CeHOCS - Obsessive Compulsive Score-6 weeks
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.
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Children's e-Hospital Identity Number
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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
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Excessively bothered by sticky substances or residues
Concerned will get ill because of contaminant
Excessive concern with environmental contaminants (e.g. asbestos, radiation, toxic waste)
Excessive concern with household items (e.g. cleaners, solvents)
Other (please describe in paragraph below)
Concerns or disgust with bodily waste or secretions (e.g. urine, faeces, saliva)
Excessive concern about animals/insects
None of the above apply
Concern with dirt, germs, certain illnesses (e.g. AIDS)
Concerned will get others ill by spreading contaminant (aggressive)
Required
Contamination Obsessions Other Information
Your answer
Aggressive Obsessions
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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
Your answer
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:
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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
Your answer
Hoarding/Saving Obsessions
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Fear of losing things
Other (please describe in paragraph below)
None of the above apply
Required
Hoarding/Saving Obsessions Other Information
Your answer
Magical Thoughts/Superstitious Obsessions
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Lucky/unlucky numbers, colours, words
Other (please describe in paragraph below)
None of the above apply
Required
Magical Thoughts/Superstitious Obsessions Other Information
Your answer
Somatic Obsessions
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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
Your answer
Religious Obsessions (Scrupulosity)
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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
Your answer
Miscellaneous Obsessions
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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
Your answer
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
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Your answer
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
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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
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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
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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
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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
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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
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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
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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
Your answer
Checking Compulsions
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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
Your answer
Repeating Rituals
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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
Your answer
Counting Compulsions
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Objects, certain numbers, words, etc (please describe in paragraph below)
None of the above apply
Required
Counting Compulsions Other Information
Your answer
Ordering/Arranging
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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
Your answer
Hoarding/Saving Compulsion
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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
Your answer
Excessive Games/Superstitious Behaviours
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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
Your answer
Rituals Involving Other Persons
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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
Your answer
Miscellaneous Compulsions
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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
Your answer
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.
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Your answer
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
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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
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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
*
Choose
None
Mild - only slightly anxious or frustrated if compulsions prevented, or only slight anxiety or frustration during performance of compulsions.
Moderate - reports that anxiety or frustration would mount but remain manageable if compulsions prevented. Anxiety or frustration increases but remains manageable during performance or compulsions.
Severe - prominent and very disturbing increase in anxiety or frustration if compulsions interrupted. Prominent and very disturbing increase in anxiety or frustration during performance of compulsions.
Extreme - incapacitating anxiety or frustration from any intervention aimed at modifying activity. Incapacitating anxiety or frustration develops during performance of compulsions.
9. Resistance Against Compulsions
How much does your child try to fight the habits?
Please select as appropriate
*
Choose
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 almost all compulsions without attempting to control them, but does so with some reluctance.
Extreme - completely and willingly yields to all compulsions
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
*
Choose
Complete control
Much control - experiences pressure to perform the behaviour, but usually able to exercise voluntary control over it
Moderate control - strong pressure to perform behaviour, can control it only with difficulty
Little control - very strong drive to perform behaviour, must be carried to completion, can only delay with difficulty
No control - drive to perform behaviour experienced as completely involuntary and overpowering, rarely able to delay activity (even momentarily)
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