Predicting Effectiveness of Cognitive Behavioral Therapy for Pediatric OCD

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In children with tics, cognitive behavioral therapy may be more effective than medication alone.
In children with tics, cognitive behavioral therapy may be more effective than medication alone.

According to the results of a systematic review published in Psychiatry Research, the effectiveness of cognitive behavioral therapy (CBT) in children and adolescents with obsessive-compulsive disorder (OCD) was mediated by the presence of tics and a family history of OCD.

To evaluate factors that moderate or predict efficacy of CBT in children with OCD, researchers systematically reviewed randomized controlled trials for moderators and noncontrolled trials for predictors. Participants in included studies were under the age of 18 years at baseline and were diagnosed with OCD. Eligible studies evaluated CBT monotherapy with an exposure and response component.

A total of 4 randomized controlled trials on moderation (N=365) and 31 primarily uncontrolled studies on predictors of CBT outcomes (the number of participants ranged from 12 to 269) were evaluated. According to moderation analyses, a family history of OCD reduced the efficacy of CBT compared with pill placebo.

Among children who failed to respond to an initial course of CBT, the presence of a tic disorder was associated with reduced efficacy of continued CBT. The researchers also found that in children with tics, CBT may be more effective than medication alone.

In predictor analyses, worse response to CBT was associated with older age, higher OCD symptom severity, higher level of OCD-related impairment, worse depressive symptoms, the presence of any comorbid mental disorder, and higher family accommodation of OCD symptoms. Medication at baseline was not a predictor of CBT effectiveness.

The researchers noted that the evidence presented in this systematic review was “still preliminary and requires replication.” They explained however, that the results allow “several tentative conclusions… having a first-degree family member with OCD and the presence of tics may be important considerations for initial choice of treatment [and] the presence of tics may also be important when considering options for children who [do] not respond to an initial course of CBT.”


Turner C, O'Gorman B, Nair A, O'Kearney R. Moderators and predictors of response to cognitive behaviour therapy for pediatric obsessive-compulsive disorder: a systematic review. Psychiatry Res. 2018;261:50-60.

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