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Clinical Correlates of Hoarding With and Without Comorbid Obsessive-Compulsive Symptoms in a Community Pediatric Sample

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Objective

We assessed the prevalence and clinical correlates of hoarding, with and without obsessive-compulsive (OC) symptoms, in a community-based pediatric sample.

Method

We measured hoarding and OC symptoms using the Toronto Obsessive-Compulsive Scale (TOCS) in 16,718 youth aged 6 to 17 years in the community. We classified participants with high and low symptom counts for hoarding and OC into 4 groups: hoarding+OC; hoarding-only; OC-only; and control (no OC or hoarding symptoms). We compared these 4 groups on parent- or self-reported medical and psychiatric conditions, anxiety symptoms measured with the Child Behavior Checklist (CBCL), and attention-deficit/hyperactivity disorder (ADHD) symptoms measured with the Strengths and Weaknesses of Attention-Deficit/Hyperactivity Disorder Symptoms and Normal Behavior Scale (SWAN).

Results

Almost 10% of participants were in the high hoarding group. Of these participants, 40% did not fall into the high OC group. The prevalence of reported psychiatric disorders (e.g., ADHD, autism spectrum disorder, obsessive-compulsive disorder) was greater in the hoarding (hoarding+OC and hoarding-only) and OC groups (hoarding+OC and OC-only) than in the nonhoarding (OC-only and control) and non-OC groups (hoarding-only and control), respectively. ADHD, specifically inattentive, symptoms were more common in the hoarding-only than in the OC-only group while anxiety symptoms were more common in the OC-only than in the hoarding-only group.

Conclusion

In a community pediatric sample, hoarding symptoms occurred in both the presence and absence of obsessive-compulsive symptoms. Hoarding symptoms alone had some unique clinical correlates, in particular, more inattentive ADHD symptoms and fewer anxiety symptoms. These findings suggest that hoarding is distinct from OC traits in youth.

Section snippets

Participants

The sample has been described elsewhere.30 A total of 17,263 individuals aged 6 to 17 years were recruited for the Thoughts, Actions and Genes (TAG) project at the Ontario Science Centre in Toronto, Ontario, Canada. Parents of children aged 6 to 15 years or participants aged 13 to 17 years provided consent, completed rating scales for OC, hoarding, and ADHD traits, and responded to questions about history of medical/psychiatric conditions diagnosed in the community (referred to henceforth as

Results

Hoarding and OC symptoms were common among children from our community sample: 8.9% (n = 1,483) were hoarding-positive and 6.1% (n = 1,013) were OC-positive. The overlap of hoarding-positive and OC-positive was substantial (n = 661; 60%) but not complete (χ2 [1, n = 3,930] = 936.6, p < .001) (Table 1). The hoarding-positive group was 10.5 times more likely than the hoarding-negative group to be OC-positive (95% CI = 9.0–12.4). If parents rather than youth themselves filled out the TOCS, the

Discussion

This study is the first to examine the correlates of high hoarding with and without high OC symptoms in children and adolescents in the community. We demonstrated that hoarding existed in the absence of OC symptoms in 40% of youth. Approximately 10% of our participants were classified as hoarding-positive (both hoarding symptoms; a score of +2 or more on both hoarding items), and more than 40% of these participants were classified as OC-negative (no OC symptoms; scores of –2 or less on all OC

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    Clinical guidance is available at the end of this article.

    CIHR operating grants awarded to P.A. (MOP-106573) and R.S. (MOP – 93696) and a CIHR fellowship for C.L.B. supported this work.

    Dr. Dupuis served as the statistical expert for this research.

    The authors thank Lauren Erdman, MSc, of the Hospital for Sick Children, for statistical support and everyone involved in collecting the dataset.

    Disclosure: Dr. Schachar has consulted for Highland Therapeutics, Purdue Pharma, and ehave. He is the Toronto Dominion Bank Financial Group Chair in Child and Adolescence Psychiatry. Dr. Arnold holds patent “SLC1A1 Marker for Anxiety Disorder” with J.L. Kennedy and M.A. Richter. Drs. Burton, Crosbie, Dupuis, Mathews, and Soreni report no biomedical financial interests or potential conflicts of interest.

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