Internet-Delivered, Family-Based Treatment for Early-Onset OCD: A Preliminary Case Series

Abstract

Given the burdens of early-onset obsessive-compulsive disorder (OCD), limitations in the broad availability and accessibility of evidence-based care for affected youth present serious public health concerns. The growing potential for technological innovations to transform care for the most traditionally remote and underserved families holds enormous promise. This article presents the rationale, key considerations, and a preliminary case series for a promising behavioral telehealth innovation in the evidence-based treatment of early-onset OCD. We developed an Internet-based format for the delivery of family-based treatment for early-onset OCD directly to families in their homes, regardless of their geographic proximity to a mental health facility. Videoteleconferencing (VTC) methods were used to deliver real-time cognitive-behavioral therapy centering on exposure and response prevention to affected families. Participants in the preliminary case series included 5 children between the ages of 4 and 8 (MAge = 6.5) who received the Internet-delivered treatment format. All youth completed a full treatment course, all showed OCD symptom improvements and global severity improvements from pre- to posttreatment, all showed at least partial diagnostic response, and 60% no longer met diagnostic criteria for OCD at posttreatment. No participants got worse, and all mothers characterized the quality of services received as “excellent.” The present work adds to a growing literature supporting the potential of VTC and related computer technology for meaningfully expanding the reach of supported treatments for OCD and lays the foundation for subsequent controlled evaluations to evaluate matters of efficacy and engagement relative to standard in-office evidence-based care.

The Feasibility of eHealth in Mental Health Care

“…To date, a variety of eHealth applications have been developed for OCDs [10,11,26,27], phobias [15,16,29] and other common mental health problems such as depression [26,30,53], anxiety [54], panic disorder [12], and generalized anxiety disorder [12,28,29]. Both short and long-term positive outcomes have been reported when using these applications [12,[28][29][30][31][32][33][34][35].…”

Teletherapy Delivery of Caregiver Behavior Training for Children with Attention-Deficit Hyperactivity Disorder

“…The two groups improved comparably across all constructs. Finally, Comer et al 21 are examining the delivery of treatment for early-onset obsessive-compulsive disorder through in home videoconferencing. Early results indicate successful engagement of both the child in the behavioral interventions and the family in supportive therapy.…”

Evidence-Based Psychological Treatments of Pediatric Mental Disorders

“…Additionally, ERP for pediatric OCD is able to be delivered in an intensive format, occurring multiple times during the week instead of the standard weekly administration [50,55,56]. Because technology has been increasingly incorporated into mental health care, preliminary studies investigating the utility of providing ERP through telehealth mechanisms have also shown promise in decrease OCD symptom severity [57][58][59].…”