State of research regarding treatments addressing ocd and related behaviors in teens and adults with down syndrome: findings from a scoping rapid review

For individuals with Down syndrome, obsessive-compulsive traits and behaviors (OCD) begin in adolescence and persist throughout adulthood. Evidence-based OCD interventions exist, but their applicability for the Down syndrome population is unknown. Few studies have occurred exclusively with the pediatric population; therefore, our aim was to identify and determine the efficacy of interventions used to target OCD in teens and adults with Down syndrome. A scoping rapid review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was conducted in April 2023. PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, PsycINFO, and Scopus/MEDLINE databases were searched using keywords and Medical Subject Headings (MeSH) terms. The initial search yielded 290 unique articles, of which 11 were found to meet the predefined inclusion/exclusion criteria. Across the 11 case reports and case series articles written between 1992 and 2017, a total of 37 teens and adults with Down syndrome received psychotherapy, psychopharmacology, alternative or complimentary therapy, or a combination treatment. Ages ranged from 10 to 63 years (average age = 32.5 years; SD = 12.4 years). OCD symptoms targeted for treatment included food and hygiene rituals, obsessional slowness, other gross motor compulsions, dressing rituals, hoarding, repetitive tidying, ordering compulsions, and checking rituals. A total of 73% were treated with medication only; the remaining 26% were treated with behavioral therapy alone or medication and behavioral therapy. Active intervention ranged from 4 days to 4 years. Medications varied, including SSRIs (62%), benzodiazepines (BZD)/barbiturates (11%), second-generation antipsychotics (SGAs) (16%), first-generation antipsychotics (FGAs) (5%), tricyclic antidepressants (TCAs) (16%), and other medications (N-methyl-D-aspartate [NMDA] antagonists, anticonvulsants, stimulant, benzothiazole, 16%), or a combination. Overall, 78% reported partial clinical symptom improvement, 11% reported complete symptom resolution, and 11% showed no improvement. While most articles yielded positive outcomes, generalizability was poor. Robust results often correlated with SSRI use, although behavioral therapy alone offered promising results. Our review noted knowledge gaps and the need for more research on psychopharmacologic and behavioral modalities to develop evidence-based guidelines to address OCD in persons with Down syndrome.