Treatment Of Obsessive-compulsive Disorder In Children Research Articles

Technology-based CBT in Reducing Symptoms of OCD in Children: A Systematic Review

Background: Obsessive Compulsive Disorder (OCD) is an anxiety disorder affecting up to 3% of children and adolescent in the United States. Cognitive behavioral therapy (CBT) is the first-line treatment for mild to moderate OCD in children. Despite the benefits of CBT in treatment of OCD, only one-third of clinicians regularly use CBT compared to psychotropic medication due to lack of access. The COVID-19 pandemic has resulted in increased relapses in OCD severity and further limited access to traditional face-to-face CBT treatment due to health and safety precautions. Purpose: This systematic review aims to demonstrate the efficacy of technology-based CBT by evaluating results of clinical trials and its comparability to traditional CBT methods. Methods: An evidence-based search was conducted using terms such as “Obsessive-Compulsive disorder” AND “ internet” AND “cognitive behavior therapy” and “children”. A total of 716 articles were identified. Results: After screening titles, abstracts, and full articles for relevance, 7 studies with a total of 254 subjects and four different programs involving technology-based CBT were included in this systematic review. Information gathered in this review support the use of technology-based CBT as an effective treatment in reducing the severity of OCD symptoms as shown by statistically significant reductions in Children Yale-Brown Obsessive-Compulsive Scale scores. Additionally, the results from this review support previous clinical studies demonstrating that effects of technology-based CBT were non-inferior to traditional CBT methods. Conclusion: The results of this systematic review support the use of technology-based CBT for the treatment of OCD in children and adolescents, especially in times where access to in-person therapist sessions are not possible due to geographical or global concerns. Additional research is needed to understand the impact and acceptability of new CBT methods on daily-life as well as the effectiveness of technology-based methods on more severe cases of OCD.

Clinical significance of family accommodation and parental psychological distress in a sample of children and adolescents with obsessive-compulsive disorder aged 8-17 years old

BackgroundFamily Accommodation (FA) refers to the involvement of family members (especially parents) in the compulsive behaviors of children and adolescents with Obsessive-Compulsive Disorder (e.g. modifying family routines or facilitating avoidance of obsessive-compulsive triggers). Many studies have examined the high prevalence of FA in this clinical population; however, less is known about its clinical significance and relationship to the individual psychological distress of parents. In our study, we investigated the clinical significance of FA examining its relationship with obsessive-compulsive symptomatology, functioning, anxiety and depressive symptoms in a clinical sample (n = 51) of children and adolescents with Obsessive-Compulsive Disorder (OCD) aged 8–17 years old and their parents, included to examine their individual psychological distress.MethodsThe sample was divided into two groups: the High Accommodation group (n = 36) and the Low Accommodation group (n = 15).ResultsResults demonstrated that children and adolescents in the OCD High Accommodation group reported major functional impairment in global (p = .001313), social (p = .000334) and role (p = .000334) domains, and higher depressive symptoms than the Low Accommodation group. Both fathers and mothers from the High Accommodation group reported a higher level of individual psychological distress compared to mothers and fathers from the Low Accommodation group (p = .040365).ConclusionsThe findings of this study show that FA is common in children and adolescents with OCD and it could cause not only an impairment of the patient’s global, social and role functioning but also a high level of individual psychological distress in the single parent. The presence of FA should therefore be carefully investigated and considered in planning assessment and treatment of OCD in children and adolescents.

Online Cognitive Bias Modification of Interpretation for Children With Obsessive-Compulsive Disorder

Objective: Numerous children with Obsessive-Compulsive Disorder (OCD) either have no access to its main treatment, i.e. Cognitive Behavioral Therapy (CBT), or fail to respond to it. Cognitive Bias Modification of Interpretation (CBMI) is a novel and promising intervention that targets the incorrect interpretation of intrusive thoughts and impulses, i.e. the characteristics of OCD. The present study aimed to determine the effects of CBMI in children with OCD for the first time. Besides, we evaluated the possibility of online implementation of this intervention. Methods: A sample of 35 children with OCD (aged 7-12 years) were randomly assigned to two study groups. The experimental group (n=18) received CBMI and the controls (n=17) received placebo treatment. Interpretation bias and OCD severity were assessed at pre-test, post-test, and 2-month follow-up stages, using the Obsessive Compulsive Inventory-Child Version (OCICV), Obsessive Beliefs Questionnaire-Child Version (OBQCV), and Ambiguous Scenarios Task (AST). The present study results were analyzed using two-way repeated-measures Analysis of Variance (ANOVA) and Paired Samples t-test. Results: The collected findings demonstrated that after receiving CBMI, children’s propensity to positively interpret ambiguous situations was increased, their tendency towards negative interpretation and OCD severity was also decreased. There was no such significant change in the control group. Furthermore, the effects of CBMI was sustained at the 2-month follow-up step. Conclusion: This study provided preliminary evidence that suggests CBMI is capable of modifying interpretation bias in children with OCD, can reduce the severity of their disorder, and works as an online intervention. This brief and inexpensive intervention could be considered as an auxiliary or standalone treatment for OCD in children.

Executive function predicts cognitive-behavioral therapy response in childhood obsessive-compulsive disorder

Cognitive-behavioral therapy (CBT) is considered first-line treatment for childhood obsessive-compulsive disorder (OCD). Despite CBT's efficacy, too many children and adolescents do not fully respond to treatment, making the identification of predictors of treatment response highly relevant. Executive functions (EF) have been suggested to constitute such predictors, but studies with pediatric samples are scarce. In the present study, we investigated latent level EF test performance and ratings of daily life EF behavior as predictors of CBT response in pediatric OCD. We further examined the stability of EF from pre-to post-treatment and the association of EF changes with OCD severity change. EF test performance significantly predicted exposure-based CBT outcome. Patients with better EF test performance had significantly elevated risk of non-response relative to patients with poorer performance. Daily life EF behavior in OCD probands improved after treatment relative to controls. The findings suggest that EF performance impacts CBT outcome, and that exposure-based CBT is well-suited for children and adolescents with OCD and poorer EF test performance. This study supports the relevance of EF in CBT for childhood OCD and denotes a possible need for development of enhanced treatments for children and adolescents with OCD and superior EF performance.

Introduction to the Special Issue

Obsessive-compulsive disorder (OCD) has long been considered a complex and disabling psychiatric condition, marked by intrusive and unwanted imagery (obsessions) that is usually accompanied by ritualized behavior designed to neutralize the obsessions. Treatment research has shown that, for those who complete treatment, significant improvement can be achieved (Simpson et al., 2011; Storch, Geffken, et al., 2007). There is a growing consensus that the first-line psychosocial treatment for OCD is exposure with response prevention (ERP; McKay et al., 2013; Olatunji et al., 2013). In the case of children, meta-analyses have shown that ERP is highly efficacious, with large effect sizes (mean d = 1.98; Abramowitz, Whiteside, & Deacon, 2005). Indeed, practice parameters recommend ERP monotherapy as the treatment of choice for mild and moderate cases, and together with antidepressant medication for only the most severe presentation. Although this augurs well for the treatment of children with OCD, not all children respond to treatment and ERP dissemination remains a challenge. Accordingly, this special issue is devoted to cases involving variations in treatment delivery and symptom presentation in childhood OCD. The articles that form this special issue address a variety of special circumstances that take the reader beyond the findings from randomized controlled trials that evaluate the efficacy of ERP in general. Instead, these cases help the reader understand the issue of comorbidity and how to successfully contend with it during treatment, and provide a peek at several promising avenues that are emerging in the treatment of childhood OCD. These include addressing family-related complications in treatment delivery, specific developmental phases (i.e., in very young children), Also examined in this special are cases with under severe stigmatizing conditions, when symptoms present with complex comorbidities, and evaluation of interventios that by capitalizes on technological advances in service delivery.

Pediatric Obsessive-Compulsive Disorder

Effective treatment for childhood obsessive-compulsive disorder (OCD) is available, including exposure with response prevention and other cognitive-behavioral interventions. However, many children with OCD reside in locations in which few providers have adequate training to implement these procedures correctly. Family accommodation of childhood OCD symptoms further complicates the delivery of existing treatments. The advent of web camera technology has created the opportunity to provide therapy to individuals who otherwise could not access expert care. This case illustrates the treatment of an 8-year-old child with severe OCD who lived in a remote region of the United States. Treatment was administered twice daily for 5 days via web camera. At a 3-month follow-up, the child showed significant improvement in her OCD symptoms and in overall disability. Other symptoms (anxiety and anxiety sensitivity) were reduced, but not at a statistically significant level. The implications for treatment are considered.

Family factors predict treatment outcome for pediatric obsessive-compulsive disorder.

To examine family conflict, parental blame, and poor family cohesion as predictors of treatment outcome for youths receiving family-focused cognitive behavioral therapy (FCBT) for obsessive-compulsive disorder (OCD). We analyzed data from a sample of youths who were randomized to FCBT (n = 49; 59% male; M age = 12.43 years) as part of a larger randomized clinical trial. Youths and their families were assessed by an independent evaluator (IE) pre- and post-FCBT using a standardized battery of measures evaluating family functioning and OCD symptom severity. Family conflict and cohesion were measured via parent self-report on the Family Environment Scale (Moos & Moos, 1994), and parental blame was measured using parent self-report on the Parental Attitudes and Behaviors Scale (Peris, Benazon, et al., 2008b). Symptom severity was rated by IEs using the Children's Yale-Brown Obsessive Compulsive Scale (Scahill et al., 1997). Families with lower levels of parental blame and family conflict and higher levels of family cohesion at baseline were more likely to have a child who responded to FCBT treatment even after adjusting for baseline symptom severity compared with families who endorsed higher levels of dysfunction prior to treatment. In analyses using both categorical and continuous outcome measures, higher levels of family dysfunction and difficulty in more domains of family functioning were associated with lower rates of treatment response. In addition, changes in family cohesion predicted response to FCBT, controlling for baseline symptom severity. Findings speak to the role of the family in treatment for childhood OCD and highlight potential targets for future family interventions.

LONG-TERM DURABILITY OF COGNITIVE BEHAVIORAL THERAPY GAINS FOR PEDIATRIC OBSESSIVE-COMPULSIVE DISORDER

Children who receive cognitive-behavioral therapy (CBT) to target obsessive-compulsive disorder (OCD) have been found to evidence decreased symptoms at 12 or 24 months after treatment. 1 Barrett PD Farrell L Dadds M Boulter N Cognitive-behavioral family treatment of childhood obsessive-compulsive disorder: long-term followup and predictors of outcome. J Am Acad Child Adolesc Psychiatry. 2005; 44: 1005-1014 Abstract Full Text Full Text PDF PubMed Scopus (134) Google Scholar , 2 March JS Mulle K Herbel B Behavioral psychotherapy for children and adolescents with obsessive-compulsive disorder: an open-trial of a new protocol-driven treatment package. J Am Acad Child Adolesc Psychiatry. 1994; 33: 333-341 Abstract Full Text PDF PubMed Scopus (209) Google Scholar However, no studies published to date have explored the long-term durability of CBT gains beyond 24 months. Here, we report on the 24- to 36-month durability of treatment gains for youths who had participated in a previous CBT trial for OCD.

Cognitive-behavioral family treatment for childhood obsessive-compulsive disorder: A 7-year follow-up study

This study evaluated the long-term durability of individual and group cognitive-behavioral family-based therapy (CBFT) for childhood obsessive-compulsive disorder (OCD). Thirty-eight participants (age 13–24 years) from a randomized controlled trial of individual or group CBFT for childhood OCD were assessed 7 years post-treatment. Diagnostic, symptom severity interviews and self-report measures of OCD, anxiety, and depression were administered. Seven years after treatment, 79% of participants from individual therapy and 95% from group therapy had no diagnosis of OCD. These results are near identical to results found at 12 and 18 months follow-ups of the same sample. No significant differences were found between treatment conditions, self-reports of symptom severity, except that depressive symptoms were significantly more pronounced for individual treatment condition, and those in the older age group (19–24 years of age). Results suggest that CBFT for obsessive-compulsive disorder is effective 7 years post-treatment.

Cochrane review: Behavioural and cognitive behavioural therapy for obsessive compulsive disorder in children and adolescents

AbstractBackgroundWhile behavioural or cognitive‐behavioural therapy (BT/CBT) is recommended as the psychotherapeutic treatment of choice for children and adolescents with obsessive‐compulsive disorder (OCD), the application of BT/CBT to paediatric OCD may not be straightforward.ObjectivesThis review examines the overall efficacy of BT/CBT for paediatric OCD, its relative efficacy against psychopharmacology and whether there are benefits in using BT/CBT combined with medication.Search strategyWe searched CCDANCTR‐Studies and CCDANCTR‐References (searched on 5/8/2005), MEDLINE, EMBASE, PsycINFO, the reference lists of all selected studies and handsearched journals specifically related to behavioural treatment of OCD.Selection criteriaIncluded studies were randomised controlled trials or quasi‐randomised trials with participants who were 18 years of age or younger and had a diagnosis of OCD, established by clinical assessment or standardised diagnostic interview. Reviewed studies included the standard behavioural or cognitive‐behavioural techniques, either alone or in combination, compared with wait‐list or pill placebo.Data collection and analysisThe quality of selected studies was assessed by two independent reviewers. The primary outcomes comprised of endpoint scores on the gold standard clinical outcome measure of OCD symptoms, distress and interference (CY‐BOCS) and endpoint OCD status.Main resultsFour studies with 222 participants were considered eligible for inclusion and for data extraction. Two studies showed significantly better post‐treatment functioning and reduced risk of continuing with OCD at post‐treatment for the BT/CBT group compared to placebo or wait‐list comparisons. We suggested that the POTS 2004 result, equal to a difference of about eight points on the CY‐BOCS, represented the best available estimate for the efficacy of BT/CBT relative to no treatment. (WMD ‐7.50; 95% CI ‐11.55, ‐3.45). Pooled evidence from two trials indicated that the efficacy of BT/CBT and medication did not differ significantly (WMD ‐3.87; 95% CI ‐8.15, 0.41). There was evidence of the benefit of combined BT/CBT and medication compared to medication alone (WMD ‐4.55; 95% CI ‐7.40, ‐1.70), but not relative to BT/CBT alone (WMD ‐2.80; 95% CI ‐7.55, 1.95). The rates of drop out suggested BT/CBT is an acceptable treatment to child and adolescent patients and their families.Authors' conclusionsAlthough only based on a small number of studies, behavioural or cognitive‐behaviour therapy appears to be a promising treatment for OCD in children and adolescents. It can lead to better outcomes when combined with medication compared to medication alone. Additional trials are needed to confirm these findings. In the interim, consideration should be given to the ways in which BT/CBT might be made more widely available as a treatment for OCD in children and adolescents.Plain language summaryPlain language summaryBehavioural and cognitive‐behavioural therapy for obsessive‐compulsive disorder (OCD) in children and adolescentsThe onset of obsessive‐compulsive disorder often occurs in childhood and adolescence. It can be an extremely debilitating disorder, resulting in high levels of distress, impairment and disruption of psychosocial development. It also has a considerable impact on other family members. While there is evidence that medication can reduce symptoms, behavioural and cognitive‐behavioural therapy (BT/CBT) are often proposed as acceptable alternative treatments. These therapies have various components, but commonly include assisting the child to better tolerate the anxiety provoking situations and thoughts, without the use of compulsive behaviour to manage their anxiety. Other components include psycho‐education about anxiety and OCD, cognitive training involving learning to identify and challenge unhelpful ways of thinking, and parental involvement.This review identified four RCTs, involving 222 participants, evaluating the benefits of behavioural and cognitive‐behavioural therapy. The results from two individual studies show that, compared to a wait‐list or pill placebo, BT/CBT is an effective treatment for reducing OCD symptoms and lowering the risk of having OCD after treatment. Based on two studies that directly compared BT/CBT with anti‐OCD medication, there was no evidence to suggest that either BT/CBT or anti‐OCD medication was superior to the other. When combined with medication, BT/CBT produces better outcomes than medication alone, but combining medication and BT/CBT does not result in better outcomes than BT/CBT alone.Although based on a small number of studies, these findings provide some support for the potential value of BT/CBT in the treatment of children and adolescents with OCD. Sufferers and their families may wish to enquire about the appropriateness of BT/CBT, and to request information about the availability of appropriately skilled clinicians.

Behavioural and cognitive behavioural therapy for obsessive compulsive disorder in children and adolescents

While behavioural or cognitive-behavioural therapy (BT/CBT) is recommended as the psychotherapeutic treatment of choice for children and adolescents with obsessive-compulsive disorder (OCD), the application of BT/CBT to paediatric OCD may not be straightforward. This review examines the overall efficacy of BT/CBT for paediatric OCD, its relative efficacy against psychopharmacology and whether there are benefits in using BT/CBT combined with medication. We searched CCDANCTR-Studies and CCDANCTR-References (searched on 5/8/2005), MEDLINE, EMBASE, PsycINFO, the reference lists of all selected studies and handsearched journals specifically related to behavioural treatment of OCD. Included studies were randomised controlled trials or quasi-randomised trials with participants who were 18 years of age or younger and had a diagnosis of OCD, established by clinical assessment or standardised diagnostic interview. Reviewed studies included the standard behavioural or cognitive-behavioural techniques, either alone or in combination, compared with wait-list or pill placebo. The quality of selected studies was assessed by two independent reviewers. The primary outcomes comprised of endpoint scores on the gold standard clinical outcome measure of OCD symptoms, distress and interference (CY-BOCS) and endpoint OCD status. Four studies with 222 participants were considered eligible for inclusion and for data extraction. Two studies showed significantly better post-treatment functioning and reduced risk of continuing with OCD at post-treatment for the BT/CBT group compared to placebo or wait-list comparisons. We suggested that the POTS 2004 result, equal to a difference of about eight points on the CY-BOCS, represented the best available estimate for the efficacy of BT/CBT relative to no treatment. (WMD -7.50; 95% CI -11.55, -3.45). Pooled evidence from two trials indicated that the efficacy of BT/CBT and medication did not differ significantly (WMD -3.87; 95% CI -8.15, 0.41). There was evidence of the benefit of combined BT/CBT and medication compared to medication alone (WMD -4.55; 95% CI -7.40, -1.70), but not relative to BT/CBT alone (WMD -2.80; 95% CI -7.55, 1.95). The rates of drop out suggested BT/CBT is an acceptable treatment to child and adolescent patients and their families. Although only based on a small number of studies, behavioural or cognitive-behaviour therapy appears to be a promising treatment for OCD in children and adolescents. It can lead to better outcomes when combined with medication compared to medication alone. Additional trials are needed to confirm these findings. In the interim, consideration should be given to the ways in which BT/CBT might be made more widely available as a treatment for OCD in children and adolescents.

Cognitive-Behavioral Family Treatment of Childhood Obsessive-Compulsive Disorder: Long-Term Follow-up and Predictors of Outcome

The aims were to (1) evaluate the long-term durability of individual and group cognitive-behavioral family therapy for childhood obsessive-compulsive disorder and (2) investigate pretreatment predictors of long-term outcome. Undertaken at a university-based clinic, this study involved 48 participants (8-19 years old) who had received individual or group cognitive-behavioral family therapy. Participants and parents were assessed at 12 and 18 months following treatment with standardized assessments, including diagnostic and symptom severity interviews, child self-report measures of anxiety and depression, and parental self-report of distress. Pretreatment data were used for the prediction of long-term outcome. Analyses indicated treatment gains were maintained, with a total of 70% of participants in individual therapy and 84% in group therapy diagnosis free at follow-up. There were no significant differences between the individual or group conditions across measures. Results indicated that higher pretreatment severity and higher family dysfunction predicted worse long-term outcome. The results suggest that cognitive-behavioral family therapy for obsessive-compulsive disorder provides long-term relief that it is equally effective in individual and group-based therapy. Focusing on family dysfunction may improve long-term prognosis.

Cognitive-Behavioral Family Treatment of Childhood Obsessive-Compulsive Disorder: A Controlled Trial

To evaluate the relative efficacy of (1) individual cognitive-behavioral family-based therapy (CBFT); (2) group CBFT; and (3) a waitlist control group in the treatment of childhood obsessive-compulsive disorder (OCD). This study, conducted at a university clinic in Brisbane, Australia, involved 77 children and adolescents with OCD who were randomized to individual CBFT, group CBFT, or a 4- to 6-week waitlist control condition. Children were assessed before and after treatment and at 3 months and 6 months following the completion of treatment using diagnostic interviews, symptom severity interviews, and self-report measures. Parental distress, family functioning, sibling distress, and levels of accommodation to OCD demands were also assessed. Active treatment involved a manualized 14-week cognitive-behavioral protocol, with parental and sibling components. By an evaluable patient analysis, statistically and clinically significant pretreatment-to-posttreatment change occurred in OCD diagnostic status and severity across both individual and group CBFT, with no significant differences in improvement ratings between these conditions. There were no significant changes across measures for the waitlist condition. Treatment gains were maintained up to 6 months of follow-up. Contrary to previous findings and expectations, group CBFT is as effective in reducing OCD symptoms for children and adolescents as individual treatment. Findings support the efficacy and durability of CBFT in treating childhood OCD.

Open trial of cognitive behavior therapy for childhood obsessive–compulsive disorder

Examined the utility of CBT for childhood obsessive–compulsive disorder (OCD) including a preliminary exploration of predictors of response to this form of treatment. A total of 42 youngsters (mean age 11.8 years, 60% female, 52% on medication at baseline) with DSM-IV OCD were treated openly using a developmentally sensitive treatment protocol based on exposure plus response prevention (ERP). The treatment response rate (CGI<2) was 79% with a mean decrease from baseline in NIMH Global scores of 45%. Response was not related to age, gender, baseline medication status, comorbid symptomatology, or therapist experience. Poorer outcome was associated with more severe obsessions and greater OCD-related academic impairment at baseline. When presented in a developmentally appropriate manner, CBT is a useful treatment for childhood OCD. Controlled trials are needed to provide a more rigorous test of this treatment approach and provide better information regarding potential mediators and moderators of outcome.

Review of The secret illness: Part one: Understanding obsessive compulsive disorder. Part two: Managing obsessive compulsive behavior in schools..

CLARE MULLEN, PRODUCER Secret Illness. Part One. Obsessive Compulsive Disorder. Part Two: Obsessive Compulsive Behavior in Schools. Edmonton, ON: Dymphna Productions, 2000, two video tapes, 33 minutes each. (C$195 each or $345 the set; Fax: (780)432-7309) Reviewed by AIDAN STOKES Producer Clare Mullen undertook the production of the two-video set, The Secret Illness, with a group of clinicians, educators, and parents of children with Obsessive Compulsive Disorder (OCD) in an effort to help families and teachers understand and cope with the disorder. Part I, entitled Understanding Obsessive Compulsive Disorder in Children, deals with the impact of the disorder on children and their families, while Part II, Managing Obsessive Compulsive Behaviour in Schools, offers education about the disorder and outlines behavioural management strategies for school personnel. An educational videotape should inform but not overstate the difficulties with the disorder. Thus, the content of such videotape may seem bland in comparison to the depiction of the disorder in commercial TV productions, many of which serve to appal rather than inform through sensationalization of the subject in the interests of good television. Invariably, it seems that it is the most severe cases with the most bizarre symptoms that are portrayed. One of the main challenges for the producer of an educational videotape is to present material that is relevant to the majority of individuals with the disorder and their families, and to do so in an accurate, sympathetic, and hopeful manner. Information needs to be presented with a perspective sufficiently broad to allow most with the disorder to identify with some of the individuals portrayed. approach should be balanced and realistic and reflect current knowledge of the disorder. In applying the above criteria to The Secret Illness, how well does this venture succeed? With rather mixed success, in my view: Certain segments are excellent, while others are somewhat pedestrian. Part I commences with an overview of OCD provided by a psychologist and a psychiatrist. information presented is generally accurate, but certain key findings in the literature have been either minimized or omitted. In contrast to the data presented, it is now generally accepted that approximately 2% of children and adolescents are estimated to be affected by OCD (Zohar, 1999). Further, there is scant reference made to subcategories and co-morbidities, and given that these are often important in treatment planning, their omission is notable. There was also little mention of the familial or genetic contributions to the disorder. next segment of the video shows clips of interviews with children as they discuss their symptoms and the impact upon them. These are handled sensitively with a couple of poignant reminders of the severity of the impact of this disorder on quite young children. However, one segment with a young man whose face was hidden, presumably in the interests of confidentiality, was upsetting to one parent whom I asked to review the video. She commented [it was as] if he had committed a crime. next segment where parents discussed how they coped with having OCD in the family is perhaps the most disappointing due to the heavy emphasis on the difficulties encountered, with little discussion of the strategies which the parents might use in dealing with a child with the disorder. section on treatment covered the empirically supported treatments but not in sufficient detail. Drug treatment is suggested as the primary mode of intervention in the disorder. Certainly, pharmacological intervention plays a major role in the treatment of childhood OCD and is often effective, but little attention was paid to its pitfalls, including nonresponse and partial response as well as some of the adverse effects of drug treatment. …

Case Study: Bibliotherapy and Extinction Treatment of Obsessive-Compulsive Disorder in a 5-Year-Old Boy

Cognitive-behavioral therapy (CBT) is an effective treatment for childhood obsessive-compulsive disorder (OCD). However, no case studies of children younger than 7 years old have been published. This case report describes a 5-year-old boy with severe OCD. Treatment consisted of parent- and teacher-directed extinction of compulsive reassurance-seeking, and bibliotherapy with an age-appropriate book on OCD. Compulsive behavior decreased rapidly and remained at a low level through the remainder of treatment. At posttreatment and at 1- and 3-month follow-up assessments, the patient's OCD symptoms were markedly improved. This report suggests that very young children may respond well to brief CBT.

Cognitive-behavioral family treatment of childhood obsessive-compulsive disorder: preliminary findings.

The effectiveness of a 14-week cognitive-behavioral family treatment protocol for childhood obsessive-compulsive disorder (OCD) was piloted using a volunteer sample of seven children aged 10-14 years. The primary outcome measures were diagnostic status, symptom severity, and global functioning which were assessed at pre- and post-treatment, and at three-month follow-up. A series of self-report measures assessing obsessive-compulsive symptomatology, depression, and family factors were also completed at pre- and post-treatment. The results indicated that six participants no longer met criteria for OCD at post-treatment, with a mean reduction of 60% in symptom severity. Self-reported obsessive-compulsive symptomatology and family involvement in the disorder also significantly decreased across time. The findings support the efficacy of cognitive-behavioral treatment with a structured family component for childhood OCD. Further research investigating the comparative efficacy of treatment with and without family involvement is warranted.

Pharmacological Treatment of Childhood Obsessive-Compulsive Disorder: From Theory to Practice

Discusses pharmacological treatment of childhood obsessive-compulsive disorder (OCD), chronic and underrecognized psychiatric condition that affects up to 2% to 3% of children and adolescents. Research in OCD in children, including neuropharmacology, brain imaging, genetics, and clinical phenomenology, informs current views of OCD pathophysiology. Contemporary research supports the notion of a dysregulation in serotonin subsystems in the central nervous system, with target areas of dysfunction including basal ganglia and orbitofrontal cortex. Pharmacotherapy, along with cognitive-behavioral approaches, constitutes the indicated treatment for childhood OCD. Pharmacological treatment is best guided by a phenomenological understanding of the type of obsessions and compulsions, the intensity and frequency of their presentation with attention to behavioral reinforcements, and psychosocial factors that affect the course of the disease. Serotonin-enhancing agents, such as fluoxetine, fluvoxamine, paroxetine, and sertraline and citalopram (SSRIs) are first-line pharmacological agents, whereas refractory symptoms can be treated by augmentation with neuroleptics or other agents. Clomipramine is as effective as the SSRIs but its use may be accompanied by increased side effects. Genetic factors probably influence susceptibility to OCD as well as response to treatment, and the elucidation of these and other risk factors will be important elements in the future understanding and treatment of this disorder.

Pharmacological Interventions in Autism: Theoretical and Practical Issues

Discusses pharmacological treatment of childhood obsessive-compulsive disorder (OCD), chronic and underrecognized psychiatric condition that affects up to 2% to 3% of children and adolescents. Research in OCD in children, including neuropharmacology, brain imaging, genetics, and clinical phenomenology, informs current views of OCD pathophysiology. Contemporary research supports the notion of a dysregulation in serotonin subsystems in the central nervous system, with target areas of dysfunction including basal ganglia and orbitofrontal cortex. Pharmacotherapy, along with cognitive-behavioral approaches, constitutes the indicated treatment for childhood OCD. Pharmacological treatment is best guided by a phenomenological understanding of the type of obsessions and compulsions, the intensity and frequency of their presentation with attention to behavioral reinforcements, and psychosocial factors that affect the course of the disease. Serotonin-enhancing agents, such as fluoxetine, fluvoxamine, paroxetine, and sertraline and citalopram (SSRIs) are first-line pharmacological agents, whereas refractory symptoms can be treated by augmentation with neuroleptics or other agents. Clomipramine is as effective as the SSRIs but its use may be accompanied by increased side effects. Genetic factors probably influence susceptibility to OCD as well as response to treatment, and the elucidation of these and other risk factors will be important elements in the future understanding and treatment of this disorder.

Childhood Obsessive-Compulsive Disorder: A Review

Obsessive-compulsive disorder (OCD) holds a particular interest for child psychiatrists because of the high proportion of cases with onset in childhood and adolescence. Over the last two decades, substantial progress has been made in describing OCD in children and adolescents and in developing and implementing effective treatments. In addition, research on the phenomenology, neurobiology, and psychopharmacology of OCD has led to its current conceptualization as a developmental neuropsychiatric disorder. In this article, the fourth in a series on OCD, the authors summarize the most recent data on the phenomenology, etiology, neurobiology, and treatment of OCD in children and adolescents.