Challenges of insight assessment in pediatric obsessive-compulsive disorder: Initial results and clinical considerations from a measure development study

Background Assessing insight among OCD-affected youth has been limited by the absence of a multi-item measure for this population. The present study outlines the development of the Measure of Insight for Obsessive-Compulsive Disorder (MI-OCD), presents initial findings, and explores conceptual challenges. Methods Along with the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS), the 7-item MI-OCD was administered to 178 OCD-affected youth aged 7–19 (mean age = 13.5, SD = 2.8; 55% female) presenting for assessment across three OCD-specialty clinics. Items 4–7 were only completed by those with an identified feared outcome (61%). Results MI-OCD items were positively correlated with the CY-BOCS’ insight question, but were not related to age or avoidance. Correlations and factor analysis indicated items coalesced around concepts of symptoms as unwanted (1–3) and symptoms as useful/valid (4–7), although factor fit and internal consistency was sub-optimal. Most youth perceived their symptoms as unwanted (positively correlated with severity), while the extent to which youth perceived symptoms as useful was more varied (not associated with severity). Discussion Insight remains a challenging construct to assess in youth given various developmental, psychological, and environmental confounds. The MI-OCD may be useful in the context of evaluating and addressing individual barriers to treatment engagement over time.