Ricky and the Spider – a video game to support cognitive behavioural treatment of children with obsessive-compulsive disorder

Abstract

Objective: Paediatric obsessive-compulsive disorder (OCD) is a chronic condition with lifetime prevalence estimates of 1% to 3%. It is often associated with severe disruptions of family functioning and impairment of peer relationships as well as academic performance. The OCD Expert Consensus Guidelines for treating childhood obsessive compulsive disorder recommend cognitive behaviour therapy (CBT) as the first-line treatment of choice for prepubescent children. However, availability of cognitive behaviour therapy for paediatric obsessive compulsive disorder in the community is scarce. Moreover, there is a lack of treatment approaches specifically designed for younger children who suffer from obsessive compulsive disorder. Method: In order to enhance dissemination of empirically supported treatments, the therapeutic video game Ricky and the Spider (www.rickyandthespider.uzh.ch) was developed for children between the ages of 6 and 12 who suffer from obsessive compulsive disorder. The game is not a self-help game and should be played under the guidance of a therapist. It offers a child-friendly metaphor to understand obsessive compulsive disorder and the cognitivebehavioural treatment approach by incorporating the following elements: psycho-education, the cognitive model of obsessive compulsive disorder, creating a symptom hierarchy, the use of externalizing techniques to cope with anxiety and unpleasant feelings, and exposure - response prevention exercises. The game exists in German and English. Results: Ricky and the Spider is available since January 2012 and, up to now, has been purchased by 56 child psychiatric institutions or practitioners in Switzerland, Germany and Austria. In a preliminary evaluation, 13 therapists conveyed data of 18 children with a diagnosis of obsessive compulsive disorder in whose therapy the game was used. According to their therapists, all children had enjoyed playing the game during therapy. Therapists perceived the game as helpful for the explanation of important CBT concepts and to enhance child motivation for therapy. OCD was judged as remarkably less severe in the case of fifteen children and as unchanged in one child. All 15 children who answered the questionnaire reported being satisfied their therapist had used Ricky and the Spider during treatment, and they all appreciated the game as helpful to understand their OCD. A clear limitation of the data is the small number and the lack of a control group. Conclusions: Preliminary data on the applicability and appropriateness of Ricky and the Spider show that the game seems to be well accepted by young children affected with obsessive compulsive disorder. Moreover, therapists perceive the game as helpful for the explanation of the CBT treatment approach for OCD and to enhance child motivation for treatment. However, Ricky and the Spider is only a therapeutic tool and cannot replace the therapist. As children and adolescents with obsessive compulsive disorder have a heightened risk for clinically significant psychiatric and psychosocial problems as adults, intervening early offers an important opportunity to prevent the development of longstanding problem behaviours.