Moderators and predictors of response to cognitive behaviour therapy for pediatric obsessive-compulsive disorder: A systematic review. (March 2018)

• Record Type: Journal Article
• Authors: Turner, Cynthia; O'Gorman, Beth; Nair, Archana; O'Kearney, Richard
• Is Part Of: Psychiatry research. Volume 261(2018)
• Page Start: 50
• Page End: 60
• Publication Date: 2018-03
• Subjects: Pediatric OCD -- CBT -- Effect moderators -- Predictors; Psychiatry -- Periodicals; Psychiatry -- periodicals; Psychiatrie -- Périodiques; 616.89
• DOI: 10.1016/j.psychres.2017.12.034
• Languages: English
• ISSNs: 0165-1781

Abstract

Abstract: We report a systematic review of moderators of CBT efficacy for pediatric OCD relative to other treatments. CENTRAL, MEDLINE, EMBASE, CINAHL, and PsycINFO were searched for RCTs reporting on effect moderation for CBT outcomes. Five studies (N = 365) examined 17 variables with three significant moderators identified. Compared to pill-placebo, CBT monotherapy was not effective for children with a family history of OCD but was for those without a family history. For children with a family history, CBT plus sertraline efficacy was attenuated but remained significant. For children with tics, CBT but not sertraline remained superior to pill-placebo. For non-responders to initial treatment with CBT, continuing CBT was inferior to commencing sertraline for those with tics but was not different for those without tics. A supplementary review identified older age, symptom and impairment severity, co-morbidity and family accommodation as consistent predictors of a poorer outcome to CBT. Current evidence for moderation effects is post-hoc, from single RCTs, has small Ns and requires replication. The review identifies family history of OCD and the presence of tics as factors requiring further examination in properly conducted trials and about which clinicians need to show care in their treatment recommendations. Highlights: Individual treatment response to CBT for pediatric OCD is considerably variable. The first systemic review of moderators of CBT outcomes against other treatments. Evidence is post-hoc, from single RCTs, has small Ns and requires replication. Co-morbid tics and a family OCD history may moderate CBT outcomes against sertraline. Studies with larger Ns and testing a-priori and plausible hypotheses are required.