BACKGROUND: Influences of race and ethnicity have received limited attention in pediatric obsessive-compulsive disorder (OCD), despite noted importance in other psychiatric diseases. We sought to compare racially defined groups presenting to a North American tertiary care pediatric OCD subspecialty clinic.

METHODS: Clinician-rated and parent/child-reported information was extracted from a research data registry comprising OCD-affected youth assessed between 2011 and 2018. The study population was aggregated into racial groups, defined as Caucasian, Asian, and “other.” Country of origin and spoken language were used as ethnicity proxies. Obsessive-compulsive disorder phenotype, clinical course, and family environment were compared, with inclusion of mixed Asian-Caucasians in post-hoc analyses.

RESULTS: Asian youth reported significantly later ages of OCD symptom onset, clinical diagnosis, and treatment compared with Caucasian youth and were significantly less likely to have participated in OCD-specific treatment, despite similar clinician recommendation rates. Obsessive-compulsive disorder severity and comorbidities did not differ across groups. Asian parents reported significantly higher levels of family blame and conflict than Caucasian parents, but similar prevalence of OCD family history.

CONCLUSIONS: Clinically relevant differences were identified between Asians and Caucasians, highlighting the need for individualized care that respects the influences of ethnicity and race in pediatric OCD. Replication and future study of additional racial groups is warranted.