Pediatric obsessive–compulsive disorder as a developmental disorder of cognitive–emotional control: a transdiagnostic and family-integrated perspective

Pediatric obsessive-compulsive disorder (OCD) is a complex condition that typically emerges in childhood or adolescence and is closely linked to developmental changes in cognitive and emotional control. This mini-review offers a clinically oriented synthesis of pediatric OCD from a developmental and transdiagnostic perspective, framing it as a disturbance of flexibility, inhibition, and distress regulation that organizes its clinical presentation. Variations in these control processes across development shape the content and form of obsessive-compulsive symptoms and contribute to their frequent overlap with conditions such as autism spectrum disorder, tic disorders and Tourettic OCD, ADHD, bipolar disorder, and psychosis-risk presentations, which share similar regulatory vulnerabilities. Within this framework, family accommodation is conceptualized as an interpersonal extension of the child's regulatory difficulties, temporarily reducing distress while reinforcing reliance on external control. A transdiagnostic focus on underlying regulatory mechanisms also helps to clarify why interventions such as developmentally adapted cognitive-behavioral therapy with exposure and response prevention, family-focused treatments, and process-based transdiagnostic protocols can promote more flexible cognitive-emotional regulation in both the child and the family system. Taken together, these elements support a developmental, family-integrated, and transdiagnostic conceptualization of pediatric OCD centered on cognitive-emotional control.