Cognitive Behavior Therapy for Pediatric Obsessive-Compulsive Disorder

Abstract

addition of cognitive behavior therapy (CBT) to serotonin reuptake inhibitor (SRI) treatment was efficacious among participants aged 7 through 17 years who had a primary diagnosis of obsessive-compulsive disorder (OCD) and partial response to SRI medication.1 However, this study did not address the effect of comorbidity on CBT or SRI treatment. In this study, 59.7% of the participants had 1 or more comorbidities, 21.8% had attention-deficit/hyperactivity disorder (ADHD), and 15.3% had tic disorder. The authors reported no difference in comorbidities or SRI medications in the 3 treatment groups (SRI only, SRI plus instructions in CBT, and SRI plus CBT); however, the P value for Pearson 2 test for tic disorder was .06, which was not statistically significant but still worth consideration. The authors did not do pairwise comparisons to show whether there was a difference in having tic disorder between the SRI-only group (21.4%) and the SRI plus CBT group (4.8%).One pediatric OCD study has shown that several psychiatric comorbid disorders, including ADHD and tic disorder, were associated with a significantly poorer response to open-label SRI treatment.2 Another study found that, relative to those participants without a psychiatric comorbid disorder, response rates to CBT were significantly lower for patients with comorbid ADHD and those with 1 or more psychiatric comorbid disorders.3 However, the current study did not look at whether participants in the same treatment group with different comorbidities or SRI medications had similar response rates to the treatment. Because of this, the results cannot be generalized to all children and adolescents with OCD.Pediatric patients with OCD and ADHD may respond to SRI plus CBT treatment differently than patients with comorbid tic disorder or other comorbidities. I encourage the authors to report the treatment response by comorbidity and type of SRI medication to provide health care professions with important information needed to treat pediatric patients with OCD and psychiatric comorbid disorders.