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Rituals and sensory hypersensitivities in a child may be early warning signs of adult obsessive-compulsive disorder (OCD), according to the results of two studies from Israel.

A strong reaction to everyday events as recorded on a sensory profile was highly correlated with ritualism on the Childhood Routine Inventory (CRI) in one study (r=0.68, P<0.001), reported Reuven Dar, PhD, and colleagues from Tel Aviv University.

In the second study, recollected oral and tactile hypersensitivity was positively correlated with symptoms measured by the Obsessive-Compulsive Inventory-Revised (OCI-R) scales (r=0.34, P<0.001). Adult hypersensitivity in both areas was positively correlated with all six of the inventory subscales. None of the differences between the various correlation coefficients was significant.

The findings appeared in the March 2012 issue of the Journal of Behavior Therapy and Experimental Psychiatry.

Children with sensory processing disorders demonstrate exaggerated or inappropriate responses to everyday sensory inputs; these responses are seen as either over- or undersensitivity, the authors explained. "Examples of common presenting symptoms for over-responsiveness [hypersensitivity] include aversive responses of the child to certain types of clothing, refusal to eat certain types of foods, and strong reactions when others touch him/her."

Previous research has suggested a potential link between hypersensitivity and excessive ritualism. But other than some case studies, "no research to date has focused explicitly on the relation between sensory processing, childhood ritualism, and adult obsessive-compulsive symptoms," the investigators noted.

To explore that relationship, the authors conducted two different studies. Study one involved 61 parents of children ages 4 to 6.4 years. The parents were administered the CRI, a 20-item questionnaire measuring compulsive-like behavior in children that uses a five-point scale to assess the intensity and frequency of repetitive behaviors.

Trait anxiety in children of these parents was measured using a shortened version of the Screen for Child Anxiety-Related Emotional Disorders (SCARED). The eight included items use a five-point scale to assess five factors across many common childhood fears.

Sensory reactions were measured using the Sensory Profile, a 125-item questionnaire that looks at a child's responses to sensory events in everyday life across each system. Seventeen items that correlated highly with the Sensory Profile's Ritualism scale (r=0.30 or higher) were combined to create the Oral and Tactile Hypersensitivity Scale (OTHS).

When the researchers looked at correlation in study one between the OTHS and ritualism reported in the CRI, there was a significant relationship (r=0.74, P< 0.001). They next excluded five items from the CRI that dealt with sensory issues to avoid possible overlap. The correlations remained robust (r=0.66, P < 0.001), although significantly smaller than the correlation with the full scale (t= -4.11, P<0.001).

When they controlled for possible confounding by anxiety, the partial correlation was moderate and significant, indicating that hypersensitivity was correlated with ritualism beyond a correlation with anxiety.

Study two was Internet-based and involved 314 participants. OCD tendencies were measured using the OCI-R, a listing of 18 characteristic symptoms to be rated on a 4-point Likert scale indicating the prevalence of a symptom over the last month. In this instance, trait anxiety was assessed using the anxiety subscale from the International Personality Item Pool, a 10-item personality inventory. Oral and tactile hypersensitivity was measured using the OTHS as in study one.

Consistent with the results of the first study, recollected childhood oral and tactile sensitivity was positively correlated with results of the OCI-R (r=0.41, P<0.001) in study two. When they controlled for anxiety, they continued to find that the sensitivity was correlated with obsessive-compulsive symptoms beyond their correlation with anxiety.

In both studies, there were no significant differences between the genders in any of the correlations (all P values >0.05).

The authors noted that one of the limitations of study one was indirect testing of the child's sensitivity instead of using parental reporting. There also were no control populations available. Both studies were cross-sectional in design. Study two was further limited by the use of a measure that required recollection of childhood behaviors.

"All of the conclusions drawn from these studies concern the relations between variables rather than the absolute values of these variables in the general population," wrote the authors. "We believe that the strength and consistency of the relationships found between these factors in the current studies suggest that further studies would be a worthwhile pursuit."

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