Advances in the Management of Pediatric OCD: Predictors, Moderators, and New Frontiers

Pediatric OCD is associated with substantive symptoms, impairment across multiple domains and, if left untreated, clinically significant dysfunction extending into adulthood. Fortunately, the efficacy and effectiveness of several forms of treatment have now been established, the most studied of which is cognitive behavioral therapy (CBT) involving exposure plus response prevention (ERP). Our review describes this literature in detail, and also covers the search for predictors and moderators of outcome which may help identify patient subgroups at risk for partial or non-response (treatment-resistant).

ERP is efficacious both alone and in combination with pharmacotherapy with serotonin reuptake inhibitors (SRIs) and appears to retain its benefits beyond the context of the academic medical centers where the protocols were developed and tested initially. However, there are still some patients who do not respond fully to the first-line interventions. Data on several potential candidates for prediction and moderation is reviewed, factors that limit the utility of the extant literature are described, and new initiatives are discussed which may allow the field to move forward in informing the development of the algorithms necessary for the application of the principles of precision medicine in pediatric OCD.

Efficacious treatments for pediatric OCD have been identified, but response to these first-line interventions is neither universal nor complete. Issues in play that limit access to efficacious forms of care including ERP at present are described, and potential solutions are offered to address current barriers to improving empirically supported interventions and increasing treatment access.