A Better Way to Treat Obsessive-Compulsive Kids

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Obsessive compulsive disorder (OCD) can be a nasty enough condition when it strikes an adult. When it hits in childhood it’s far crueler. Not only are kids unequipped to understand what’s happening to them, they are also being denied what should be the best — or at least most worry-free — years of their lives.

That’s one of the reasons that attentive parents  move to treat the condition fast, and that often means drug therapy, which seems like the most direct — and certainly least expensive — way to get the job done. According to a recent study in the Journal of the American Medical Association, however, those parents are leaving a big component of effective treatment on the table — a component that could double the odds of their kids recovering.

OCD is an anxiety disorder — unlike, say, narcissism, which is a personality disorder — and that’s a very good thing. Anxiety disorders are extremely amenable to cognitive-behavioral therapy, particularly a kind known as exposure and response prevention (ERP). For OCD sufferers who fear contamination, for example, ERP might involve touching a feared object like a doorknob or a trash can and then resisting the urge to wash their hands for a fixed period of time. Over the course of weeks, that period of abstinence will grow longer and the category of newly touchable objects will grow bigger. In as little as three months, the condition may be in check.

The problem is, behavioral therapy is expensive and insurance companies may cover it only partially or not at all. What’s more, it’s time-consuming. Better just to pop any one of a number of types of antidepressants known as selective serotonin reuptake inhibitors (SSRIs) — most of which are available in cheap, fully covered generics.

In order to determine how effective that pills-only strategy is, a group of researchers headed by psychologist Martin Franklin of the University of Pennsylvania School of Medicine recruited a sample group of 124 OCD patients aged 7 to 17 years and divided them into three subgroups. A third of them would begin a medication-only protocol; a third would get medication plus instructions in behavioral strategies; and a third would get medication plus in-person therapy sessions to teach and rehearse the behavioral tactics.

At the end of a 12-week period, the kids’ OCD symptoms were evaluated using what’s known as the Children’s Yale-Brown Obsessive Compulsive Scale. The Yale-Brown scale scores kids on a range of OCD metrics, including how much anxiety they’re experiencing, the kinds of rituals they’re performing and how much time those rituals take. The benchmark Franklin and his colleagues were looking for was a 30% reduction in OCD symptoms — a level of relief that may not be full recovery, but can be a life-altering improvement and make kids receptive to more treatment still.

In the medication-only group, just 30% of the kids exhibited the 30% improvement; for medication plus behavioral instructions it was a tick better — 34%. The kids who received both meds and therapy sessions more than doubled that, with 68.6% getting 30% better.

The good news for children with OCD is not so much that the results are so robust. ERP has long been known to be an extremely powerful tool, and for many therapists, it’s the main tool, with drugs used merely as an adjunct and only when needed. The true significance is that Franklin’s study is clinical proof of that accepted wisdom — a powerful, peer-reviewed cudgel that will make it harder for insurance companies to deny kids the treatment. The faster that suffering children get the care they need, the more years of genuine childhood they’ll have.