The behavioral treatment, which involved parents
heavily and is already known to work for older kids and teens, left
almost three-quarters of the young children significantly better
off, according to objective measurements.
"I really think that the results highlight this family-based
cognitive behavior therapy model as the first-line treatment for
children with OCD," Jennifer Freeman, the study's lead author, told
Freeman is affiliated with the Alpert Medical School of Brown
University, the Pediatric Anxiety Research Clinic at Rhode Island
Hospital and the Intensive Program for Obsessive-Compulsive Disorder
at Bradley Hospital in Providence, Rhode Island.
People with OCD have a set of compulsions — feeling compelled to do
something — that cause them distress or disrupt their daily lives.
For example, a person may have an intense fear that something bad
will happen unless they perform a certain action multiple times.
The condition has been found to run in families, according to the
U.S. National Institutes of Health (NIH), but its cause is still
About 2.2 million U.S. adults are affected by OCD, with
approximately one-third of those having developed symptoms as
children, according to NIH.
Considerable research has shown that CBT alone or in combination
with anti-anxiety medicine is effective in treating OCD among older
children and adolescents, Freeman and her colleagues write in JAMA
There was little evidence about what worked for younger children
with OCD, however.
For the new study, researchers from three academic medical centers
in the U.S. randomly assigned 127 children between ages five and
eight years old to one of two groups.
One group of 63 received a version of the family-based CBT designed
to meet the needs of younger kids and their parents. The therapy
emphasizes understanding, managing and reducing OCD symptoms.
That's accomplished through lessons and exercises, including
educating the families about the condition and showing parents and
children how to respond to compulsions or other symptoms.
Unlike the version for older children and adolescents, the CBT for
younger children requires much more parental involvement and lessons
and activities geared toward the child's developmental level.
The other group of 64 kids received a family-based relaxation
therapy, for comparison. It teaches children and their families
relaxation techniques but does not specifically address OCD or its
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The treatments were administered to each family over 14 weeks, at
the end of which an independent evaluator reported that 72 percent
of the children in the CBT group were either "very much" or "much"
improved. That compared to 41 percent of kids in the relaxation
Freeman said that evaluation means the children and parents reported
a significant improvement in everyday life. For example, the
children's compulsions may have diminished and caused less
disruption in their lives.
There was also a greater decrease in the severity of OCD symptoms
among those in the CBT group, compared to those who got the
Freeman said she and her colleagues are starting to look at data
from the children past the initial 14 weeks. That will show whether
the after-effects of CBT are sustained over months or years.
"That's going to help us understand what next steps need to be
taken," Anne Marie Albano told Reuters Health.
Albano, who was not involved in the new study, directs the Columbia
University Clinic for Anxiety and Related Disorders in New York.
She said the additional data will tell researchers if children need
additional sessions after the 14 weeks and if they will eventually
"I think this is so critical," she said. "And the people in public
health should be jumping on this and disseminating the treatment so
therapists learn how to do this."
Freeman said the version of family-based CBT used in this study may
not be widely available, but her group has published a manual to
help therapists learn how to administer the treatment.
Psychiatry, online April 23, 2014.
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