Severe pediatric obsessive compulsive disorder and co-morbid autistic symptoms: Effectiveness of cognitive behavioral therapy

• CBT is expected to be less effective for children with severe OCD.
• CBT is also assumed to be less suitable in case of an autism spectrum disorder.
• OCD severity and autistic symptoms were not found to be predictive of CBT efficacy.
• CBT monotherapy is effective for the majority of children with OCD.

Clinical consensus exists on the recommendation to add medication to cognitive behavioral therapy (CBT) for children with moderate to severe obsessive compulsive disorder (OCD). However, it has never been examined if CBT monotherapy indeed is less effective for this subgroup. In addition, CBT is often expected to be less suitable in case of an autism spectrum disorder. The aim of the present study was to examine if CBT monotherapy is an effective treatment for children with severe OCD and for children with co-morbid autistic symptoms.MethodsParticipants were 58 children (8–18 years) with OCD. They were randomized over two conditions: a waitlist followed by CBT, and directly starting CBT. After CBT, participants were followed during a one-year period. Linear mixed model analyses were performed to examine if severity and autistic symptoms were predictors of treatment effect.ResultsResults showed that neither baseline severity, F(2, 196.52)=.29, p=.75, nor autistic symptoms, F(1, 182.72)=2.09, p=.15, were predictive of treatment effect.ConclusionResults suggest that the majority of children with OCD, including children with severe OCD and with autistic symptoms, can be treated effectively with CBT. Therefore, the recommendation to combine CBT and medication for children with moderate to severe OCD may need refinement.