SMILES: A Child-Centered OCD Recovery Model Derived Through Thematic Analysis

Abstract

Background:

Obsessive-compulsive disorder (OCD) in children and adolescents presents unique clinical challenges, requiring individualized care. Recovery is a subjective process, and a structured recovery model is needed to guide and support children during their journey. This study explores the meaning of recovery for children with OCD and develops a model that addresses their specific needs throughout treatment.

Methods:

The central research question aimed to explore the meaning of recovery for children living with OCD. A purposive sampling approach was employed to recruit five participants each from the 7–12 years (children) and 13–17 years (adolescents) age groups, with theme saturation achieved after ten transcripts. Participants were required to have had OCD for at least six months and be in remission. Data were analyzed using thematic analysis, with the final themes synthesized into a conceptual model, SMILES. Ethical approval from the institute and informed consent were obtained from the participants and their parents.

Results:

Participants identified six key areas of recovery. These areas, derived through inductive thematic analysis, form the components of the recovery model represented by the acronym SMILES, which stands for Sense of self, Mental Health and Well-being, Institution of school, Lifestyle, Extracurricular, and Social. The SMILES model can be used in two formats—Rainbow Recovery and Blooming Recovery—based on the child’s preference.

Conclusions:

The SMILES model can enhance clinical practice by aiding clinicians in establishing a connection with children, thereby facilitating the delivery of holistic care.

Keywords

Qualitative children and adolescents obsessive-compulsive disorder recovery

Key Messages:

Holistic and Individualized Care: The SMILES recovery model offers a developmentally sensitive, age-adapted framework for engaging children and adolescents with OCD.

Flexible Implementation: Clinicians can choose between two formats based on the child’s level of understanding.

Practical Utility and Research Potential: The model is a practical tool for guiding discussions and monitoring progress throughout recovery, with potential for broader application and validation in future research.

Qualitatively, recovery can be clinical, functional, personal, or social, and quantitatively, it can be partial or complete. While instruments such as Global Assessment of Functioning,¹ Children’s Global Assessment Scale,² serve as tools to measure functional recovery, they may also have a very individualized meaning. From her lived experience, Patricia Deegan defined recovery as both a process and an outcome:

A process, a way of life, an attitude, and a way of approaching the day’s challenges. It is not a perfectly linear process. […] The need is to meet the challenge of the disability and to re-establish a new and valued sense of integrity and purpose within and beyond the limits of the disability; the aspiration is to live, work, and love in a community in which one makes a significant contribution.³

There is also the concept of “recovering from” and a “recovering in” mental illness. The former defined as “the amelioration of symptoms and other deficits … allowing the person to resume personal, social, and vocational activities within what is considered a normal range.” The latter being “…only one aspect of an otherwise whole person … the process of living one’s life, pursuing one’s hopes and aspirations, with dignity and autonomy, in the face of the on-going presence of an illness and/or vulnerability to relapse.”⁴

Mataix-Cols et al. (2016) conceptually defined recovery in obsessive-compulsive disorder (OCD) as “the patient no longer meets syndromal criteria for the disorder and has had no more than minimal symptoms.” They further proposed an operational definition:

[I]f a structured diagnostic interview is feasible, recovery is characterized by the individual no longer meeting diagnostic criteria for OCD for at least one year. Suppose a structured diagnostic interview is not feasible. In that case, recovery is indicated by a (C)Y-BOCS score of ≤12, along with a Clinical Global Impression-Severity (CGI-S) rating of 1 (“normal, not at all ill”) or 2 (“borderline mentally ill”), sustained for at least one year.⁵

Burchi et al.⁶ proposed a more comprehensive operational definition of recovery in OCD, incorporating symptomatic, durational, and functional (both objective and subjective) criteria. They suggested that a Y-BOCS score of ≤12 is a reliable cut-off to predict a clinical state in which residual symptoms, if present, do not interfere with everyday life. Additionally, a CGI-S score of 1 should be achieved, along with self-reported functional measures, such as a score of <10 on the Work and Social Adjustment Scale (WSAS) in adults or the Children’s OCD Impact Scale (COIS) in children. Furthermore, they recommended two years, aligning with recovery models in schizophrenia, as an appropriate criterion to define recovery in OCD.

Although subjective aspects of recovery have been considered through the inclusion of self-report measures, existing definitions often fail to capture what recovery truly means to an individual. Recovery is often perceived as a journey of incremental progress accompanied by a growing sense of agency. In adults, recovery indicators commonly include a return to everyday routines, access to safe and secure housing, and the restoration of social connectedness. Education and employment are recognized as facilitators and indicators of recovery. Kühne et al. (2019) highlighted a divergence in research priorities between adult patients with OCD and professionals. Patients emphasized the importance of understanding the development and maintenance of the disorder alongside psychotherapy and its efficacy. In contrast, professionals prioritized the optimization and efficacy of psychotherapy as the primary research goal.⁷

Similarly, in the context of children, it is crucial to recognize their perspectives as key stakeholders in the treatment process. While management plans are typically devised in the child’s best interests, children’s voices are not always adequately represented. Developing a recovery model grounded in this population’s “felt needs” would align with their best interests and improve the relevance and effectiveness of treatment strategies. We have reported the lived experiences of children and adolescents with OCD and also the barriers and facilitators of their recovery process. This study aims to comprehensively analyze the meaning of recovery for children living with OCD and design a recovery model that addresses the felt needs of these children during the treatment process.

Methods

Research Questions

Central Research Question

What is the meaning of recovery for children living with OCD?

Issue Sub-questions

What does it mean to be entirely all right for children living with OCD?

How do children living with OCD describe the state of being utterly all right in their own words?

Sampling

Purposive sampling of five participants, each from the 7–12 age group (children) and the 13–17 age group (adolescents), was conducted until theme saturation was reached. Theme saturation was deemed to have occurred when no new themes emerged during the analysis of the tenth transcript. This sampling strategy was employed to ensure adequate representation of both children and adolescents. Participants were required to speak in English and fulfill the criterion of having had the illness for a minimum duration of six months and being in remission at the time of intake, as defined by Mataix-Cols et al. (2016).⁵ Participants were recruited from June 2018 to May 2019.

Study Setting

The study was conducted in inpatient (IP) and outpatient (OP) settings within a tertiary-care child and adolescent psychiatry department. Face-to-face interviews took place in a private consultation room designed for therapeutic and research interactions, ensuring a comfortable and distraction-free environment. Only the participant and the researcher were present in the interview room. After providing consent and assent, two participants withdrew from the study due to difficulties articulating themselves fluently in English during the detailed interview.

Procedure

The first author, a qualified female psychiatrist with a Master’s degree in Psychiatry (MD) and expertise in child and adolescent mental health, who was pursuing super-specialization in child and adolescent psychiatry at the time of the study conducted the interviews. She was not directly involved in the clinical care of any participants before the study. This was ensured to minimize any potential bias arising from an existing therapeutic relationship. Participants were recruited through referrals from other clinicians in the department. A semi-structured interview guide, pilot-tested by the first author and validated by senior researchers, was used during the interviews. The process emphasized rapport-building, open-ended questions, reflective practices to minimize biases, and audio-recording to ensure accurate data collection, with behavioral observations made to capture emotional context and enrich understanding of participants’ experiences. The interviews ranged from 1 hour 4 minutes to 2 hours 47 minutes, averaging 1 hour 49 minutes.

Analysis

This study is part of a larger project where we employed interpretative phenomenological analysis (IPA) to explore the lived experiences of children with OCD,⁸ and inductive thematic analysis to identify barriers and facilitators to recovery.⁹ IPA provided in-depth insights into individual, subjective experiences, while thematic analysis allowed for a broader perspective by systematically identifying shared patterns across participants. For the specific objective of exploring the meaning of “recovery” for children with OCD, the research question was kept open-ended to uncover patterns or meanings. Since the primary aim was to explore what recovery means to children, inductive thematic analysis, a data-driven approach, was chosen as it allows the themes to emerge naturally. Braun and Clarke’s robust and highly flexible framework was adopted for analysis.¹⁰ The first author engaged in reflexive practices, including maintaining a research journal to document assumptions and evolving thoughts during the analysis. This helped maintain awareness of potential biases and ensured that interpretations were grounded in the data rather than preconceived notions. A dual-layered analysis was conducted, incorporating both semantic (explicit) coding (e.g., direct statements about recovery) and latent (underlying meaning) coding (e.g., struggles with identity and resilience). Although the approach was flexible, it remained structured to ensure methodological rigor.

Transcription of audio-recorded interviews and data coding process was primarily conducted by the first author, who immersed herself in the data by repeatedly reading the transcripts, making initial notes to identify potential codes, and generating initial codes. These codes were then systematically refined to ensure they accurately reflected the essence of the data. The process involved iterative cycles of reviewing and refining codes and themes to maintain coherence and distinctiveness. To enhance the rigor of the analysis, investigator triangulation was employed. A senior researcher with expertise in qualitative research independently reviewed a subset of transcripts and codes to ensure consistency and credibility. Any discrepancies were discussed and resolved through consensus. Regular discussions were held with peers who critically reviewed the themes and subthemes, providing feedback that helped refine both the coding framework and the interpretations. feedback to refine the coding framework and interpretations. Their input helped identify potential biases and improve the coherence of the thematic structure. A final set of themes was developed to understand the participants’ experiences comprehensively. The original transcripts were not returned to the participants for review or correction. However, member checks were conducted to strengthen the findings’ reliability further. The themes were summarized and shared with participants to ensure the interpretations accurately reflected their experiences. Participants confirmed that the themes resonated with their perspectives, and no significant modifications were required based on their feedback. A conceptual model was developed by synthesizing the themes identified through the thematic analysis to provide a structured framework for understanding the findings. A study design flowchart is presented in Figure 1 , illustrating the relevance of an open-ended exploration in capturing children’s perspectives on recovery from OCD. The study adhered to COREQ guidelines, and the checklist was submitted as supplementary material.

Figure 1.

Study Design Flowchart: Investigating Children’s Perspectives on Recovery from Obsessive–Compulsive Disorder (OCD).

Ethical Considerations

Permission to conduct the research was obtained from the Institutional Ethics Committee (Approval no. NIMH/DO/IEC (BEH. Sc. DIV)/2018, l1 April 2018). The study’s objectives and procedures were thoroughly explained to both the children Before participation, all participants and their parents provided written informed assent and consent, respectively. Measures were taken to ensure anonymity and confidentiality throughout the study.

The recruitment process and additional methodological details are thoroughly discussed in previous manuscripts focusing on the lived experiences,⁸ as well as the barriers and facilitators to recovery in children and adolescents with OCD.⁹

Results

Overview of Clinical–sociodemographic Profile

The study included 10 participants (four girls, six boys) aged 10–17 years, with a mean age of 11, from various socioeconomic backgrounds and an urban setting, who had an onset of OCD between 9.5 and 13 years and a diagnosis between 10 and 14.5 years. The duration of illness ranged from 10 months to 4 years and 6 months. All received combined pharmacotherapy and cognitive behavioral therapy (CBT), except one who only received CBT, and six required IP treatment during their care. The remission period varied between 12 and 28 weeks. The detailed socioeconomic and clinical profiles of the sample are provided in previous papers.^8,9

SMILES Recovery Model

The recovery model centers on the key domains identified by participants as essential to leading a fulfilling life. Therefore, it is grounded in children’s perspectives based on their insights. Participants identified six domains of functioning that they considered critical to recovery from illness. These domains, derived through inductive thematic analysis, form the foundation of the recovery model and are represented by the acronym SMILES:

Sense of Self

Mental Health and Well-being

Institution of School

Lifestyle

Extracurricular

Social

Table 1 details each domain, with illustrative excerpts from participant transcripts (three excerpts per theme) to capture their perspectives and support the identified themes.

Table 1.

Excerpts from Transcripts Illustrating the Six Domains of the SMILES Model.

Sl No.	Domain	Excerpts
1.	Sense of Self	P3: “When I had OCD, I was off my usual character. I was not myself. I am happy I have regained that sense of being me.” (11yr old boy) P4: “Talking about recovery, another aspect that I would want to include is ‘self-control’. I want to have good self-control.” (15yr old girl) P10: “I need self-confidence to face my residual fears. I need to attempt to overcome those situations where OCD is affecting me.” (17yr old girl)
2.	Mental Health and Well-being	P3: “I want to be able to think positive. It will make me feel better, which in turn will help me to move forward in life and stay happy!” (11yr old boy) P7: “I want to keep improving with regard to OCD. I should not have to put in a conscious effort to actually do something normally. I mean it should come naturally!” (16yr old girl) P5: “To be completely alright means not to have any of the OC behaviours. I should not act on my obsessive thoughts or do compulsions.” (14yr old boy)
3.	Institution of School	P1: “Graph of my academic performance went down. I worked hard and I am happy that it has come back to normal. I am getting marks I used to get.” (10yr old boy) P9: “My studies were affected due to OCD. I want to do well in school. I like to make projects, I like science.” (11yr old boy) P10: “I lost an academic year as I had stopped going to school because of my problem. I must complete my 12^th and go to college without losing another year.” (17yr old girl)
4.	Lifestyle	P1: “The thoughts and compulsions are reducing. It is easier for me to do whatever activities in my routine I have to do. I want to be normal.” (10yr old boy) P2: “I should have good food habits, a good routine like doing some household chores. It is important to have good physical activity, so I can stay healthy.” (15yr old boy) P9: “I should not just sit at home avoiding things. It is important to have good physical activity, so I can stay healthy” (11yr old boy)
5.	Extracurricular	P6: “To me, life without OCD is me spending more time on other activities – going to different classes, reading books, doing arts and craft – all things I like doing. Maybe that’s what I would be like fully without OCD.” (12yr old girl) P8: “I wished to play games, but I could not play when I was not feeling well. I am trying now, but I want to be able to play games well again.” (12yr old boy) P9: “Things are much better now. I like to cycle and even cook. I will be able to do all that if I am without OCD.” (11yr old boy)
6.	Social	P2: “I should be able to talk to my friends the way I used to earlier. I should go out and meet them more often.” (15yr old boy) P5: “My thoughts are coming in the way of being friends with others. I should be able to mingle with all the friends.” (14yr old boy) P6: “I stopped meeting friends when I had a lot of problems. I want to spend more time with them. May be, gradually I will be able to do that.” (12yr old girl)

Visual Representation of SMILES Recovery Model

We adapted the SMILES model to suit children and adolescents, ensuring that it aligns with their cognitive, emotional, and social abilities. We propose two formats for presenting this model, allowing clinicians to choose based on the child’s level of understanding. These are visual representations of the “SMILES” recovery model. Colors were carefully chosen to represent respective domains since the work of Goethe (1810), who attributed some colors to emotional responses¹¹; lot of work has been done in this field. Meier and Robinson (2005) posited the metaphor theory of color,¹² and it is known that colors can carry meanings. The colors yellow, pink, green, blue, violet, and orange have been used symbolically to represent optimism (Sense of Self), nurturance (Mental Health and Well-being), growth (Institution of School), peace (Lifestyle), creativity (Extracurricular), and friendliness (Social) for the respective domains.

SMILES: Rainbow Recovery

The recovery model has been presented using the rainbow analogy. The sun coming out after a shower of rain symbolizes “hope” in the recovery process, and the spectrum of vibrant colors represents the various domains of recovery ( Figure 2 ).

Figure 2.

SMILES: Rainbow Recovery.

SMILES: Blooming Recovery

A child’s mind has been likened to the tender petals of a flower,¹³ a metaphor applied to illustrate the impact of OCD.⁸ This model symbolizes the revival of a withering flower overcoming OCD, representing the journey to full health. Each petal represents a domain of the SMILES model, as illustrated in Figure 3.

Figure 3.

SMILES: Blooming Recovery.

Discussion

Domains of the SMILES Recovery Model

Sense of Self

The “self” has many facets to it. Rogers (1959) elucidated three elements of self—self-image, self-worth or self-esteem, and ideal self. How one views oneself constitutes the self-image. Self-esteem is related to how much value one places on oneself. What one wishes to be is the ideal self.¹⁴ In our study, participants acknowledged regaining their sense of self or expressed the need to gain self-control or self-confidence aligning with the concept of “ideal self.”

Mental Health and Well-being

In 2022, the World Health Organization (WHO) redefined mental health as a state of mental well-being that enables people to cope with the stresses of life, realize their abilities, learn well and work well, and contribute to their communities.¹⁵ Participants expressed their desire to be completely “free of OCD” or have a positive state of mind to stay happy, which points toward mental health and well-being as one of the recovery goals.

Institution of School

In this context, the term “institution of school” encompasses academic performance, which is associated with self-concept,¹⁶ and emotional intelligence.¹⁷ Children spend a significant portion of their time in school, where they are expected to fulfill the role of a student. Analysis of participants’ narratives indicates that OCD notably interferes with their academic functioning. Their struggle with OCD significantly impacts this domain, as they report striving to maintain or improve their academic performance.

Lifestyle

Lifestyle, encompassing practices such as diet, exercise, and daily routines, is critical in facilitating regular functioning during the treatment process. Incorporating lifestyle and behavioral strategies is integral to promoting positive mental health across the preventive-to-therapeutic continuum.¹⁸ Participants in this study acknowledged the significance of maintaining a healthy routine and emphasized its essential role in achieving complete recovery.

Extracurricular

Extracurricular activities, encompassing sports, arts, clubs, and other nonacademic pursuits, have been shown to influence health-related outcomes positively.^19,20 Analysis of participants’ interviews highlights the relevance of this domain in recovery, detailing various extracurricular activities and their role in enhancing life satisfaction among children.

Social

Social development is crucial for a child’s well-being, with friendships fostering emotional growth and mental health.²¹ Participants in this study emphasized the importance of meaningful friendships; however, their narratives indicate that OCD adversely impacted their social lives. These findings highlight the profound implications of OCD on the social developmental trajectory of affected children.Overall, it is noteworthy that participants identified interrelated domains, including peer relationships, academic achievement, extracurricular activities, lifestyle, mental health, well-being, and sense of self, as central to defining recovery.

Adaptation of the SMILES Model for Children and Adolescents

Piaget’s theory of cognitive development²² outlines how children’s cognitive abilities evolve through stages, influencing how they comprehend abstract concepts like recovery. We proposed two visual representations of the SMILES recovery model—Rainbow Recovery and Blooming Recovery—to accommodate variations in children’s cognitive, emotional, and social development. The format selection is guided by the child’s level of understanding and ability to relate to metaphors and visual stimuli. The concrete operational stage (7–11 years) emphasizes logical thinking with tangible representations, making the “Rainbow Recovery” model more suitable for younger children who understand visual analogies like a rainbow. The imagery of a rainbow emerging after a storm is a simple and intuitive way to convey the idea of hope and progress, making it easier for younger children to grasp the concept of recovery without needing to process abstract symbolism. Adolescents in the formal operational stage (11 years and above) can grasp abstract and symbolic representations, making the “Blooming Recovery” model a meaningful metaphor for personal growth. The metaphor of a withering flower regaining vitality symbolizes resilience and growth, aligning with their ability to understand more nuanced representations of recovery. Clinicians and caregivers can select a model that aligns with the child’s developmental stage, cognitive abilities, and personal preferences, thus enhancing the effectiveness of the recovery framework.

How Does It Compare to Existing Models of Recovery?

Recovery Star Model

It outlines key domains essential for a fulfilling life, such as physical health, self-care, relationships, work, identity, and mental health management. It aids individuals in monitoring progress across recovery phases. It facilitates discussions in clinical settings (with families), community settings (with peers to design care plans), and policymaking (to inform health interventions).²³ Similarly, the SMILES model emphasizes interconnected domains and supports holistic, person-centered care, serving as a tool for discussions and progress monitoring throughout recovery.

Community-based Rehabilitation Model

The WHO provides a community-based rehabilitation (CBR) matrix outlining complementary sectors integral to rehabilitation strategies. This matrix comprises five key components: health, education, social, livelihood, and empowerment. Notably, the components are not intended to be viewed sequentially in recovery.²⁴ Similarly, the domains of the SMILES framework should also be understood as complementary and nonsequential in recovery.

Substance Abuse and Mental Health Services Administration (SAMHSA)’s Recovery Model

The SAMHSA developed a consensus statement outlining principles essential for mental health recovery. These ten principles include a holistic approach, respect, peer support, hope, strengths-based and shared responsibility, relational aspects, nonlinear progression, cultural relevance, trauma-informed care, and a person-driven focus.²⁵ The SMILES model aligns with SAMHSA’s guiding principles by emphasizing a holistic, person-centered approach that highlights recovery’s nonlinear and individualized nature.

Strengths and Limitations

To the best of our knowledge, this is the first recovery model uniquely proposed for children and adolescents with OCD and, more broadly, for any childhood mental disorder. Developing child-centered models that incorporate lived experiences necessitates the use of qualitative methodologies. These models can subsequently be applied to larger samples and tested for reliability and validity using quantitative methods. Since qualitative research aims for in-depth exploration rather than statistical generalizability, the primary focus of this study was to capture rich, detailed narratives from children in remission from OCD. While qualitative interviews may inherently involve recall bias, the specific focus of this study—exploring recovery and how children define it—minimizes the likelihood of such bias influencing the findings. Only English-speaking participants were recruited to ensure linguistic consistency for a nuanced data interpretation. While this may limit transferability to non-English-speaking populations, the detailed accounts provide valuable insights into the lived experience of recovery. Sociodemographic homogeneity (e.g., lifestyle, social scrutiny, and support) and clinical homogeneity were also ensured by selecting individuals with at least six months of illness who were in remission at enrolment—including participants in remission allowed them to reflect on more nuanced aspects of recovery beyond the core illness, enabling them to provide more comprehensive responses. While this approach is a strength, it differs from capturing narratives of those in the acute phase of illness. Additionally, as a single-site study, the findings reflect children’s experiences within a specific clinical and sociocultural context. Future research could further explore the SMILES model’s applicability in diverse linguistic, cultural, and clinical settings to enrich its relevance across populations and in larger samples and evaluate its reliability and validity using quantitative methods.

Conclusions

The SMILES recovery model is developmentally sensitive with age-adapted frameworks designed to facilitate dialogue with children and adolescents with OCD, offering holistic and individualized care. It comprises six interconnected domains, identified through inductive thematic analysis, and represented by SMILES: Sense of Self, Mental Health and Well-being, Institution of School, Lifestyle, Extracurricular, and Social. It is implemented in two formats—Rainbow Recovery and Blooming Recovery—allowing clinicians to choose based on the child’s level of understanding. The model serves as a tool for facilitating discussions and monitoring progress throughout the recovery process.

Supplemental Material

Supplemental material for this article available online.

Footnotes

Acknowledgements

We extend our gratitude to all the children who took part in the study and to their parents for granting permission for their participation.

Data Availability Statement

The data supporting the findings of this study are easily available from the corresponding author, upon reasonable request.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Declaration Regarding the Use of Generative AI

None used.

Ethical Approval

The study was approved by the Institutional Ethics Committee at National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore (Approval Number: NIMH/DO/IEC (BEH. Sc. DIV)/2018, l1 April 2018).

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Prior Presentation

The data was presented orally at the IACAPAP Congress-2022 held in Dubai (5–9 December 2022).

References

Endicott

, Spitzer

, Fleiss

, . The global assessment scale. A procedure for measuring overall severity of psychiatric disturbance. Arch Gen Psychiatry, 1976; 33(6): 766–771. DOI: 10.1001/archpsyc.1976.01770060086012.

Shaffer

, Gould

, Brasic

, . A children’s global assessment scale (CGAS). Arch Gen Psychiatry, 1983; 40(11): 1228–1231. DOI: 10.1001/archpsyc.1983.01790100074010.

Deegan

. Recovery: The lived experience of rehabilitation. Psychosoc Rehabil J, 1988; 11(4): 11–19. DOI: 10.1037/h0099565.

Davidson

and Roe

Recovery from versus recovery in serious mental illness: One strategy for lessening confusion plaguing recovery. J Ment Health, 2007; 16(4): 459–470. DOI: 10.1080/09638230701482394.

Mataix-Cols

, Fernández de la Cruz

, Nordsletten

, . Towards an international expert consensus for defining treatment response, remission, recovery and relapse in obsessive-compulsive disorder. World Psychiatry, 2016; 15(1): 80–81. DOI: 10.1002/wps.20299.

Burchi

, Hollander

and Pallanti

From treatment response to recovery: A realistic goal in OCD. Int J Neuropsychopharmacol, 2018; 21(11): 1007–1013. DOI: 10.1093/ijnp/pyy079.

Kühne

, Brütt

, Otterbeck

, . Research priorities set by people with OCD and OCD researchers: Do the commonalities outweigh the differences?. Health Expect, 2021; 24(Suppl 1): 40–46. DOI: 10.1111/hex.13005. Epub November 28, 2019.

Sravanti

, Kommu

JVS

, Girimaji

, . Lived experiences of children and adolescents with obsessive-compulsive disorder: Interpretative phenomenological analysis. Child Adolesc Psychiatry Ment Health, 2022; 16(1): 44. DOI: 10.1186/s13034-022-00478-7.

Sravanti

, Madegowda

, Velusamy

AJP

, . Navigating recovery in childhood OCD: A qualitative analysis of barriers and facilitators. Child Adolesc Psychiatry Ment Health, 2024; 18(1): 160. DOI: 10.1186/s13034-024-00851-8.

10.

Braun

and Clarke

Using thematic analysis in psychology. Qualitative Res Psychol, 2006; 3(2): 77–101.

11.

Goethe

. Theory of Colors. London: Frank Cass, 1810.

12.

Meier

and Robinson

. The metaphorical representation of affect. Metaphor Symb, 2005; 20(4): 239–257. DOI: 10.1207/s15327868ms2004_1.

13.

Sanivarapu

. Child psyche. Indian J Psychiatry, 2013; 55(3): 300. DOI: 10.4103/0019-5545.117156.

14.

Rogers

. A theory of therapy, personality, and interpersonal relationships as developed in the client-centered framework, In: Koch

(ed) Psychology: A study of a science, vol. 3: Formulations of the person and the social context. New York (NY): McGraw-Hill, 1959, pp.184–256.

15.

World Health Organization. World mental health report: Transforming mental health for all. Geneva: World Health Organization, 2022.

16.

Susperreguy

, Davis-Kean

, Duckworth

, . Self-concept predicts academic achievement across levels of the achievement distribution: Domain specificity for math and reading. Child Dev, 2018; 89(6): 2196–2214. DOI: 10.1111/cdev.12924. Epub September 18, 2017.

17.

Corcoran

, Cheung

ACK

, Kim

, . Effective universal school-based social and emotional learning programs for improving academic achievement: A systematic review and meta-analysis of 50 years of research. Educ Res Rev, 2018; 25: 56–72. DOI: 10.1016/j.edurev.2017.12.001.

18.

Prakash

, Chatterjee

, Srivastava

, . Role of various lifestyle and behavioral strategies in positive mental health across a preventive to therapeutic continuum. Ind Psychiatry J, 2020; 29(2): 185–190. DOI: 10.4103/ipj.ipj_126_20. Epub March 15, 2021.

19.

Hallal

, Andersen

, Bull

, . Lancet physical activity series working group. Global physical activity levels: Surveillance progress, pitfalls, and prospects. Lancet, 2012; 380(9838): 247–257. DOI: 10.1016/S0140-6736(12)60646-1.

20.

Ricci

, Clevenger

, Sellers

, . Associations between extracurricular activity participation and health-related variables in underrepresented children. Sports Med Health Sci, 2020; 2(2): 102–108. DOI: 10.1016/j.smhs.2020.06.001.

21.

National Research Council (US) and Institute of Medicine (US) Committee on integrating the science of early childhood development; Shonkoff

, Phillips

, editors. From neurons to neighbourhoods: The science of early childhood development. Washington (DC): National Academies Press (US), 2000, 7, Making friends and getting along with peers. Available from: https://www.ncbi.nlm.nih.gov/books/NBK225544/

22.

Scott

and Cogburn

. Piaget. [Updated January 9, 2023]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing, 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448206/

23.

Killaspy

, White

, Taylor

, . Psychometric properties of the mental health recovery star. Br J Psychiatry, 2012; 201(1): 65–70. DOI: 10.1192/bjp.bp.111.107946.

24.

Khasnabis

, Heinicke

Motsch K

, Achu

, . editors. Community-based rehabilitation: CBR Guidelines. Geneva: World Health Organization, 2010.

25.

Substance Abuse and Mental Health Services Administration. Guiding principles and elements of recovery-oriented systems of care: What do we know from the research? Center for Substance Abuse Treatment, SAMHSA, 2009. p. 12. https://www.naadac.org/assets/2416/sheedyckwhitterm2009_guiding_principles_and_elements.pdf

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.03 MB

0.00 MB