Evidence Base Update of Psychosocial Treatments for Pediatric Obsessive-Compulsive Disorder: Evaluating, Improving, and Transporting What Works

Abstract

Pediatric obsessive-compulsive disorder is a chronic and impairing condition that often persists into adulthood. This review refreshes the state of support for psychosocial treatments and the predictors or moderators that relate to their efficacy and evaluates how the literature has improved since the last update in 2014. A secondary goal is to propose an additional framework for the categorization of studies based on central research questions rather than treatment format. Psychosocial treatment studies conducted since the last review are described and evaluated according to methodological rigor and evidence-based classification using the Journal of Clinical Child and Adolescent Psychology evidence-based treatment evaluation criteria. Findings again converge in support of cognitive-behavioral therapy (CBT) as an effective and appropriate first-line treatment for youth with obsessive-compulsive disorder. Family-focused CBT is now well-established. A number of other treatments including CBT+ D-Cycloserine, CBT+ Sertraline, CBT+ positive family interaction therapy, and technology-based CBT are now probably efficacious. Demographic, clinical, and family factors are consistent predictors of CBT outcome with conflicting findings for neurocognitive predictors. The field has advanced significantly since the last review, but there is still room for improvement. Some of the conclusions that can be drawn may be limited by our evaluation criteria. Future directions are proposed to advance treatment outcome research beyond a focus on which treatments work to exploring factors that account for how and why they work.

Innovations in the Delivery of Exposure and Response Prevention for Obsessive-Compulsive Disorder

“…When treating pediatric OCD, simple adoption of successful methods in the treatment of adult OCD is misguided. The past two decades, however, have witnessed advances in the development and evaluation of developmentally appropriate psychosocial interventions for pediatric OCD (Freeman et al 2018;Melin et al 2019). The most successful among these interventions have been family-based (Freeman et al 2018;Melin et al 2019;Thompson-Hollands et al 2014a), placing increased focus on the role of parents in treatment engagement and working to reduce patterns of providing reassurance or helping with or performing compulsions, or family accommodation (Peris et al 2017;Piacentini et al 2011).…”

Implementing Strategic Flexibility in the Delivery of Youth Mental Health Care: A Tailoring Framework for Thoughtful Clinical Practice

“…However, if the therapist does not appreciate that the function of the exposure task is to increase the child's anxiety, and that the presence of family members is serving as a distraction, then the modification may inadvertently promote the use of safety behavior which is contraindicated in the treatment of OCD (Conelea et al, 2012). As such, given that exposure is a core component of effective treatment for OCD in youth (Freeman et al, 2018), modifications that address motivation to complete the exposure without attenuating its effects are more appropriate (e.g., reducing the difficulty of the exposure or including more pre-exposure processing). Importantly, for a given case, the treatment component(s) selected for flexible implementation should be conceptually linked with the tailoring factor(s) that call for treatment flexibility, but also linked theoretically to principles of the treatment.…”

Barn med nevrodegenerativ sykdom og tvangshandlinger

“…Det er kjent at kombinert behandling med sertralin og eksponering med responsprevensjon er effektiv behandling for tvangslidelser hos barn (11), men om det gir bedre effekt med sertralin i tillegg til eksponering med responsprevensjon er uklart pga. få studier (12). Det kan dermed vaere mest effektivt å gi psykologisk behandling alene en periode, også hos barn med intellektuell funksjonssvikt (13).…”