Before treatment begins, it is important for the clinician to fully understand pediatric OCD and how it affects daily functioning and the family. This includes learning about:
- The specific types of OCD symptoms that are present
- How severe and/or impairing symptoms are
- When the symptoms started
- How aware the child is that symptoms are a part of OCD
- Whether there is resistance or hesitation about receiving treatment,
- Ways in which the child and his or her family understand and respond to OCD symptoms.
Environmental, genetic, and other factors combine in a complex way within the brain to lead to OCD. Because of this, both biologic (medication) and non-biologic (cognitive behavioral therapy) approaches can be successful in treating OCD.
For more information about how to conduct a comprehensive diagnostic and clinical assessment of pediatric OCD, here.
There are two primary treatment approaches that have been repeatedly proven to work for OCD: a type of cognitive behavior therapy called exposure and response prevention (ERP) and a group of medications called serotonin-reuptake inhibitors (SRIs). The decision to start treatment with ERP alone, medication alone, or with both ERP and medication depends very much on the individual situation.
ERP, Medications, or Both?
Exposure and response prevention (ERP) therapy should always be considered as the first-line of treatment for children and adolescents with OCD, either on its own or with medication.
Medication should be considered when children are experiencing moderate to severe OCD-related impairment or distress and when ERP is unavailable or only partially effective. Given the potential of medication side effects, it is preferable to begin treatment with ERP alone among children and adolescents with mild illness and among those opposed to medication use.
For those without access to an OCD-experienced, ERP-trained clinician and/or with poor motivation or insight, an initial trial with a SRI alone may be optimal until ERP treatment becomes more tolerable or available. Other factors that may suggest the usefulness of starting with a medication include the presence of other disorders in addition to OCD such as depression, psychosis, or other anxiety disorders that can interfere with CBT motivation.