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Young children with OCD respond to family-based therapy


 

FROM JAMA PSYCHIATRY

A family-based program of cognitive-behavioral therapy eased symptoms of obsessive-compulsive disorder in young children significantly better than did a traditional relaxation-based treatment.

Almost three-fourths of the youngsters who underwent the family-based therapy were "very much" or "much" improved after 14 weeks of treatment, Jennifer Freeman, Ph.D., and her colleagues wrote in a recently published report (JAMA Psychiatry 2014 April 23 [doi:10.1001/jamapsychiatry.2014.170]).

The number needed to treat to achieve one additional responder over the relaxation-based program was about three, wrote Dr. Freeman, codirector of the pediatric anxiety research clinic at Bradley-Hasbro Children’s Research Center, Providence, R.I., and her coauthors.

The Pediatric Obsessive-Compulsive Disorder Treatment Study for Young Children (POTS Jr.) study randomized 127 children aged 5-8 years to either the family-based or relaxation-based treatments. More than 90% of the participants were white, 1.6% were black, 2.4% were Asian, 3.1% were mixed race, and 3.1% were unreported. Meanwhile, 95.3% were not Hispanic, and 4.7% were Hispanic. The participants’ families’ annual income range was $70,000-$80,000.

The family-based treatment was made up of four components: "g1) psychoeducation; 2) behavior management skills training (parent tools); 3) externalizing OCD and [exposure plus response prevention] (child tools); and 4) family process components."h for both parents and children. Parents learn about different ways to manage their child’s OCD behaviors – ignoring and rewords for example – as well as modeling positive behavior and helping the child learn self-regulation through exposure and response prevention. The cognitive-behavioral skills are simplified to improve the child’s ability to understand and employ them.

The relaxation-based program focuses on stress reduction and on teaching children how to recognize anxiety and other negative feelings, as well as positive feelings.

Assessments were conducted at baseline and 5, 9, and 14 weeks with a symptoms scale and the Clinical Global Impressions Severity and Improvement scales.

Children were a mean of 7 years old and had a mean 2-year duration of symptoms. By the end of the study, 72% of those in the family-based group were much or very much improved, compared with 41% of those in the relaxation group – a statistically significant difference. An effects size analysis determined that the difference also was clinically significant.

Dr. Freeman and her associates cited several limitations. For example, the enrollment of children from nonwhite and non–English speaking families was limited, which raises questions about whether the conclusions are generalizable, they said. "gSimilarly, the lack of socioeconomic diversity in the sample is a concern,"h they wrote.

Because the program is individually tailored to a child’s unique developmental level, it introduces the idea that treatment for obsessive-compulsive disorder can begin early, possibly interrupting symptom acceleration, the author said.

"With appropriate parental support, young children with OCD who undergo family-based [therapy] can make significant gains beyond what can be expected from having parents attempt to teach relaxation strategies to their children with OCD. Hopefully, these gains in overall development can decrease the chronicity and morbidity of this debilitating illness."h

The study was supported by several universities and the National Institute of Mental Health. Dr. Freeman had no financial disclosures, but one coauthor reported financial relationships with numerous pharmaceutical companies.

msullivan@frontlinemedcom.com

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