The Children’s Obsessional Compulsive Inventory–Revised – Parent Report (ChOCI-R-P) is a 38-item parent-report measure of obsessive–compulsive disorder (OCD) symptoms in children and adolescents aged 7 to 17 years (Uher et al., 2008). It is completed by a parent or caregiver who is familiar with the child’s experiences. There is also a self-report version of the ChOCI (ChOCI-R-S) that can be completed by children or adolescents aged 7 to 17 years.
OCD in children and adolescents is characterised by recurrent unwanted thoughts (obsessions) and repetitive behaviours or mental acts (compulsions) that the child feels compelled to perform. If untreated, paediatric OCD is associated with substantial functional impairment in academic, social and family domains and tends to persist into adulthood (Heyman et al., 2006). Reliable measurement of severity in young people is challenging because children may under-report or over-report their symptoms during clinical interview, and parents often have observable information about compulsions (washing, checking, ordering) that the child cannot articulate. A parent-report measure offers a useful complement to a child-report, particularly for younger children and for tracking change over time.
The ChOCI-R-P comprises six scored outputs across two construct dimensions:
Example ChOCI-R-P Item
The measure is designed for use with children and adolescents who have an established or suspected diagnosis of OCD. Its primary application is progress monitoring during treatment for paediatric OCD, where pre-treatment, mid-treatment and post-treatment scores can be compared to track symptom reduction and functional improvement. The subscale structure of the ChOCI-R-P can also guide where a clinician focuses exposure hierarchies and cognitive intervention. Additionally, the measure can inform formulation, where the symptom and impairment profile contributes to a broader case conceptualisation alongside diagnostic interview and child-report data.
The ChOCI-R-P results in six raw scores, computed by summing item responses. Higher values indicate greater OCD severity. The measure produces two parallel sets of scores: symptoms (how often and how strongly OCD presents) and impairment (how much OCD disrupts daily life).
Three open-text items in each symptom section (items 11 to 13 for habits and items 30 to 32 for thoughts) ask the parent to describe the child’s three most upsetting habits and thoughts. These items are not scored, but provide additional detail to aid treatment planning.
Each raw score is presented alongside a percentile rank against an OCD-clinical reference sample (Uher et al., 2008). A percentile of 50 corresponds to the OCD-clinical reference average; a percentile of 80 indicates a score exceeding approximately 80% of OCD-diagnosed children in the reference group. Because the reference sample is clinical (not community), percentile interpretation is positional within an OCD-diagnosed group: a percentile of 50 reflects the average level for a child diagnosed with OCD, not the general paediatric population.
Each score is accompanied by a descriptor label derived from the Uher et al. (2008) OCD-clinical reference sample. Total Symptoms and Total Impairment thresholds are defined on raw scores; subscale thresholds mirror the Total’s percentile cuts. These labels show where the child sits within an OCD-diagnosed reference group, not within the general paediatric population.
Symptoms (three bands): Low (below typical for children with OCD, percentile <18), Moderate (within typical OCD-clinical range, percentile 18–85), and High (above typical OCD-clinical range, percentile ≥86). Raw-score boundaries:
Impairment (five bands): Subclinical (atypically low for the OCD-clinical reference, percentile ≤1), Mild (below typical for children with OCD, percentile 2–16), Moderate (within typical OCD-clinical range, percentile 17–58), Severe (above typical OCD-clinical range, percentile 59–89), and Extreme (at the top of the OCD-clinical distribution, percentile ≥90). Raw-score boundaries:
Each subscale captures a clinically distinct dimension of OCD presentation. Higher scores on Compulsion Symptoms indicate that the parent has observed more frequent or more severe compulsive behaviours, including washing, checking, ordering, counting, repeating, and reassurance-seeking. Higher scores on Obsession Symptoms indicate more frequent intrusive thoughts of harm, contamination, doubt, mortality, blasphemy, or aggressive content. Higher scores on Compulsion Impairment indicate greater functional disruption from compulsions, including time spent, interference with school and friends, distress when prevented from acting, weak resistance, low control, and avoidance. Higher scores on Obsession Impairment indicate equivalent disruption from obsessive thinking.
When the ChOCI-R-P is administered on multiple occasions, change between administrations is interpreted via a Reliable Change Index (RCI). A change of approximately 8 raw-score points or greater on Total Impairment, or 9 or greater on Total Symptoms, is interpreted as a reliable change that exceeds measurement error at the 95% confidence level.
On first administration, the report presents a results table followed by two construct sections (Symptoms and Impairment). Each section contains two horizontal raw-score charts. The first plots the construct’s total as a single bar with the client’s raw score against a 25th-to-75th percentile reference rectangle and a dashed line at the clinical average from the OCD-clinical reference sample. The second plots the construct’s two subscales (Compulsion and Obsession) with their own reference rectangles and clinical-average lines.
On repeat administration, the report presents the same results table followed by a 2×2 grid of multi-administration raw-score line plots: Symptoms across the top row (Total on the left, Compulsion and Obsession subscales on the right) and Impairment across the bottom row (same layout).
The ChOCI-R is a revision of the original CHOCI (Shafran et al., 2003), refined to improve item-level psychometrics and broaden severity coverage. The original CHOCI used 19 symptom items rated on a three-point scale (1 to 3) and a 10-item impairment scale derived from the CY-BOCS interview, scored 0 to 4. The ChOCI-R retains the 10 best-performing symptom items per section (compulsions and obsessions), changes the symptom response format to a three-option scale scored 0 to 2, and adds an avoidance item to each impairment section to align with the adult Y-BOCS. The remaining five impairment items (time, interference, distress, resistance, control) are unchanged between the original CHOCI and the ChOCI-R (Uher et al., 2008).
Psychometric validation of the ChOCI-R was conducted in a sample of 285 children and adolescents attending an OCD clinic over the period 2000 to 2006 (Uher et al., 2008). All children met ICD-10 criteria for OCD established via structured clinical interview.
Factor-analytic work supports the use of separate Compulsion and Obsession subscales for clinical interpretation. Exploratory analysis of the parent-report ChOCI-R recovered three factors broadly corresponding to Compulsions, Obsessions and Resistance, with the parent version showing less clean obsession/compulsion separation than the self-report version (Uher et al., 2008). This pattern is consistent with parents inferring obsessions from observed behaviours rather than directly accessing the child’s internal experience. The NovoPsych scoring approach prioritises the clinically meaningful distinction between compulsive and obsessive content, producing separate Compulsion and Obsession scores at both the Symptoms and Impairment levels.
Internal consistency of the parent-report ChOCI-R is strong across the four subscales and two totals (Uher et al., 2008). For the impairment scales, Cronbach’s α was .84 (Obsessions Impairment, N = 240), .78 (Compulsions Impairment, N = 269) and .87 (Total Impairment, N = 240). For the symptom scales, α was .86 (Obsession Symptoms, N = 240), .75 (Compulsion Symptoms, N = 269) and .85 (Total Symptoms, N = 240). The lower α for the Compulsion Symptoms scale reflects the heterogeneity of compulsive behaviours, with the hand-washing item showing a low item-total correlation; the authors retained the item to preserve coverage of a clinically common compulsion.
Convergent validity was demonstrated through a moderate correlation between the parent-report ChOCI-R Total Impairment and the CY-BOCS Total score (r = 0.45, N = 199, p < .001; Uher et al., 2008). The moderate (rather than strong) correlation, compared with r = 0.55 for the self-report ChOCI-R against the CY-BOCS, reflects the partial independence of parent observation and clinician-rated severity in young people.
Inter-rater agreement between parent-report and child-report ChOCI-R was strong, with intraclass correlation coefficients of 0.77 (95% CI 0.69–0.83) for Total Impairment, 0.70 (95% CI 0.59–0.77) for Obsessions Impairment, and 0.80 (95% CI 0.74–0.85) for Compulsions Impairment (Uher et al., 2008).
Item-response theory (IRT) analysis demonstrated that the parent-report ChOCI-R-P provides better discrimination across the mild-to-moderate severity range than the CY-BOCS interview, which discriminates best at the most severe end of the spectrum (Uher et al., 2008). This complementary discriminatory profile supports the use of the ChOCI-R-P as a routine outcome measure in clinical practice, where many children present in the mild-to-moderate severity range and finer-grained discrimination is clinically useful.
The ChOCI-R-P has demonstrated sensitivity to change in three independent treatment studies spanning the paediatric age range (7 to 17). Lenhard and colleagues (2017) reported a within-group pre-post effect of d = 0.68 (95% CI 0.18–1.18) and a between-group effect of d = 0.59 (95% CI 0.09–1.10) favouring internet-delivered CBT over waitlist in adolescents aged 12 to 17 (N = 67; p = .012), with continued improvement to a 3-month follow-up. Aspvall and colleagues (2018) reported very large pre-post effects (d = 2.15, 95% CI 1.07 to 3.20) in a 12-week internet-delivered CBT open trial with young children aged 7 to 11 (N = 11), with α = .87 in that sample (replicating Uher et al., 2008). Chessell and colleagues (2024) reported large pre-post effects in a parent-led brief CBT case series of pre-adolescents aged 5 to 12 (N = 10): d ≈ −1.0 for symptoms and d ≈ −1.1 for impairment, with 50% reliable improvement on symptoms and 60% on impairment at post-treatment.
Reference percentiles are derived from Uher and colleagues (2008): 285 consecutive referrals (240 to 269 with complete parent-report data per subscale) to an OCD clinic between 2000 and 2006, all meeting ICD-10 criteria for OCD via structured clinical interview, with no significant sex differences (boys’ average age = 13.7, range 7 to 18; girls’ average age = 13.7, range 9 to 18). Reference parameters for the parent-report subscales are Compulsion Symptoms average = 9.8, SD = 4.5; Obsession Symptoms average = 8.4, SD = 5.2; Total Symptoms average = 18.3, SD = 8.0; Compulsion Impairment average = 16.5, SD = 4.2; Obsession Impairment average = 15.5, SD = 5.0; Total Impairment average = 32.1, SD = 8.4. Because this reference sample is clinical (not community), percentile interpretation is positional within an OCD-diagnosed reference group: a percentile of 50 reflects the average level for a child diagnosed with OCD, not the general paediatric population. No community-sample reference data exists for the parent-report ChOCI-R-P, and the original authors note that confirmation in primary care and population-based samples remains needed (Uher et al., 2008).
Symptoms and Impairment measure related but distinct dimensions: how often and how strongly symptoms are present, and how much they disrupt daily life. The two can move independently and the gap itself is informative. Where symptoms are elevated but impairment is lower, possible explanations include early presentation, effective coping strategies, or family routines that accommodate symptoms in ways that buffer functional impact. The reverse profile (lower symptoms with elevated impairment) may indicate that the symptoms present are particularly entrenched or distressing, or that the parent is observing functional effects without fully identifying the underlying symptoms. Both divergent profiles warrant looking beyond the totals during formulation.
Discrepancies between informants are common and the gap itself is useful clinical data. Parents typically have better visibility of observable compulsions (washing, checking, asking for reassurance) and tend to underestimate obsessions and covert rituals. Children may underreport when symptoms feel shameful, when insight is limited (more common in younger children), or when they have learned to mask symptoms in front of caregivers. When the parent score substantially exceeds the child score, consider limited insight, minimisation, or symptom concealment. When the child score exceeds the parent score, suspect covert symptoms or content the child has not disclosed at home. Both reports remain valid; the divergence becomes a formulation discussion point and frequently flags family accommodation patterns worth targeting in treatment.
The validated age range is 7 to 17 years. Subsequent treatment trials have applied the measure as low as age 5 in small samples and as low as age 7. Use below age 7 should be interpreted with caution as percentile interpretation may be less reliable because the reference distribution does not include this end of the range. The reference sample included 18-year-olds, so the measure can be used at this age, though a self-report adult measure such as the OCI-R may be more appropriate.
For active CBT-with-Exposure and Response Prevention, weekly or fortnightly parent-rated ChOCI-R-P provides a session-level signal: a falling Compulsion subscale with a still-elevated Obsession subscale often indicates the family is reducing observable rituals while the underlying obsessional content remains untreated, suggesting the exposure hierarchy needs to shift toward the feared thought rather than the behaviour. A flat or rising Impairment score despite falling Symptoms scores typically points to entrenched family accommodation that has not yet been targeted. Plateaus across several weeks warrant a hierarchy review and a check on between-session exposure adherence. In maintenance or follow-up, 4 to 6 weekly intervals are usually sufficient to detect re-emergence early. Trial protocols have used both weekly and pre/post/3-month schedules.
Yes, where the child is able to complete a self-report. The parent-rated ChOCI-R-P and the child self-rated ChOCI-R-S are most powerful when used together: administering both at initial assessment gives the clinician a multi-informant baseline that supports more confident formulation and treatment planning. During active treatment, the two measures can be used flexibly. Weekly or fortnightly ChOCI-R-P is the typical pattern for tracking observable change, with periodic ChOCI-R-S to check whether the child’s own experience is shifting alongside the behavioural picture. For younger children who cannot reliably self-report, the ChOCI-R-P alone remains a strong progress-monitoring tool.
Uher, R., Heyman, I., Turner, C. M., & Shafran, R. (2008). Self-, parent-report and interview measures of obsessive–compulsive disorder in children and adolescents. Journal of Anxiety Disorders, 22(6), 979-990. doi:10.1016/j.janxdis.2007.10.001
Aspvall, K., Andrén, P., Lenhard, F., Andersson, E., Mataix-Cols, D., & Serlachius, E. (2018). Internet-delivered cognitive behavioural therapy for young children with obsessive–compulsive disorder: Development and initial evaluation of the BIP OCD Junior programme. BJPsych Open, 4(3), 106–112. https://doi.org/10.1192/bjo.2018.10
Chessell, C., Halldorsson, B., Walters, S., Farrington, A., Harvey, K., & Creswell, C. (2024). Therapist guided, parent-led cognitive behavioural therapy (CBT) for pre-adolescent children with obsessive compulsive disorder (OCD): A non-concurrent multiple baseline case series. Behavioural and Cognitive Psychotherapy, 52, 243–261. https://doi.org/10.1017/S1352465823000450
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Stiede, J. T., Spencer, S. D., Onyeka, O., Mangen, K. H., Church, M. J., Goodman, W. K., & Storch, E. A. (2024). Obsessive–compulsive disorder in children and adolescents. Annual Review of Clinical Psychology, 20, 355–380. https://doi.org/10.1146/annurev-clinpsy-080822-043910
Uher, R., Heyman, I., Turner, C. M., & Shafran, R. (2008). Self-, parent-report and interview measures of obsessive–compulsive disorder in children and adolescents. Journal of Anxiety Disorders, 22(6), 979–990. https://doi.org/10.1016/j.janxdis.2007.10.001
