Evidence Base Update for Psychosocial Treatments for Pediatric Obsessive-Compulsive Disorder

Abstract

Pediatric obsessive-compulsive disorder (OCD) is a chronic and impairing condition that often persists into adulthood. Barrett, Farrell, Pina, Peris, and Piacentini (2008), in this journal, provided a detailed review of evidence-based psychosocial treatments for youth with OCD. The current review provides an evidence base update of the pediatric OCD psychosocial treatment literature with particular attention to advances in the field as well as to the methodological challenges inherent in evaluating such findings. Psychosocial treatment studies conducted since the last review are described and evaluated according to methodological rigor and evidence-based classification using the JCCAP evidence-based treatment evaluation criteria (Southam-Gerow & Prinstein, this issue). Findings from this review clearly converge in support of cognitive-behavioral therapy as an effective and appropriate first line treatment for youth with OCD (either alone or in combination with medication). Although no treatment for pediatric OCD has yet to be designated as “well-established,” both individual and individual family-based treatments have been shown to be “probably efficacious.” Moderators and predictors of treatment outcome are discussed as are the areas where we have advanced the field and the areas where we have room to grow. The methodological and clinical challenges inherent in a review of the evidence base are reviewed. Finally, future research directions are outlined.

Notes

Note:. ADHD = attention-deficit/hyperactivity disorder; ADIS: C = Anxiety Disorders Interview Schedule for DSM-IV: Child Version; ADIS-CSR: Anxiety Disorders Interview Schedule for DSM-IV Clinician Severity Rating; BAI = Beck Anxiety Inventory; BDI = Beck Depression Inventory; BSI = Brief Symptom Inventory; CBCL = Child Behavioral Checklist; CDI = Children's Depression Inventory; CGI-S = Clinical Global Impression- Severity Scale; CHOCI = Children's Obsessional Compulsive Inventory; COIS = Child OCD Impact Scale; CRAS = Children's Responsibility Attributions Scale; CRIQ = Child Responsibility Interpretation Questionnaire ; CSDS = Child Sheehan Disability Scale; CY-BOCS = children's Yale-Brown Obsessive-Compulsive Scale; CBT = cognitive behavioral therapy; DASS-21 = Depression Anxiety Stress Scale-2; DY-BOCS = Dimensional Yale-Brown Obsessive-Compulsive Scale; ERP = exposure and response prevention; FAD = Family Asessment Device; FAS = Family Accommodation Scale; HSUQ = Health Service Use Questionnaire; ICBT = individual cognitive behavioral therapy; IUS-12 = Intolerance of Uncertainty Scale; KSADS-PL = Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version; NR = not reported; OBQ-44 = Obsessive Belief Questionnaire (44 Item Version); OBQ-87 = Obsessive Beliefs Questionnaire (87 Item Version); OCD = obsessive-compulsive disorder; OCI = Obsessive-Compulsive Inventory; MASC = Multidimensional Anxiety Scale for Children; MASC-OC: Multidimensional Anxiety Scale-Obsessive Compulsive Screen; MANSA = Manchester Short Asessment of Quality of Life; MFQ = The Moods and Feelings Questionnaire; NIMH -GOCS = National Institute of Mental Health - Global Obsessive Compulsive Scale; PDD = pervasive developmental disorder; PPVT-4 = Peabody Picture Vocabulary Test - Fourth Edition; RADS-2 Reynolds Adolescent Depression Scale, 2nd edition; RT = relaxation therapy; SCARED = Screen for Child Anxiety-Related Emotional Disorders; SCAS = Spence Children's Anxiety Scale; SRI = serotonin reuptake inhibitors; STAI = State-Trait Anxiety Inventory; TAF-R Thought Action Fusion Scale – Revised; WROC = Weekly Parental Ratings of OC Behaviors; YBOCS = Yale-Brown Obsessive-Compulsive Scale.

Note: Adapted from Silverman and Hinshaw (2008) and Division 12 Task Force on Psychological Interventions’ reports (Chambless et al., 1998; Chambless et al., 1996), from Chambless and Hollon (1998), and from Chambless and Ollendick (2001). Chambless and Hollon (1998) described criteria for methodology.

Note: CBT = cognitive behavioral therapy.