If a young person needs to go to a clinic to be assessed for OCD, they need to know what sort of thing to expect. Here is an example of a clinic leaflet that gets sent out to children and families before they go to the OCD clinic:
What is OCD?

Some young people have thoughts or ideas that keep coming into their minds even when they do not want them to. These thoughts often feel silly or unpleasant and are called obsessions. Compulsions are things that people feel they have to do, even when they do not want to. Often people try to stop themselves from doing these things, but feel frustrated or worried unless they can finish. Problems with obsessions and compulsions can cause distress and worry, and can begin to affect young people at school, with their friends, and in their families. Many children have mild obsessions and compulsions at some time, but when it becomes a problem for the young person and their families, it is called obsessive compulsive disorder, sometimes called OCD for short.

Recent studies show that OCD may affect 1% of young people. We do not know the cause of OCD, but it usually has a lot to do with being anxious, and latest research suggests that a chemical imbalance in the brain may be involved; there is no suggestion that the way children are brought up causes OCD.

Some people with OCD get better on their own, but most need help; there are some treatments which are particularly useful, and these are the ones recommended by our clinic.

What happens in the clinic?

In the clinic we see young people with OCD, and their families. Sometimes the referring doctor and the family want an opinion as to whether a child or teenager does have OCD. We offer an assessment of the difficulties, and where appropriate, treatment.

Assessment

Once the young person has been referred, we will write and offer an appointment if the type of difficulty seems appropriate for our clinic. Sometimes, with permission from the family, we will request information from the school and other professionals who have been involved.

The assessment in the clinic is tailored to the needs of the individual child or teenager, and will usually take 23 hours. We would ask parents to give a full account of the difficulties, and how they have dealt with the problem. The doctor will also perform a general physical examination.

Sometimes it is helpful to use tests, games or puzzles to look at abilities and
difficulties in a variety of areas: reasoning, school work etc. The clinic psychologist may be involved in this part of the assessment.

After the assessment we meet the family to feedback our findings, and to discuss what intervention would be helpful. We will also feedback results of the assessment, and recommendations, to the referrer and the family doctor.

Treatment

Families may have come from a long distance to our clinic, or they may live locally. If the patient lives far away, sometimes it is most sensible for them to be referred back to local services for treatment; for children or teenagers living near by, we may be able to offer treatment ourselves.

One of the first steps in treatment is helping young people and families understand obsessive compulsive disorder and how it affects them. Depending on the needs of the child and family, we might have family meetings to discuss this, and we may also see parents and the young person separately.

Medication

Medication can help some people with obsessive compulsive disorder. If drug treatment is considered appropriate, this will be discussed fully with the young person and family, to help them decide whether they would like to try medication.

Cognitive behaviour therapy

Another helpful treatment for OCD is cognitive behaviour therapy. This involves a detailed assessment of the problem, often starting with the child and family keeping a diary of the obsessions and compulsions. The aim of the treatment is to teach young people how to get in control of the problem, by tackling it a little bit at a time. Cognitive behaviour therapy needs to take place over several sessions; we may carry out some treatments ourselves or refer to local services with advice.

About 70-80% of children are likely to respond to treatment with medication and cognitive behaviour therapy. We would hope to offer the best treatments for OCD, many of which have been well tested in clinical trials and shown to be successful. Amongst the children we treat there will inevitably be some children we are unable to help; we would plan to inform families if this is the case so as not to continue with unhelpful treatment. Sometimes children have other difficulties in addition to OCD, such as developmental problems or depression, and these problems may need assessment and treatment if they do not change when the OCD improves.