Dear Editor,
A two-year-and-four-month-old girl presented with a forty-five-day history of spitting on her hand if someone touched her. She started asking her parents or people known to her to spit on her body whenever she was touched. She insisted on having a bath every time she was touched; some days her parents were compelled to bathe her more than twenty-five times a day. She threw tantrums, started licking herself, and cried incessantly if her demands were not met. She also developed symmetry compulsions, insisting that her toys and clothes should be placed in a certain manner.
The child’s developmental milestones and reciprocal social interaction were age-appropriate. There was no family history of OCD. C-reactive protein, serum ceruloplasmin, serum vitamin D3, EEG, and brain MRI were within normal limits. Parent ratings on the children’s yale-brown obsessive-compulsive scale showed a score of eighteen indicating a severe degree of OCD.
Her parents were instructed not to give in to her unreasonable demands. A behavior therapy schedule was initiated with weekly follow-up sessions. But, her symptoms continued unabated even after five sessions.
We started her on risperidone 0.25 mg daily at bedtime since her parents found it difficult to manage her. The child showed significant improvement over the next three weeks. Once symptoms improved, the drug was discontinued, and she was managed with behavior interventions alone. But, one week after risperidone was discontinued, the symptoms relapsed. We restarted risperidone at the same dose, and she remained symptom-free thereafter. She did not have any side effects.
Early identification and treatment of OCD in children is essential to prevent chronicity and distress.[1,2] Symptoms of OCD in very young children may be mistaken for developmentally normal ritualistic behaviors.[3] Lack of insight and limited ability to express distress may also contribute to delayed diagnosis. In preschool children, OCD may present as behavior problems, aggression, or anxiety symptoms.[3]
Cognitive behavior therapy (CBT), focusing on reducing family accommodation of compulsions, was found to be effective in controlling symptoms in very young children.[2] However, in certain cases, CBT may not show improvements. In such situations, the physician remains in dilemma because there are no guidelines regarding the prescription of psychotropics in very young children. Although SSRIs are the first line of drugs in OCD, their safety and tolerability in very young children are not clear. Risperidone is well tolerated in preschool children with autistic spectrum disorders.[4] This case shows that low-dose risperidone helps in improving OCD in very young children and is well tolerated.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the legal guardian has given his consent for images and other clinical information to be reported in the journal. The guardian understands that names and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.
Author's contribution
Conceptualization, methodology, writing (original draft) RKR. Review and editing: PK, MS.
Conflicts of interest
There are no conflicts of interest.
Funding Statement
Nil.
REFERENCES
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