Treatment

General Background

Many children and adolescents with OCD have a long delay between the start of their OCD symptoms and the start of proper diagnosis treatment. Sadly OCD symptoms often worsen when left untreated.  However, the good news is that OCD is usually very treatable.  As such it is especially important for families, children, adolescents and clinicians to have a clear understanding of current, proven ways of managing this illness.  This article summarizes treatment approaches that have been recommended by leading pediatric OCD clinicians and experts.

Before treatment begins, it is important for the clinician to fully understand many aspects about OCD and how it is affecting functioning and the family.  This includes learning about the specific types and severity of OCD symptoms that are present and most impairing, when the symptoms started, the degree of awareness by the youth that the symptoms are a part of OCD, whether there is resistance or hesitation about receiving treatment, and ways in which the family and youth 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) approaches have been shown to successfully treat OCD. There are two main treatment approaches that have been repeatedly proven to work for OCD. These include cognitive-behavior therapy (CBT) and a group of medications called serotonin-reuptake inhibitors (SSRIs and clomipramine).  The decision of whether to start treatment with CBT alone, an SSRI alone or with both CBT and medication depends very much on the individual situation. 

Deciding between CBT, medications or both

Cognitive-behavioral therapy (CBT) should always be considered as a part of OCD treatment, either with or without medication. CBT is safe and effective as a treatment for OCD, and medication alone is usually not as effective, nor as long-lasting as those from medication plus CBT. But finding a behavior therapist who treats childhood OCD is often very challenging. For this reason, many children with OCD are treated solely with medications. Medication treatment should be considered when children are experiencing severe OCD-related impairment or distress, and when CBT is unavailable or only partially effective. Given the potential of medication side effects, it is preferable to begin treatment with CBT alone among children and adolescents with mild illness, and among those opposed to medication use. 

For those without access to an OCD-experienced, CBT-trained clinician and/or with poor motivation or insight, an initial trial with a SSRI alone may be optimal until CBT treatment becomes feasible 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.

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