The study, from researchers at the Bradley Hasbro Children’s Research Center in Rhode Island, found family-based CBT that included exposure/response prevention (EX/RP) was more effective in reducing OCD symptoms for these children than a relaxation program.
“CBT has been established as an effective form of OCD treatment in older children and adolescents, but its effect on young children has not been thoroughly examined,” said Jennifer Freeman, Ph.D., a staff psychologist at the research center and clinical co-director of the Intensive Program for OCD at Bradley Hospital, who led the study.
“These findings have significant public health implications, as they support the idea that very young children with emerging OCD can benefit from behavioral treatment.”
The study was conducted at three academic medical centers over a five-year period. The researchers studied 127 children between the ages of five and eight who had been diagnosed with OCD. The children were randomly assigned to either family-based CBT with EX/RP or family-based relaxation therapy. Both therapies lasted 14 weeks.
The family-based CBT focused on helping the child and parent understand, manage, and reduce OCD symptoms. Strategies included psychoeducation, parenting strategies, and family-based exposure treatment, so children could gradually practice facing feared situations while learning to tolerate anxious feelings, the researcher explained.
The family-based relaxation therapy focused on learning about feelings and implementing muscle relaxation strategies aimed at lowering the child’s anxiety.
At the end of the trial period, 72 percent of the children receiving CBT with EX/RP were rated as “much improved” or “very much improved” on the Clinical Global Impression-Improvement scale, versus 41 percent of children receiving the family-based relaxation therapy, the researchers report.
According to Freeman, the traditional approach for children this young with OCD symptoms has been to watch and wait.
“This study has shown that children with early onset OCD are very much able to benefit from a treatment approach that is uniquely tailored to their developmental needs and family context,” she said. “Family-based EX/RP treatment is effective, tolerable, and acceptable to young children and their families.”
She added that she hopes the family-based CBT model will become the first-line choice for young children with OCD in community mental health clinics where they first go for treatment.
Earlier intervention may help address the chronic issues many children have with OCD, as well as the impact the debilitating illness can have on their overall development, she noted.
“We use this family-based CBT model for treating children in this age range in both our Pediatric Anxiety Research Clinic and our Intensive Outpatient Program with much success,” said Freeman. “My hope is that others will utilize this treatment model to the benefit of young children at the onset of their illness.”
“The findings from this study support extending downward the age range that can benefit from CBT with EX/RP for pediatric OCD treatment,” she concluded.
“With appropriate parental support, young children with OCD can make significant gains beyond what can be expected from having parents attempt to teach relaxation strategies to their children with OCD.”
The study, funded by the National Institute of Mental Health, was published online in JAMA Psychiatry.
Source: Bradley Hospital