Evidence-Based Psychosocial Treatments for Child and Adolescent Obsessive–Compulsive Disorder

Abstract

Child and adolescent obsessive–compulsive disorder (OCD) is a chronic and debilitating condition associated with a wide range of impairments. This article briefly discusses the phenomenology of OCD, the theory underlying current treatment approaches, and the extant psychosocial treatment literature for child and adolescent OCD relative to the criteria for classification as an evidence-based intervention. Studies were evaluated for methodological rigor according to the classification system of Nathan and Gorman (2002) and then were assessed relative to the criteria for evidence-based treatments specified by Chambless et al. (1998), Chambless et al. (1996), and Chambless and Hollon (1998). Results from exposure-based cognitive behavioral therapy (CBT) trials with children and adolescents have been consistent, with remission rates of the disorder ranging from 40% to 85% across studies. Findings from this review indicate that individual exposure-based CBT for child and adolescent OCD can be considered as a probably efficacious treatment. CBT delivered in a family-focused individual or group format can be considered as a possibly efficacious treatment. Moderators, mediators, and predictors of treatment outcome are discussed, as are implications and generalizability of extant findings to real-world settings. We conclude with recommendations for best practice and future research directions.

Notes

Note: ICBT = individual cognitive behavioral therapy; POTS = Pediatric OCD Treatment Study; NR = not reported; OCD = obsessive–compulsive disorder; CY-BOCS = Children's Yale-Brown Obsessive-Compulsive Scale (Scahill et al., 1997); NIMH = National Institute of Mental Health Global Scale (Murphy, Pickar, & Alterman, 1982); MDD = Major Depressive Disorder; PDD = Pervasive Developmental Disorder; TS = Tourette's Syndrome; SRI = serotonin reuptake inhibitors; CBT = cognitive behavioral therapy; SER = Sertraline; COM = Combination Treatment; PBO = Placebo; MR = Mental Retardation; ADIS–C = Anxiety Disorders Interview Schedule for DSM–IV Child Version (Silverman & Albano, 1996); CDI = Children's Depression Inventory (Kovacs, 1992); MASC = Multidimensional Anxiety Scale for Children (March et al., 1997); FAD = McMaster Family Assessment Device (Epstein et al., 1983); DASS = Depression Anxiety Stress Scale (Lovibond & Lovibond, 1995); SAS = Sibling Accommodation Scale (Calvocoressi et al., 1995); WL = Wait List; Wk = Week; dx = diagnosis; Inc = Inclusion Criteria; Exc = Exclusion Criteria.

Note: ICBT = individual cognitive behavioral therapy; yrs = years; Inc = Inclusion Criteria; Exc = Exclusion Criteria; NR = not reported; OCD = obsessive–compulsive disorder; TS = Tourette's Syndrome; MR = Mental Retardation; MDD = Major Depressive Disorder; SRI = serotonin reuptake inhibitors; CY-BOCS = Children's Yale–Brown Obsessive-Compulsive Scale (Scahill et al., 1997); LOI–C = Leyton Obsessional Inventory–Child Version (Berg, Rapoport, & Flament, 1986); CDS = Children's Depression Scale (Lang & Tisher, 1978; Luteijn, 1981); CBCL = Child Behavior Checklist (Achenbach, 1991); CMI = Clomipramine; CBT = cognitive behavioral therapy; WT = weekly treatment; IT = intensive treatment; HDRS = Hamilton Depression Rating Scale (Hamilton, 1960); CGI–S = Clinical Global Impressions–Severity rating (Guy, 1976); COIS–P = Children's Obsessive Compulsive Impact scale–Parent Report (Piacentini et al., 2003); CDI = Children's Depression Inventory (Kovacs, 1992); FAS = Family Accommodation Scale (Calvocoressi et al., 1995); MASC = Multidimensional Anxiety Scale for Children (March et al., 1997); NIMH = National Institute of Mental Health Global Scale (Murphy, Pickar, & Alterman, 1982); ADHD = attention deficit hyperactivity disorder; PDD = Pervasive Developmental Disorder; PTSD = posttraumatic stress disorder; PD = Personality Disorder; GCBT = group cognitive behavioral therapy; CGAS = Children's Global Assessment Scale (Shaffer et al., 1983); SER = Sertraline.

¹Following Cohen (1988), between group effect sizes were calculated as follows:

Note: Effect size (Cohen's d = M ₁–M ₂/ _{s pooled}. ICBT = individual cognitive behavioral therapy; yrs = years; NR = not reported; Inc = Inclusion Criteria; Enc = Exclusion Criteria; OCD = obsessive–compulsive disorder; SSRI = selective serotonin reuptake inhibitors; CY-BOCS = Children's Yale–Brown Obsessive-Compulsive Scale (Scahill et al., 1997); NIMH = National Institute of Mental Health Global Scale (Murphy, Pickar, & Alterman, 1982); CGI-I = Clinical Global Impressions-Improvement; CGI–S = Clinical Global Impressions–Severity rating (Guy, 1976); tx = treatment; MR = Mental Retardation; HAM-A = Hamilton Anxiety Rating Scale (Hamilton, 1960); CGAS = Children's Global Assessment Scale (Shaffer et al., 1983); HDRS = Hamilton Depression Rating Scale (Hamilton, 1960); MDD = Major Depressive Disorder; TS = Tourette's Syndrome; ADIS-C/P = Anxiety Disorders Interview Schedule for DSM-IV Child/Parent Version (Silverman & Albano, 1996); CDI = Children's Depression Inventory (Kovacs, 1992); FAS = Family Accommodation Scale (Calvocoressi et al., 1995); FAD = McMaster Family Assessment Device (Epstein, Baldwin, & Bishop, 1983); PANDAS = pediatric autoimmune neuropsychiatric disorders associated with streptococcus; TODS–PR = Tourette's Disorder Scale–Parent Rated (Shytle et al., 2003); MASC = Multidimensional Anxiety Scale for Children (March et al., 1997); PDD = Pervasive Developmental Disorder; K-SADS-PL = Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (Kaufman, Birmaher, Brent, & Rao, 1997); GCBT = group cognitive behavioral therapy; CBCL = Child Behavior Checklist (Achenbach, 1991); PSI = Parenting Stress Index (Abidin, 1995); COIS-P/C = Children's Obsessive Compulsive Impact Scale-Parent/Child Report (Piacentini et al., 2003).

²Within group effect sizes were calculated using the following formula: d = (X _post – X _pre)/ _spooled (Cohen, 1988).

Note: POTS = Pediatric OCD Treatment Study Team.