Pediatric OCD: Family Interactive Therapy Reduces Symptom Severity

Positive Family Interaction Therapy (PFIT) plus sessions of individual child cognitive-behavioral therapy (CBT) reduces symptom severity and impairment in children with obsessive-compulsive disorder (OCD), according to a study published in the Journal of the American Academy of Child & Adolescent Psychiatry. The study also reported that PFIT improves family functioning.

Tara S. Peris, PhD, associate professor of psychiatry and biobehavioral sciences at the University of California Los Angeles (UCLA) Semel Institute and program director of the UCLA ABC Partial Hospitalization Program, and colleagues randomly assigned 62 children with a primary diagnosis of OCD and at least 2 indications of poor family functioning to receive 12 sessions of individual child CBT plus either weekly parent psychoeducation and session review (standard therapy) or 6 sessions of PFIT. Blind raters evaluated outcomes and tracked responders to a 3-month follow-up visit.

Participants ranged in age from 8 to 17, with a mean age of 12.71. PFIT consisted of sessions of family therapy aimed at improving OCD-related emotion regulation and problem solving. Compared with standard therapy, PFIT demonstrated better overall response rates on the Clinician Global Impression-Improvement scale (CGI-I; 68% vs 40%, P =.03). Furthermore, 58% of patients receiving PFIT experienced remission compared with 27% treated with standard therapy (P =.01). 

In addition, PFIT produced significantly greater reductions in functional impairment, symptom accommodation, and family conflict, and enabled improvements in family cohesion. Of note, reductions in accommodation experienced in the PFIT group were identified as a potential mechanism of change in pediatric OCD treatment.

Study limitations included the small sample size and the brief follow-up period. In addition, although independent evaluators were blinded to the therapy received, therapists themselves were not blind to the study hypotheses.

However, the investigators noted that no previous study has demonstrated that changes in symptom accommodation account for clinical improvement in youths receiving CBT for OCD. These findings underscore the importance of working with families to change patterns of response to OCD.

Reference

Peris TS, Rozenman MS, Sugar CA, McCracken JT, Piacentini J. Targeted family intervention for complex cases of pediatric obsessive-compulsive disorder: a randomized controlled trial [published online October 3, 2017]. J Am Acad Child Adolesc Psychiatr. 2017. doi:10.1016/j.jaac.2017.10.008