence is warranted. Subjects included children and adolescents meeting DSM-III-R and DSM-IV criteria for OCD referred to a specialized OCD clinic. All youth were systematically evaluated with structured diagnostic interviews and clinical assessment by an OCD expert. Irrespective of current age, an earlier age at onset predicted increased risk for attention deficit hyperactivity disorder, simple phobia, agoraphobia and multiple anxiety disorders. In contrast, mood and psychotic disorders were associated with chronological age and were more prevalent in older subjects. Tourette's disorder showed associations with both chronological age and age at onset. Chronological age and age at onset predicted different patterns of comorbidity and dysfunction in children and adolescents with OCD. Considering the heterogeneity of OCD, age at onset may help identify meaningful developmental subtypes of the disorder beyond chronological age.

(Received September 11 2000)
(Reviewed December 13 2000)
(Revised February 6 2001)
(Accepted February 7 2001)

Key Words: Obsessive–compulsive disorder; paediatric; developmental; age at onset; chronological age.

c1 Address for correspondence: Dr D. A. Geller, Pediatric OCD Clinic, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA. Tel.: (617) 855-3560 Fax: (617) 855-3691 E-mail: