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Treatment of obsessive-compulsive disorder in children and adolescents

Author
David Rosenberg, MD
Section Editor
David Brent, MD
Deputy Editor
Richard Hermann, MD

INTRODUCTION

Obsessive-compulsive disorder (OCD) is a severe, prevalent and most often chronically debilitating disorder characterized by repetitive, ritualistic and distressing thoughts, ideas, and behaviors over which a person typically has very little if any control. Research suggests that as many as 50 percent of all cases have their onset in childhood and adolescence [1].

Treatments for OCD in children and adolescents include medications and psychotherapy. A combination of medication and psychotherapy may be useful in cases of more-severe, comorbid or treatment refractory illness.

This topic reviews the treatment of OCD in children and adolescents. The epidemiology, pathogenesis, clinical manifestations, course, assessment and diagnosis of OCD in children and adolescents are discussed separately. The epidemiology, pathogenesis, clinical manifestations, course, assessment, diagnosis, and treatment of OCD in adults are also discussed separately. Pediatric autoimmune neuropsychiatric disorder associated with group A streptococci (PANDAS) is also discussed separately. (See "Obsessive-compulsive disorder in children and adolescents: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis" and "Pharmacotherapy for obsessive-compulsive disorder in adults" and "Obsessive-compulsive disorder in adults: Epidemiology, pathogenesis, clinical manifestations, course, and diagnosis" and "Psychotherapy for obsessive-compulsive disorder in adults" and "PANDAS: Pediatric autoimmune neuropsychiatric disorder associated with group A streptococci".)

OVERVIEW

Effective treatments for OCD in children and adolescents include cognitive behavioral therapy (CBT) and serotonergic reuptake inhibitors (SRIs) [2,3]. For mild to moderate cases of pediatric OCD, we suggest first-line treatment with CBT. An SRI can be used first-line in cases of patient and family preference or if CBT were not available. (See 'Comparing medication and CBT' below and 'Efficacy' below.)

For more severe presentations of pediatric OCD, we suggest first-line treatment with a combination of an SRI and CBT. The SRI may be needed to decrease the OCD and associated anxiety symptoms to a level where CBT can be effective [4]. In our clinical experience, concomitant use of CBT may allow for the use of a lower dose of an SRI than would otherwise be needed, potentially reducing medication side effects. (See 'Combining medication and CBT' below and 'Efficacy' below.)

                           

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Literature review current through: Nov 2016. | This topic last updated: Sun Jul 17 00:00:00 GMT 2016.
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