CeHOCS - Obsessive Compulsive Score-6 weeks

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The Children's e-Hospital Obsessive Compulsive Scoring Matrix is designed to allow us to measure your child's obsessions and compulsions and see the response to treatment. The matrix is based on the Children's Yale-Brown Obsessive Compulsive Scale. This form is to be used 6 weeks after starting treatment to evaluate the response.

Children's e-Hospital Identity Number *

Todays date *

YYYY

Your Child's Name *

I consent to the infromation on this form being used to assist the treatment of my child *

I consent to the information on this form being used for research and publication purposes (anonymised data)

Background Information

This scale is designed to rate the severity of obsessive and compulsive symptoms in children and adolescents, ages 6-17 years. Rate the characteristics of each item for the past week leading up to, and including, the time of completing this questionnaire. Answers should reflect the average of each item for the entire week, unless otherwise specified.

We are looking to evaluate your child's obsessions and compulsions.

Obsessions are thoughts, ideas or pictures that keep coming into your mind even though you do not want them to. They may be unpleasant, silly or embarrassing. An example of an obsession could be the repeated thought that germs or dirt are harming you or other people, or that something unpleasant might happen to you or someone in your family or someone special to you. These are thoughts that keep coming back, over and over again.

Compulsions are things that you feel you have to do although you may know that they do not make sense. Sometimes you may try to stop from doing them but this might not be possible. You might feel worried or angry or frustrated until you have finished what you have to do. An example of a compulsion could be the need to wash your hands over and over again even though they are not really dirty, or the need to count up to a certain number while you do certain things.

CeHOCS Obsessions Checklist

Please look at the list of obsessions below and tick all items that apply to your child.

Contamination Obsessions *

Concerned will get others ill by spreading contaminant (aggressive)

Concerns or disgust with bodily waste or secretions (e.g. urine, faeces, saliva)

Concerned will get ill because of contaminant

Excessive concern with environmental contaminants (e.g. asbestos, radiation, toxic waste)

Excessive concern about animals/insects

Excessive concern with household items (e.g. cleaners, solvents)

Other (please describe in paragraph below)

Concern with dirt, germs, certain illnesses (e.g. AIDS)

None of the above apply

Excessively bothered by sticky substances or residues

Required

Contamination Obsessions Other Information

Aggressive Obsessions *

Fear might harm self

Fear might harm others

Fear harm will come to self

Fear harm will come to others (may be because something child did or did not do)

Violent or horrific images

Fear or blurting out obscenities or insults

Fear of doing something else embarrassing *

Fear will act on unwanted impulses (e.g. to stab a family member)

Fear will steal things

Fear will be responsible for something else terrible happening (e.g. fire, burglary, flood)

Other (please describe in paragraph below)

None of the above apply

Required

Aggressive Obsessions Other Information

Sexual Obsessions - Are you having any sexual thoughts? If yes, are they routine or are they repetitive thoughts that you would rather not have and find disturbing? If yes, are they: *

Forbidden or perverse sexual thoughts, images, impulses

Content involves homosexuality *

Sexual behaviour towards others (aggressive)

Other (please describe in paragraph below)

None of the above apply

Required

Sexual Obsessions Other Information

Hoarding/Saving Obsessions *

Fear of losing things

Other (please describe in paragraph below)

None of the above apply

Required

Hoarding/Saving Obsessions Other Information

Magical Thoughts/Superstitious Obsessions *

Lucky/unlucky numbers, colours, words

Other (please describe in paragraph below)

None of the above apply

Required

Magical Thoughts/Superstitious Obsessions Other Information

Somatic Obsessions *

Excessive concern with illness or disease *

Excessive concern with body part or aspect of appearance (e.g. dysmorphophobia) *

Other (please describe in paragraph below)

None of the above apply

Required

Somatic Obsessions Other Information

Religious Obsessions (Scrupulosity) *

Excessive concern of fear of offending religious objects (God)

Excessive concern with right/wrong, morality

Other (please describe in paragraph below)

None of the above apply

Required

Religious Obsessions Other Information

Miscellaneous Obsessions *

The need to know or remember

Fear of saying certain things

Fear of not saying just the right thing

Intrusive (non-violent) images

Intrusive sounds, words, music, or numbers

Other (please describe in paragraph below)

None of the above apply

Required

Miscellaneous Obsessions Other Information

Target Symptom List for Obsessions

Please list your child's obsessive symptoms by order of severity, with 1 being the most severe, 2 the second most severe, etc.

Please list *

The following questions on obsessions will help us measure how severe your child's obsessions are. There are 5 questions on obsessions followed by 5 questions on compulsions.

The following questions are about the thoughts you are unable to stop thinking about, as detailed in the Target Symptom List.

1a. Time Occupied by Obsessive Thoughts

How much time does your child spend thinking about these things?

Please select as appropriate *

None

Mild - less than 1 hour per day or occasional intrusion

Moderate - 1 to 3 hours per day or frequent intrusion

Severe - greater than 3 and up to 8 hours per day or very frequent intrusion

Extreme - greater than 8 hours per day or near constant intrusion

Required

1b. Obsession-free Interval (not included in total score)

On average, what is the longest amount of time per day that your child is not bothered by obsessive thoughts?

Please select as appropriate *

None

Mild - long symptom free intervals, more than 8 consecutive hours per day symptom free

Moderate - moderately long symptom-free intervals, more than 3 and up to 8 hours per day

Severe - brief symptom-free intervals, from 1 to 3 consecutive hours per day symptom-free

Extreme - less than 1 consecutive hour per day symptom-free

Required

2. Interference due to Obsessive Thoughts

Please consider how much these thoughts get in the way of school or doing things with friends? Is there anything that your child can't do because of them?

If currently not in school determine how much performance would be affected if your child were in school.

Please select as appropriate *

None

Mild - slight interference with social or school activities, overall performance not impaired

Moderate - definite interference with social or school performance, but still manageable

Severe - causes substantial impairment in social or school performance

Extreme - incapacitating

Required

3. Distress Associated with Obsessive Thoughts

How much do these thoughts bother or upset your child?

Please select as appropriate *

None

Mild - infrequent, and not too disturbing

Moderate - frequent, and disturbing, but still manageable

Severe - very frequent, and very disturbing

Extreme - near constant, and disabling distress or frustration

Required

4. Resistance Against Obsessions

How hard does your child try to stop the thoughts or ignore them?

Please select as appropriate *

None - makes an effort to always resist, or symptoms so minimal doesn't need to actively resist

Mild - tries to resist most of the time

Moderate - makes some effort to resist

Severe - yields to all obsessions without attempting to control them, but does so with some reluctance

Extreme - completely and willingly yields to all obsessions

Required

5. Degree of Control Over Obsessive Thoughts

When your child tries to fight the thoughts, can they beat them? How much control do they have over their thoughts?

Please select as appropriate *

Complete control

Much control - usually able to stop or divert obsessions with some effort or concentration

Moderate control - sometimes able to stop or divert obsessions

Little control - rarely successful in stopping obsessions, can only divert attention with difficulty

No control - experienced as completely involuntary, rarely able to even momentarily divert thinking

Required

CeHOCS Compulsions Checklist

Please look at the following list of compulsions and tick all the items that apply to your child.

Washing/Cleaning Compulsions *

Excessive or ritualised hand washing

Excessive or ritualised showering, bathing, toothbrushing, grooming or toilet routine

Excessive cleaning of items, such as personal clothes or important objects

Other measures to prevent or remove contact with contaminants

Other (please describe in paragraph below)

None of the above apply

Required

Washing/Cleaning Compulsions Other Information

Checking Compulsions *

Checking locks, toys, school books or items, etc

Checking associated with getting washed, dressed or undressed

Checking that did not/will not harm others

Checking that did not/will not harm self

Checking that nothing terrible did/will happen

Checking that did not make mistake

Checking tied to somatic obsessions

Other (please describe in paragraph below)

None of the above apply

Required

Checking Compulsions Other Information

Repeating Rituals *

Rereading, erasing or rewriting

Need to repeat routine activities, for example in/out doors

Other (please describe in paragraph below)

None of the above apply

Required

Repeating Rituals Other Information

Counting Compulsions *

Objects, certain numbers, words, etc (please describe in paragraph below)

None of the above apply

Required

Counting Compulsions Other Information

Ordering/Arranging *

Need for symmetry/evening up, for example, lining items up a certain way or arranging personal items in specific patterns

Other (please describe in paragraph below)

None of the above apply

Required

Ordering/Arranging Other Information

Hoarding/Saving Compulsion *

Difficulty throwing things away, saving bits of paper, string, etc (distinguish from hobbies and concern with objects of monetary or sentimental value)

Other (please describe in paragraph below)

None of the above apply

Required

Hoarding/Saving Compulsion Other Information

Excessive Games/Superstitious Behaviours *

Excessive games (distinguish from age appropriate magical games)

Superstitious behaviours, for example, array of behaviour such as stepping over certain spots on a floor, or touching an object/self certain number of times as a routine game to avoid something bad from happening

Other (please describe in paragraph below)

None of the above apply

Required

Excessive Games/Superstitious Behaviours Other Information

Rituals Involving Other Persons *

The need to involve another person (usually a parent) in ritual, for example, asking a parent to repeatedly answer the same question, or making a parent perform certain mealtime rituals involving specific utensils *

Other (please describe in paragraph below)

None of the above apply

Required

Rituals Involving Other Persons Other Information

Miscellaneous Compulsions *

Mental rituals (other than checking or counting)

Need to tell, ask or confess

Measures (not checking) to prevent harm to self, harm to others, or terrible consequences

Ritualised eating behaviours *

Excessive list making *

Need to touch, tap, rub *

Need to do things, for example touch or arrange, until it feels just right *

Rituals involving blinking or staring *

Trichotillomanis (hair pulling) *

Other self-damaging or self-mutlilating behaviours *

Other (please describe in paragraph below)

None of the above apply

Required

Miscellaneous Compulsions Other Information

Target Symptom List for Compulsions - Please list your child's compulsive symptoms by order of severity, with 1 being the most severe, 2 the second most severe, etc. *

Questions on Compulsions

The following five questions are about the compulsions your child is unable to control.

6a. Time Spent Performing Compulsive Behaviours

How much time does your child spend doing these things?

Please select as appropriate *

None

Mild - spends less than 1 hour per day performing compulsions, or occasional performance of compulsive behaviours

Moderate - spends from 1 to 3 hours per day performing compulsions, or frequent performance of compulsive behaviours

Severe - spends more than 3 and up to 8 hours per day performing compulsions, or very frequent performance of compulsive behaviours

Extreme - spends more than 8 hours per day performing compulsions, or near constant performance of compulsive behaviours (too numerous to count)

Required

6b. Compulsion-free Interval

How long can your child go without performing compulsive behaviour?

Please select as appropriate *

No symptoms

Mild - long symptom-free interval, more than 8 consecutive hours per day symptom-free

Moderate - moderately long symptom free interval, more than 3 and up to 8 consecutive hours per day symptom-free

Severe - short symptom-free interval, from 1 to 3 consecutive hours per day symptom-free

Extreme - less than 1 consecutive hour per day symptom-free

Required

7. Interference due to Compulsive Behaviours

Please consider how much these habits get in the way of school or doing things with friends? Is there anything that your child can't do because of them?

If currently not in school determine how much performance would be affected if the patient were in school.

Please select as appropriate *

None

Mild - slight, interference with social or school activities, but overall performance not impaired

Moderate - definite interference with social or school performance, but still manageable

Severe - causes substantial impairment in social or school performance

Extreme - incapacitating

Required

8. Distress Associated with Compulsive Behaviour

How would your child feel if prevented from carrying out their habits? How upset would they become?

Please select as appropriate *

9. Resistance Against Compulsions

How much does your child try to fight the habits?

Please select as appropriate *

10. Degree of Control over Compulsive Behaviour

How strong is the feeling that your child has to carry out the habit(s)? How much control do they have over the habits?

Please select as appropriate *

Your Name *

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