Obsessive-compulsive disorder in children — OSCE

Objectives

1. Open with the child's voice and elicit the hidden obsession–compulsion cycle directly. [17] [22]
2. Map impairment and screen comorbidity, suicidality and red flags. [22]
3. Explain the diagnosis of OCD without stigma and without over-promising. [22]
4. Agree a stepped CBT-with-ERP-first plan and address family accommodation. [1] [14]

Candidate brief

12-minute station. Parent and child attend after the school flagged lateness and poor concentration. The parent says "he is just anxious" and admits they now tie his shoelaces each morning to get him to school on time. The child looks embarrassed and has not disclosed his rituals. No prior formal mental health assessment. [22]

Expected actions

• Greet the child by name and build rapport before the parent monologue. [22]
• Ask the child directly and privately about intrusive thoughts and rituals, normalising that these are common and treatable. [17] [22]
• Map the obsession–compulsion cycle, time per day, triggers and multi-setting impairment. [22]
• Screen for suicidality, depression, tics, autism traits and acute-onset features. [22]
• Name OCD as a real, treatable anxiety-spectrum condition without stigma. [22]
• Explain CBT with ERP as first-line; describe the exposure principle in family-friendly language. [1] [14]
• Frame family accommodation gently: well-meant but maintaining — reducing it is a treatment target, not a failure. [14]
• Safety-net: earlier review if mood drops, self-harm, or deterioration; mention SSRI option if moderate-severe at review. [5]

Examiner prompts

• "Parent: he is just an anxious boy." → Elicit the cycle; anxiety alone does not capture the ritual pattern. [17] [22]
• "Should I keep tying his laces?" → Explain accommodation and the goal of reducing it with support. [14]
• "Will tablets fix this?" → ERP is first-line; medication is added for moderate-severe or comorbid cases, not substituted for ERP. [1]

Marking foci

• Child-centred, direct questioning for hidden symptoms [17] [22]
• Accurate cycle and impairment mapping [22]
• Stigma-free psychoeducation and stepped-plan framing [22]
• Appropriate handling of family accommodation [14]
• Comorbidity, suicidality and red-flag screening [5] [22]
• Clear, safe follow-up plan [22]