Early responders and remitters to exposure-based CBT for pediatric OCD

- Knowledge of whom is going to be an responder or remitter at half-way point could be very useful clinically in terms of establishing estimates for families of how long their child might need to be in treatment.
- Design trials and treatment manuals with more frequent assessment of treatment response, in order to detect trajectories for treatment response and earlier points of positive response in therapy.
- Consider whether remitters could be reviewed for termination of therapy at the half-way point, finally.
- Suggest a need to allow potentially late responders more sessions over a longer period of time, to achieve sufficient treatment response.

ObjectiveTo identify both responders and remitters, at the half-way point (week 7) to exposure-based CBTfor pediatric OCD. Furthermore, evaluate the stability of the improvements, by examining both week 7 and week 14 (post-treatment)response and remission.Method269 children and adolescents, mean age 12.8, 51.3% female with a DSM-IV diagnosis of OCD were included. The NordLOTS study's design involved initial assignment of all participants to CBT. All analyses were conducted using an intent-to-treat model in which all available data were included in the analysis. Primary outcome measure was the CY-BOCS total score at weeks 7 and 14. We identified responders (CY-BOCS≤15) and remitters (CY-BOCS≤10) at the half-way point.ResultsAt week 7, 38.3% were responders (95% CI 32.4-44.5%, n=95) with a CY-BOCS total score of 10.81, symptoms reduction of 52.1%, and 13.7% were remitters (95% CI 10.0-18.6%, n=34), with a CY-BOCS total score of 5.71, symptoms reduction of 75.2%.DiscussionResponse and remission after seven weeks of treatment were persistent. However, a substantial number of non-responders and non-remitters at the half-way point, experienced response and remission at post treatment.ConclusionsGuidelines are needed to ensure that patients with OCD receive the therapy they need to achieve remission, while avoiding overutilization.Clinical trials registration information: This study was registered in Current Controlled Trials; Nordic Long-term Obsessive-compulsive disorder (OCD) Treatment Study (www.controlled-trials.com ISRCTN66385119).