title: Factors associated with poor response in cognitive-behavioral therapy for pediatric obsessive-compulsive disorder.
abstract: Cognitive-behavioral therapy (CBT) with exposure and response prevention has proved to be an effective intervention for youth with obsessive-compulsive disorder (OCD). Given advantages over psychiatric medications (i.e., serotonin reuptake inhibitors) based on superior safety, maintenance of response, and efficacy, CBT is considered the first-line treatment for youth with OCD. Nevertheless, a number of clinical factors can complicate CBT for OCD course and outcome. The authors review factors associated with poor treatment response, highlighting variables that pertain to the child, the family environment, and the treatment process. Specific topics include diminished insight, family accommodation, comorbidity, symptom presentation, and cognitive deficits. Remarkably, CBT for OCD is robust to these encumbrances in the majority of cases, despite the need for protocol modifications to tailor treatment to the individual child.
authors.affiliation: Department of Pediatrics, University of South Florida College of Medicine, St. Petersburg, FL 33701, USA. estorch@health.usf.edu
authors.forename: Eric A
authors.initials: EA
authors.lastname: Storch
authors.forename: Thröstur
authors.initials: T
authors.lastname: Björgvinsson
authors.forename: Bradley
authors.initials: B
authors.lastname: Riemann
authors.forename: Adam B
authors.initials: AB
authors.lastname: Lewin
authors.forename: Miguel J
authors.initials: MJ
authors.lastname: Morales
authors.forename: Tanya K
authors.initials: TK
authors.lastname: Murphy
mesh_terms: D001364:Awareness; D002648:Child; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D015897:Comorbidity; D018849:Controlled Clinical Trials as Topic; D003430:Cross-Sectional Studies; D005195:Family Relations; D006801:Humans; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D010349:Patient Compliance / Q000523:psychology; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D017211:Treatment Failure
chemical_list: D017367:Selective Serotonin Reuptake Inhibitors