TREATMENT OF PEDIATRIC OBSESSIVE COMPULSIVE DISORDER

University Of Pennsylvania, Philadelphia PA

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Abstract

DESCRIPTION (Adapted from applicant's abstract): One in two hundred young suffers from Obsessive-Compulsive Disorder (OCD), yet relatively few receive appropriate treatment. Both cognitive-behavior therapy (CBT) and medication appear beneficial in controlled studies; however, the relative efficacy of CBT and medication, alone and in combination, (COMB), is unknown. Thus well-designed treatment outcome studies are necessary to improve care for youth with OCD. This revised proposal constitutes one half of a (two-center) Multi-Institutional Collaborative Research Project focused on the treatment of pediatric OCD, resubmitted jointly but separately by Drs. Edna Foa at Allegheny University (AU) and John March at Duke University. Using a volunteer sample of 120 (60/site) youth age 8-16 with a DSM-IV diagnosis of OCD, the proposed 5 year treatment outcome study contrasts the degree and durability of improvement obtained across six treatment conditions: 3 active treatments, sertraline alone (SER), OCD-specific behavior therapy (CBT), both SER and CBT (SER+CBT) and 3 control treatments, pill PBO, pill PBO+Educational Support (ES) and SER+ES. The experimental design covers 2 phases. Phase I is a 2 (site) x 2 (sertraline or pill PBO) x 3 (CBT, ES or non psychosocial treatment) x 5 (repeated measures) factorial 12 week comparison of SER, CBT, COMB and the control conditions. In Phase II, responders advance to a 16 week discontinuation study to assess treatment durability. The primary outcome measure is the Yale-Brown Obsessive-Compulsive Scale. Assessments blind to treatment status take place at week 0 (pretreatment); weeks 1, 4, 8, 12 (Phase I treatment); and weeks 16, 20, 24 and 28 (Phase II discontinuation). Besides addressing comparative efficacy and durability of the specified treatments, we also examine time-action effects, differential effects on specific aspects of OCD, including functional impairment, and predictors of response to treatment.