The Rationale and Some Features of the Nordic Long-Term OCD Treatment Study (NordLOTS) in Childhood and Adolescence

Abstract

OCD is a more prevalent disorder than was once thought at a point prevalence from 0.6–1.5% in older children and young adolescents (Heyman et al. 2001) often running a chronic course as found in a meta-analysis of available outcome studies (Stewart et al. 2004). While a third of those who still were ill did fairly well, the other 2/3 had significant impairment and suffering. However, the patients had received very different therapies ranging from those known to be ineffective, such as psychodynamic psychotherapy, ‘‘classical’’ family therapy or drugs as benzodiazepines to therapies that had included CBT and/or serotonine active drugs at some point. The range of outcome did not differ as much as one would have hoped, given the range of treatments (see also Nissen and Thomsen 2008). Those who had had an inadequate first treatment tended to do worse. More than 50% of adults with OCD report onset in childhood/adolescence (Rasmussen and Eisen 1992), and we really do not know to what extent adults with OCD had been in treatment as children, nor if they had, to what extent it helped. The question of chronic pediatric OCD is not a trivial one, children with OCD grow up and many adults with OCD had childhood onset (Rasmussen and Eisen 1992). Adult OCD is the 10:th most common cause of disability from illness, including somatic illness (Lopez 1996, cited in Haynes et al. 2006).