Struggle hours for endless demands: When a child with obsessive-compulsive disorder wears parents down?

Background: To evaluate time-of-day-specific functional impairments in children with obsessive–compulsive disorder (OCD) and identify related clinical and psychosocial factors. Methods: The registry data for a total of 136 children diagnosed with OCD was analyzed. Questionnaire - Children with Difficulties (QCD) was used to assess functional difficulties across daily lives and was reported by the parents. The QCD scores of the children with OCD were compared with community norms. Multiple regression analyses were used to examine the associations of the QCD domains with age, weekday sleep, anxiety, depression, behavioral problems, and siblings. Results: The mean age of patients in the OCD group was 11.46 years (SD = 2.27), with 69 boys (51.1%) and 66 girls (48.9%). The children with OCD scored significantly lower across all QCD domains (all p < .01), with large effects for night (d = − 2.04), total QCD (d = − 2.10), school (d = − 1.90), and after-school (d = − 2.03) compared to the community sample. In the regression analyses, higher behavioral problem scores predicted better functioning in the morning and evening, whereas a greater number of siblings predicted poorer morning functioning. Higher anxiety scores were significantly associated with better night-time functioning. However, depressive symptoms were not significantly associated with overall functioning. Conclusions: Children and adolescents with OCD demonstrated marked domain-specific functional impairments, particularly during school, after school, and nighttime routines. Distinct psychosocial factors, including behavioral problems, sibling presence, and anxiety symptoms, were associated with time-specific functioning, underscoring the need for targeted, time-sensitive interventions.