Treatment Of Pediatric Obsessive-compulsive Disorder Research Articles

Self-Regulation and Other Executive Functions Relationship to Pediatric OCD Severity and Treatment Outcome

The intersection of obsessive-compulsive disorder (OCD) and executive functioning (EF) in children and adolescents is an emerging topic in the current literature. Spurred by the consistent association between increased EF deficits and higher adult obsessive-compulsive severity, a few initial studies have replicated this relationship in pediatric OCD samples and also have found preliminary evidence that EF deficits are associated with worse response to first-line psychotherapeutic or psychopharmacological treatments for pediatric OCD. This study aimed to extend the literature by providing the first comprehensive investigation of how multiple EF domains, measured repeatedly over the course of treatment, impact pediatric obsessive-compulsive severity and response to multimodal treatment. Multi-level modeling results found that deficits in shifting, inhibition, emotional control, planning/organizing, monitoring and initiating all predicted higher average obsessive compulsive severity across treatment. Interestingly, out of the eight domains of EF investigated, only emotional control moderated treatment outcome such that those with worse emotional control experienced less of a reduction in obsessive-compulsive severity during treatment. The findings generally align with previous theories for the link between EF and OCD and indicate that emotional control has important implications in the treatment of pediatric OCD. In fact, emotional control may provide one explanation for why factors such as disgust sensitivity, oppositional behavior, and third-wave behavioral treatment techniques have all been linked to pediatric OCD treatment outcome. Future research should investigate augmentation strategies that target emotional control in children and adolescents.

Extraordinarily Fast Response to Low-Dose Sertraline in a Child with Severe Obsessive-Compulsive Disorder and High Functioning Serotonin Transporter Genotype

Journal of Child and Adolescent PsychopharmacologyVol. 24, No. 2 Letters to the EditorExtraordinarily Fast Response to Low-Dose Sertraline in a Child with Severe Obsessive-Compulsive Disorder and High Functioning Serotonin Transporter GenotypeEdna Grünblatt, Senop Tschakarjan, Veronika Brezinka, and Susanne WalitzaEdna GrünblattSearch for more papers by this author, Senop TschakarjanSearch for more papers by this author, Veronika BrezinkaSearch for more papers by this author, and Susanne WalitzaSearch for more papers by this authorPublished Online:28 Mar 2014https://doi.org/10.1089/cap.2013.0064AboutSectionsView articleView Full TextSupplemental MaterialPDF/EPUBView Supplemental Data Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View articleFiguresReferencesRelatedDetailsCited byThe Molecular Genetics of Obsessive-Compulsive and Related DisordersZwangsstörungen3 June 2016 Volume 24Issue 2Mar 2014 InformationCopyright 2014, Mary Ann Liebert, Inc.To cite this article:Edna Grünblatt, Senop Tschakarjan, Veronika Brezinka, and Susanne Walitza.Extraordinarily Fast Response to Low-Dose Sertraline in a Child with Severe Obsessive-Compulsive Disorder and High Functioning Serotonin Transporter Genotype.Journal of Child and Adolescent Psychopharmacology.Mar 2014.102-104.http://doi.org/10.1089/cap.2013.0064Published in Volume: 24 Issue 2: March 28, 2014Online Ahead of Print:January 16, 2014PDF download

Dissemination of Evidence-Based Treatment for Pediatric Obsessive-Compulsive Disorder in the Southern Region of Brazil: Challenges and Future Directions.

Pediatric obsessive-compulsive disorder (OCD) is a prevalent condition that responds well to specialized treatment including cognitive behavioral therapy (CBT) or serotonin reuptake inhibitors or their combination. In Brazil, the dissemination of evidence-based treatment for pediatric OCD is hindered because of the peculiarities of the health system. The presence of a multitiered health system (public, insured, and private) with insufficient investment in public mental health and relative inaccessibility of insured/private care for most of the Brazilian population make the implementation of specialized OCD treatment centers largely unavailable in Brazil. Furthermore, lack of appropriate training in child mental health, CBT, and evidence-based approaches to OCD in current psychiatry and psychology training programs further impede improvement in diagnosis and treatment. The challenges faced in the current system in Brazil will be discussed and also strategies and programs that are currently being implemented in the south of Brazil to help address the gaps in treatment for pediatric patients with OCD.

Case Examples of Enhancing Pediatric OCD Treatment With a Smartphone Application

These case examples depict the use of a smartphone application, Mayo Clinic Anxiety Coach, to enhance the treatment of pediatric obsessive-compulsive disorder (OCD). The presented cases highlight the use of Anxiety Coach as a stand-alone intervention for mild OCD symptoms and as an adjunct to treatment for severe OCD complicated by geographical barriers. Each case includes a description of treatment, patient use of the application, objective assessment of clinical symptoms, and a qualitative interview with the families. Both patients responded well to treatment and had a positive experience with Anxiety Coach. The application encouraged the families to complete exposures between sessions and allowed a detailed examination of the patients’ engagement in homework assignments. Potential uses of smartphone applications to address challenges facing treatment of, and research on, OCD are discussed.

All in the Family

Obsessive-compulsive disorder (OCD) is common in children with rates of 1% to 4% in children and adolescents. A prominent first-line treatment for pediatric OCD is cognitive-behavioral therapy (CBT) using exposure and response prevention (ERP). However, it has also been suggested that family therapy be used as an adjunct treatment in pediatric OCD cases, as family members often accommodate or contribute to the maintenance of OCD symptoms. The following case study reviews the successful treatment of a 7-year-old with comorbid OCD and oppositional defiant disorder, in which traditional CBT and ERP for OCD was integrated with family-based approaches utilizing a family systems theory framework.

Evidence Base Update for Psychosocial Treatments for Pediatric Obsessive-Compulsive Disorder

Pediatric obsessive-compulsive disorder (OCD) is a chronic and impairing condition that often persists into adulthood. Barrett, Farrell, Pina, Peris, and Piacentini (2008), in this journal, provided a detailed review of evidence-based psychosocial treatments for youth with OCD. The current review provides an evidence base update of the pediatric OCD psychosocial treatment literature with particular attention to advances in the field as well as to the methodological challenges inherent in evaluating such findings. Psychosocial treatment studies conducted since the last review are described and evaluated according to methodological rigor and evidence-based classification using the JCCAP evidence-based treatment evaluation criteria (Southam-Gerow & Prinstein, this issue). Findings from this review clearly converge in support of cognitive-behavioral therapy as an effective and appropriate first line treatment for youth with OCD (either alone or in combination with medication). Although no treatment for pediatric OCD has yet to be designated as “well-established,” both individual and individual family-based treatments have been shown to be “probably efficacious.” Moderators and predictors of treatment outcome are discussed as are the areas where we have advanced the field and the areas where we have room to grow. The methodological and clinical challenges inherent in a review of the evidence base are reviewed. Finally, future research directions are outlined.

Does d-Cycloserine Augmentation of CBT Improve Therapeutic Homework Compliance for Pediatric Obsessive–Compulsive Disorder?

Clinical studies in adults and children with obsessive-compulsive disorder (OCD) have shown that d-cycloserine (DCS) can improve treatment response by enhancing fear extinction learning during exposure-based psychotherapy. Some have hypothesized that improved treatment response is a function of increased compliance and engagement in therapeutic homework tasks, a core component of behavioral treatment. The present study examined the relationship between DCS augmented cognitive-behavioral therapy (CBT) and homework compliance in a double-blind, placebo controlled trial with 30 youth with OCD. All children received 10 CBT sessions, the last seven of which included exposure and response prevention paired with DCS or placebo dosed 1 h before the session started. Results suggested that DCS augmented CBT did not predict improved homework compliance over the course of treatment, relative to the placebo augmented CBT group. However, when groups were collapsed, homework compliance was directly associated with treatment outcome. These findings suggest that while DCS may not increase homework compliance over time, more generally, homework compliance is an integral part of pediatric OCD treatment outcome.

706 – 110 years after first report of obsessive compulsive disorder in childhood - where do we stand?

Introduction First case report of paediatric obsessive compulsive disorder (OCD) was presented by Janet in 1903. Since then many more reports of OCD in children and adolescents have been published. OCD in adult patients has been studied in the last decades but studies for pediatric OCD only began in the last 20 years. Objectives To review the most recent knowledge on the characteristics, epidemiology, pathophysiology and treatment of pediatric OCD. Methods Review literature published on MEDLINE/Pubmed database in English language using “obsessive compulsive disorder in childhood”, “obsessive compulsive disorder in children and adolescents”, “OCD in childhood”, “OCD in children and adolescents” and “pediatric OCD” as key-words. Results OCD is common among children and adolescents, with prevalence of 1-3% that often becomes a chronic condition. OCD onset has a bimodal age distribution with one peak at age 11 and other peak in early adulthood. There is a male preponderance in affected children, high comorbidity with psychiatric disorders mainly with tic disorders and attention deficit hyperactivity disorder, higher familiality and higher rates of aggressive/harm obsessions and religious obsessions. The current etiologic model most commonly accepted points to a dysfunction of cortico-striato-thalamic loops. Cognitive behavioural therapy (CBT) and a combination of CBT with a selective serotonin reuptake inhibitor are the treatments of choice for pediatric OCD. Conclusions Pediatric OCD seems to be an OCD subtype with similarities but also with important differences from adultonset OCD. Further research is still needed to better elucidate the genetics and the exact pathophysiology of pediatric OCD.

A cross-sectional study of insight and family accommodation in pediatric obsessive-compulsive disorder

BackgroundFactors predicting treatment outcome in pediatric patients with obsessive-compulsive disorder (OCD) include disease severity, functional impairment, comorbid disorders, insight, and family accommodation (FA). Treatment of pediatric OCD is often only partly successful as some of these predictors are not targeted with conventional therapy. Among these, insight and FA were identified to be modifiable predictors of special relevance to pediatric OCD. Despite their clinical relevance, insight and FA remain understudied in youth with OCD. This study examined the clinical correlates of insight and FA and determined whether FA mediates the relationship between symptom severity and functional impairment in pediatric OCD.MethodsThis was a cross-sectional, outpatient study. Thirty-five treatment-naive children and adolescentswith DSM-IV diagnosis of OCD (mean age: 13.11 ± 3.16; 54.3% males) were included. Standard questionnaires were administered for assessing the study variables. Insight and comorbidities were assessed based on clinician’s interview. Subjects were categorized as belonging to a high insight or a low insight group, and the differences between these two groups were analyzed using ANOVA. Pearson’s correlation coefficients were calculated for the remaining variables of interest. Mediation analysis was carried out using structural equation modeling.ResultsRelative to those in the high insight group, subjects in the low insight group were younger, had more severe disease and symptoms, and were accommodated to a greater extent by their families. In addition, comorbid depression was more frequent in subjects belonging to the low insight group. Family accommodation was positively related to disease severity, symptom severity, and functional impairment. Family accommodation totally mediated the relationship between symptom severity and functional impairment.ConclusionsResults support the differences in the diagnostic criteria between adult and pediatric patients with OCD with respect to the requirement of insight. Subjects with low insight displayed clinical characteristics of increased severity compared with their high insight counterparts, suggesting that subjects with low insight may require multimodal approach to treatment. Family accommodation was found to mediate the relationship between symptom severity and functional impairment; the use of family-based approaches to cognitive behavioral therapy, with one of the aims of reducing/mitigating FA, may provide better treatment outcomes in pediatric OCD.

Attachment insecurity as a predictor of obsessive–compulsive symptoms in female children

This study was conducted to examine the capacity of attachment insecurity and its dimensions to predict the development of obsessive–compulsive (OC) symptoms in children. A total of 221 female children, aged 10–12, were administered the Children's Yale-Brown Obsessive–Compulsive Scale, Birleson Depression Self-rating Scale, and the inventory of parent and peer attachment – revised version for children. Hierarchical regressions revealed that the level of attachment insecurity was strongly associated with the symptoms of obsessive–compulsive disorder (OCD) in children. Moreover, attachment insecurity subscale scores (trust, communication, and alienation) predicted a large percentage of variance in children's OC symptoms. Although all the attachment subscale scores were significantly associated with OC symptoms in children, parent–child communication was found to be the most powerful predictor, followed by emotional alienation and trust. Implications of these findings for theory and treatment of pediatric OCD are discussed.

The pediatric obsessive compulsive disorder treatment study for young children (POTS Jr): Developmental considerations in the rationale, design, and methods

This paper presents the rationale, design, and methods of the pediatric obsessive compulsive disorder treatment study for young children (POTS Jr). The study is a multi-site randomized controlled trial (RCT) of family-based cognitive behavioral treatment (CBT) vs. family-based relaxation therapy for young children (ages 5–8) with obsessive compulsive disorder (OCD), which examines the effect of treatment on symptom reduction, functional impairment, and quality of life. Secondary aims evaluate: potential moderators and mediators of treatment response, differences in time course of response, retention rates, and maintenance of treatment gains over one year post-treatment. The sample included 127 children (53% female) and their parents. With regard to ethnicity, 89% of the sample described themselves as non-Hispanic, 5% Hispanic/Latino, and 6% did not endorse a category. In terms of race, the sample was predominantly (91%) white. Because the rationale and methods of the multi-site RCT have been well established, we emphasize here the methodological aspects of the study that were tailored to meet the developmental needs of young children with OCD. Aspects that are highlighted include: choice of control group, inclusion/exclusion criteria, assessment/measurement issues, treatment adaptations, training, and recruitment.

First-Line Treatment for Pediatric Obsessive–Compulsive Disorder

Pediatric obsessive–compulsive disorder (OCD) is a common psychiatric disorder that impairs children’s functioning in home, school, and community settings. Once thought to be an untreatable or treatment refractory disorder, evidence-based treatments now exist for pediatric OCD. Various psychological treatment approaches for pediatric OCD have been investigated and research supports the use of cognitive-behavioral therapy (CBT) with exposure and response prevention (E/RP) and combined CBT/E/RP with serotonin reuptake inhibitor pharmacotherapy. This paper reviews these approaches and highlights the prominent role of CBT/E/RP as a first-line treatment for pediatric OCD.

Incorporating play therapy into evidence-based treatment with children affected by obsessive compulsive disorder.

This article outlines the etiology, symptoms, and two of the most current evidence-based psychotherapeutic interventions associated with children diagnosed with ob-sessive compulsive disorder (OCD). Research demonstrates that a combination ofcognitive–behavioral therapy with exposure treatment, along with psychopharmaco-logical treatment, is the “gold standard” when providing mental health care tochildren with OCD (Pediatric OCD Treatment Study, 2004, Journal of the AmericanMedical Association, 292 , 1969–1976.). While play therapy has not been identi edas a singularly bene cial paradigm to mitigate the symptoms associated with OCD(Piacentini & Langley, 2004, Journal of Clinical Psychology, 60, 1181–1194.), theauthors of this article argue that play therapy can be integrated within the evidence-based treatment modalities to provide a developmentally appropriate context forchildren. Speci cally, play therapy techniques may be bene cial for children at-tempting to externalize the internal dialogue of repetitive thoughts associated withOCD. Last, implications for play therapists are addressed.

Preschool children with obsessive–compulsive disorder and fluoxetine treatment

Obsessive-compulsive disorder (OCD) is an anxiety disorder which can substantially disable children's ability to function at home and school. Clinicians frequently rely on knowledge about symptoms that can be examined early in treatment to determine future treatment effectiveness. However, OCD in preschoolers has also received little attention in literature. To the best of our knowledge, there is only one retrospective chart review and one case report in the literature for preschool cases treated with SSRIs. Therefore, the effect of fluoxetine on preschool children was imprecisely understood. The aim of this case report was to examine the efficacy and safety of fluoxetine treatment for pediatric OCD. Four preschool children with OCD completed an 8-week fluoxetine (up to 20 mg) trial. We diagnosed OCD according to Diagnostic and statistical manual of mental disorders, 4th edition, text revision (DSM-IV-TR) criteria and symptoms of OCD were assessed with the Childrens' Yale-Brown Obsessive Compulsive Scale (CY-BOCS). Initial and post-treatment symptom severity and improvement were assessed by using the severity (S) and improvement (I) scales of Clinical Global Impressions Scale (CGI). The CY-BOCS total, obsessions and compulsions subscale scores and CGI-S scores were significantly improved for all of the cases at the end of the eighth week. In this case report four preschool children, with severe OCD and resistant to the previous non-psychopharmacologic treatment responded well to fluoxetine monotherapy. On the other hand, the usage of SSRIs in preschool children remains highly controversial, due to the lack of data on safety and efficacy.

Cognitive Biases and Obsessive-Compulsive Symptoms in Children: Examining the Role of Maternal Cognitive Bias and Child Age

Objective: Multiple cognitive biases associated with adult obsessive-compulsive disorder (OCD) were tested in a clinical sample of children (ages 7–11) and adolescents (12–17) and their mothers. This study examined (a) the associations between child cognitive biases and OCD severity, (b) maternal cognitive biases and child OCD severity, and (c) maternal cognitive bias and child cognitive bias. It was hypothesized that age would significantly moderate these relationships, with stronger associations with OCD severity for cognitive bias in adolescents (relative to children), and maternal cognitive bias in younger children (relative to adolescents). Method: Forty-six children and adolescents diagnosed with OCD and their mothers completed questionnaires assessing responsibility bias, thought–action fusion (TAF), thought suppression, and metacognitive beliefs. OCD symptoms were assessed using structured diagnostic interviews and semistructured symptom interviews. Results: As predicted, age significantly moderated associations between (a) child cognitive variables and OCD severity—specifically between child responsibility and child metacognition, which were associated with OCD severity for adolescents only; (b) maternal cognitive biases and child OCD severity—specifically for maternal responsibility and thought suppression, which were significantly and positively associated with child OCD severity but not adolescent OCD severity; and (c) maternal cognitive biases and child cognitive bias—such that significant associations were evident only in the younger child sample, and only between maternal TAF self and metacognition, with child suppression and child TAF moral, respectively. Conclusion: Maternal cognitive biases are more consistently linked to greater OCD severity among younger children, whereas personal cognitive biases are associated with greater OCD symptoms in adolescents. Treatments for pediatric OCD are likely to be improved by age-specific considerations for the role of maternal and child cognitive biases associated with OCD.

MRSI correlates of cognitive–behavioral therapy in pediatric obsessive–compulsive disorder

The brain mechanisms of cognitive-behavioral therapy (CBT), a highly effective treatment for pediatric obsessive-compulsive disorder (OCD), are unknown. Neuroimaging in adult OCD indicates that CBT is associated with metabolic changes in striatum, thalamus, and anterior cingulate cortex. We therefore probed putative metabolic effects of CBT on these brain structures in pediatric OCD using proton magnetic resonance spectroscopic imaging (1H MRSI). Five unmedicated OCD patients (4 ♀, 13.5±2.8) and 9 healthy controls (7 ♀, 13.0±2.5) underwent MRSI (1.5 T, repetition-time/echo-time=1500/30 ms) of bilateral putamen, thalamus and pregenual anterior cingulate cortex (pACC). Patients were rescanned after 12 weeks of exposure-based CBT. The Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) of OCD symptoms was administered before and after CBT. Four of 5 patients responded to CBT (mean 32.8% CY-BOCS reduction). Multiple metabolite effects emerged. Pre-CBT, N-acetyl-aspartate+N-acetyl-aspartyl-glutamate (tNAA) in left pregenual anterior cingulate cortex (pACC) was 55.5% higher in patients than controls. Post-CBT, tNAA (15.0%) and Cr (23.9%) in left pACC decreased and choline compounds (Cho) in right thalamus increased (10.6%) in all 5 patients. In left thalamus, lower pre-CBT tNAA, glutamate+glutamine (Glx), and myo-inositol (mI) predicted greater post-CBT drop in CY-BOCS (r=0.98) and CY-BOCS decrease correlated with increased Cho. Interpretations are offered in terms of the Glutamatergic Hypothesis of Pediatric OCD. Similar to 18FDG-PET in adults, objectively measurable regional MRSI metabolites may indicate pediatric OCD and predict its response to CBT.

P.4.e.001 Relationship of clomipramine levels and OCD symptoms in adult patients

We conducted a meta-analysis to examine the following: the time course of response to selective serotonin reuptake inhibitors (SSRIs) and clomipramine in pediatric obsessive-compulsive disorder (OCD); whether higher doses of SSRIs are associated with an improved response in pediatric OCD; differences in efficacy among SSRI agents; differences in efficacy between SSRIs and clomipramine; and whether the time course and magnitude of response to SSRIs are different in pediatric and adult patients with OCD.We searched PubMed and CENTRAL for randomized controlled trials comparing SSRIs (or clomipramine) to placebo for the treatment of pediatric OCD and using the Children’s Yale−Brown Obsessive-Compulsive Scale as an outcome. We extracted weekly symptom data from trials to characterize the trajectory of pharmacological response to SSRIs. Pooled estimates of treatment effect were calculated based on weighted mean differences between the treatment and placebo groups.Nine trials involving 801 children with OCD were included in this meta-analysis. A logarithmic model indicating that the greatest benefits occurred early in treatment best fit the longitudinal data for both clomipramine and SSRIs. Clomipramine was associated with a greater measured benefit compared to placebo than SSRIs. There was no evidence for a relationship between SSRI dosing and treatment effect, although data were limited. Adults and children with OCD demonstrated a similar degree and time course of response to SSRIs in OCD.These results suggest that the greatest incremental treatment gains in pediatric OCD occur early in SSRI treatment (similar to adults with OCD and children and adults with major depression).

The Use of Glutamate Modulating Drugs in Obsessive Compulsive Disorder

Obsessive-compulsive disorder (OCD) is a chronic, severe and debilitating disorder, affecting over 3 million people in the United States. People afflicted with OCD have obsessions and compulsions that impair their functioning in life. According to the World Health Organization, OCD is among the ten most disabling medical conditions worldwide. The National Comorbidity Survey Replication, when examining anxiety disorders, found that OCD had the highest percentage of serious cases (50.6%) (Kessler et al., 2005). Lifetime prevalence estimates of OCD in pediatric and adult populations range from 1% to 3% (Kessler et al., 2005). The clinical presentation of OCD in childhood and adulthood is similar, making findings applicable across the age span. The mean age of onset for OCD in children is between 9 to 11 years in males and 11 to 13 years in females (Hanna, 1995). A more negative outcome is associated with an early age of onset. Furthermore, pediatric OCD was found to be chronic and unremitting in up to 87% of cases that failed to receive effective treatment (Stewart et al., 2004). Finally, an early diagnosis of OCD is associated with a higher risk for developing other psychiatric disorders into adulthood. THE CASE FOR NOVEL TREATMENTS OF OCD Serotonin reuptake inhibitors (SRI) are the only FDA approved medications for OCD. While considered effective in the clinical trial literature, treatment of OCD with SRI’s has proven limited in clinical practice. SRIs are only effective in 40 to 60% of patients (Jenike, 2004). Obviously, this leaves a considerable number still ill. Additionally, studies often define treatment response as a 20 to 40% reduction in symptoms. Hence, many subjects who are classed as “responders” still have marked symptoms after treatment (Jenike, 2004). OCD symptom severity scores, as calculated by the Children’s Yale-Brown Obsessive-Compulsive Scale (CY-BOCS), normally range from 15 to 20 post-treatment. A score in this range is still indicative of significant impairment. In addition to SRIs, cognitive behavioral therapy (CBT), alone or in combination with SRI, is also considered effective for treating OCD (POTS, 2004). Nonetheless, one-third of pediatric patients remain markedly ill even after receiving the combination of CBT and medication (POTS, 2004). What is more, data indicates that an earlier onset of OCD may be associated with the illness being more treatment refractory (POTS, 2004). Indeed, OCD is one of the few remaining psychiatric disorders for which there is a neurosurgical treatment indication. The persistence of symptoms and the limited nature of treatment response indicates that the serotonin paradigm of understanding OCD cannot fully account for the underlying neurobiology of the illness. Therefore, novel, evidence based approaches are needed to advance treatment of OCD. The glutamate hypothesis of OCD, first developed over a decade ago (Rosenberg & Keshavan, 1998), and resulting biological evidence has recently translated to the application of glutamate modulating agents for the treatment of pediatric OCD.

Treatment of Pediatric OCD

Free AccessTreatment of Pediatric OCDKyle A. B. Lapidus and Andrew R. GilbertKyle A. B. LapidusSearch for more papers by this author and Andrew R. GilbertDepartment of Psychiatry, Mount Sinai School of Medicine. E-mail: [email protected]Search for more papers by this authorPublished Online:February 2011https://doi.org/10.1521/capn.2010.15.5.6PDFPDF PLUS ShareShare onFacebookTwitterLinkedInRedditEmail ToolsAdd to favoritesDownload CitationsTrack Citations About Previous article Next article FiguresReferencesRelatedDetails Cited byCited by1. Obsessive-compulsive disorder (OCD): Gendered metaphors, blogs and online forumsOnline publication date: 1 August 2013. Go to citation Crossref Google Scholar Volume 15Issue 5Oct 2010 Information© 2010 Guilford Publications Inc.PDF download

Predictors and Moderators of Treatment Outcome in the Pediatric Obsessive Compulsive Treatment Study (POTS I)

To identify predictors and moderators of outcome in the first Pediatric OCD Treatment Study (POTS I) among youth (N = 112) randomly assigned to sertraline, cognitive behavioral therapy (CBT), both sertraline and CBT (COMB), or a pill placebo. Potential baseline predictors and moderators were identified by literature review. The outcome measure was an adjusted week 12 predicted score for the Children's Yale Brown Obsessive Compulsive Scale (CY-BOCS). Main and interactive effects of treatment condition and each candidate predictor or moderator variable were examined using a general linear model on the adjusted predicted week 12 CY-BOCS scores. Youth with lower obsessive-compulsive disorder (OCD) severity, less OCD-related functional impairment, greater insight, fewer comorbid externalizing symptoms, and lower levels of family accommodation showed greater improvement across treatment conditions than their counterparts after acute POTS treatment. Those with a family history of OCD had more than a sixfold decrease in effect size in CBT monotherapy relative to their counterparts in CBT without a family history of OCD. Greater attention is needed to build optimized intervention strategies for more complex youth with OCD. Youth with a family history of OCD are not likely to benefit from CBT unless offered in combination with an SSRI. Treatment of Obsessive Compulsive Disorder (OCD) in Children, http://www.clinicaltrials.gov, NCT00000384.