Children suffering from obsessive compulsive disorder (OCD) may find sustained relief from family-based cognitive behavioral therapy no matter how old they are, finds a new study conducted by Bradley Hasbro Children’s Research Center.

While family-based exposure therapy has in the past shown efficacy for adolescents — children typically between 12 and 18 years old — scientists are only beginning to understand how the complex disorder responds to the same treatment in younger children, in this case subjects aged 5 to 8. What the experimenters found was that CBT is just as effective, and its implementation could result in earlier prevention rather than too-late diagnosis.

“My hope is that others will utilize this treatment model to the benefit of young children at the onset of their illness,” said study leader Dr. Jennifer Freeman, staff psychologist at the Research Center, in a news release. Rather than risk catching OCD too late, Freeman regards the latest findings as evidence for early approaches.

She and her colleagues conducted a 14-week-long trial involving 127 children between the ages of 5 and 8 with a primary diagnosis of OCD. Each child received either family-based CBT with exposure/response prevention (EX/RP) or family-based relaxation therapy, which involves the child learning about his or her feelings and utilizing muscle relaxation strategies to lower anxiety levels. At the end of the study, 72 percent of the children who had been exposed to CBT enjoyed a “much improved” or “very much improved” rating. The other group, however, only achieved these ratings 41 percent of the time.

According to Freeman, the findings motivate new techniques for treating OCD among young children aside from traditional “wait and see” methods. When symptoms arise, even in the earliest stages — ranging from repeated concern with cleanliness to more extreme repetitive behaviors — parents and clinicians are normally slow to act. The behavior will typically subside, they often think. Freeman, however, believes the latest research is solid proof this is the wrong way to approach the problem.

“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. CBT isn’t an overwhelming burden either. Typically, it includes psychoeducation, parenting strategies, and family-based exposure treatment, so kids can learn at a manageable pace how to face feared situations and tolerate anxious feelings.

Some three million U.S. adults suffer from OCD, with just over half of those cases carrying the label of “severe.” Statistics on children are harder to come by; however, the Child Study Center at NYU Langone Medical Center estimates roughly one million children suffer from the disorder. Luckily for people like Freeman, who advocate earlier diagnosis, 50 percent of adult cases were noticed before the age of 15. Peak onset is normally pegged at around age 10.

It’s Freeman’s hope that the study will compel a wider clinical audience to adopt family-based CBT strategies for children in a wide band of ages. In the end, the result could be a departure from traditional methods that preach relaxation techniques as the gold standard. Confronting, not coping, in other words, may be a better option.

“With appropriate parental support,” Freeman said, “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.”

 

Source: Freeman J, Sapyta J, Garcia A, et. al. The Pediatric Obsessive-Compulsive Disorder Treatment Study for Young Children (POTS Jr)—A Randomized Clinical Trial. JAMA Psychiatry. 2014.