Personalizing the Treatment of Pediatric Obsessive-Compulsive Disorder: Evidence for Predictors and Moderators of Treatment Outcomes

Abstract

Cognitive behavioral therapy (CBT), delivered alone or with a serotonin reuptake inhibitor (SRI), is efficacious for treating pediatric obsessive-compulsive disorder (OCD), but not all youth respond optimally. Research to understand for whom a given intervention is beneficial can inform efforts to personalize treatment or tailor it to specific youths to enhance outcomes. We review studies that examined potential predictors/moderators of response to CBT, medication, and multimodal treatment for pediatric OCD: demographics, disorder-specific characteristics, general illness characteristics, neuropsychological functioning, biomarkers, family factors, and non-specific therapy factors. Methodological differences across studies make it challenging to synthesize findings and more research with large samples is needed. However, family factors have emerged as relatively consistent and strong predictors of treatment outcomes and there is preliminary support for attention to the presence of tics in treatment selection. There is little evidence for age and other demographic differences in treatment response.

Moderators and predictors of outcomes in telephone delivered compared to face-to-face cognitive behaviour therapy for paediatric obsessive–compulsive disorder: preliminary evidence from a non-inferiority RCT

“…While this evidence supports the conclusion of equivalent efficacy of TCBT and CBT at the group level, it is important to acknowledge that the adaptation of CBT for telephone delivery does modify aspects of therapeutic processes such as the therapist's sensitivity to levels of affect which, for certain young people, may diminish or augment their benefits. Identifying pre-treatment characteristics of the child/adolescent, their disorder or environmental context that predict a differential benefit from TCBT or CBT has important implications for treatment assignment and improving the likelihood of therapeutic success [16,17]. Preliminary research on moderators for remotely delivered CBT compared to CBT for adults with social anxiety disorder and depression, for example, has found that higher baseline levels of anxiety or depressive symptoms, and co-morbidity with other emotional disorders, were associated with less favourable outcomes in the remotely delivered CBT group but not in face-to-face CBT [18,19,20].…”

“…A secondary aim of the study was to identify potential predictors of CBT outcome. Knowledge of factors that are associated with an attenuated treatment response can help identify children and adolescents who may benefit from additional or more intense therapy in order to maximise outcomes [16,17] and also assist researchers in specifying factors worth further examining as effect moderators [16]. In a recent systematic review [22] we reported consistent evidence across multiple trials of CBT in children and adolescents with OCD that age, severity of pre-treatment OCD-related impairment, level of co-existing externalising and internalising symptoms, and family accommodation of OCD symptoms were predictors of poorer response to treatment.…”

D-Cycloserine augmentation of cognitive behavior therapy for pediatric OCD: Predictors and moderators of outcome

“…Multiple studies have examined predictors of CBT for pediatric OCD (Turner et al, 2018); however, only OCD symptom severity (Garcia et al, 2010; Ginsburg et al, 2008; Rudy et al, 2014; Torp et al, 2015) and degree of family accommodation (Garcia et al, 2010; Ginsburg et al, 2008; Merlo et al, 2009; Rudy et al, 2014) have been consistently examined. A recent review of the literature (Caporino and Storch, 2016) indicated that symptom severity and family accommodation do not uniformly predict outcome across studies. Other demographic and psychosocial variables have been identified as predictors, such as comorbid internalizing or externalizing disorders (Garcia et al, 2010; Storch et al, 2008; Torp et al, 2015;), age (Torp et al, 2015), functional impairment (Garcia et al, 2010), treatment expectations (Lewin et al, 2011), and gender (Rudy et al, 2014).…”

“…Other demographic and psychosocial variables have been identified as predictors, such as comorbid internalizing or externalizing disorders (Garcia et al, 2010; Storch et al, 2008; Torp et al, 2015;), age (Torp et al, 2015), functional impairment (Garcia et al, 2010), treatment expectations (Lewin et al, 2011), and gender (Rudy et al, 2014). Like OCD symptom severity and family accommodation, these psychosocial factors have not been consistently supported (Caporino and Storch, 2016; Turner et al, 2018). The conflicting findings may be attributed to variation in CBT approach (i.e., family vs. individual) or frequency of sessions (i.e., weekly vs. daily intensive; Caporino and Storch, 2016; McGuire et al, 2015).…”

“…Like OCD symptom severity and family accommodation, these psychosocial factors have not been consistently supported (Caporino and Storch, 2016; Turner et al, 2018). The conflicting findings may be attributed to variation in CBT approach (i.e., family vs. individual) or frequency of sessions (i.e., weekly vs. daily intensive; Caporino and Storch, 2016; McGuire et al, 2015). Additional research using a large sample size and methodologically rigorous design are needed to clarify discordant findings.…”