Treatment of obsessive-compulsive disorder in children and youth: A meta-analysis
- Forfatter(e)
- Steele, Dale W., Kanaan, Ghid, Caputo, Eduardo L., Freeman, Jennifer B., Brannan, Elizabeth H., Balk, Ethan M., Trikalinos, Thomas A., Adam, Gaelen P.
- År
- 2025
- Tidsskrift
- Pediatrics
- Volum
- 155
- Sider
- 1-20
- Kategori(er)
- Tvangsforstyrrelser (OCD) Livskvalitet og trivsel
- Tiltakstype(r)
- Kognitiv atferdsterapi, atferdsterapi og kognitiv terapiAntidepressiva
- Abstract
CONTEXT: We examined treatments for obsessive-compulsive disorder (OCD) in children and adolescents.
OBJECTIVE: The objective was to evaluate the comparative efficacy of behavioral and pharmacologic treatments.DATA SOURCES: Sources include 6 databases and the ClinicalTrials.gov registry; search was last updated on May 15, 2024.
STUDY SELECTION: Dual screening was augmented by Abstrackr machine learning algorithm.
DATA EXTRACTION: Data include participant characteristics, intervention details, and risk of bias. RESULTS: Results are from 71 randomized controlled trials. In the random effects network metaanalysis of OCD symptom severity, assessed by the Children’s Yale-Brown ObsessiveCompulsive Scale Total (CY-BOCS), exposure and response prevention therapy (ERP) is more effective than waitlist (net mean difference [NMD], −10.5; 95% CI, −12.6 to −8.4) and probably more effective vs behavioral control (NMD, −5.3; 95% CI, −8.0 to −2.7). Remote ERP is more effective than waitlist (NMD, −9.4; 95% CI, −11.9 to −7.0) and as effective as in-person ERP. Selective serotonin reuptake inhibitors (SSRIs) are more effective than placebo (NMD, −4.4; 95% CI, −6.1 to −2.6). Clomipramine is probably more effective than placebo (NMD, −4.5; 95% CI, −6.8 to −2.1). ERP is probably more effective than SSRI (NMD, −2.7; 95% CI, −5.4 to −0.0), and combined ERP and an SSRI are probably more effective than SSRI alone (NMD, −3.0; 95% CI, −5.1 to −1.0). Overall, treatments including ERP (ERP+SSRI, ERP, and remote ERP) comprise the 3 highest-ranked interventions.
LIMITATIONS: Non–CY-BOCS outcomes were sparsely reported.
CONCLUSIONS: ERP, delivered in-person or via telehealth, SSRIs, and clomipramine are all effective treatments. ERP, alone or in combination with an SSRI, is probably more effective than an SSRI alone.