title: Predictors associated with improved cognitive-behavioral therapy outcome in pediatric obsessive-compulsive disorder.
abstract: OBJECTIVE
  To identify predictors of treatment response in a large sample of pediatric participants with obsessive-compulsive disorder (OCD). The Nordic Long-term Obsessive compulsive disorder (OCD) Treatment Study (NordLOTS) included 269 children and adolescents, 7 to 17 years of age, with a DSM-IV diagnosis of OCD. Outcomes were evaluated after 14 weekly sessions of exposure-based cognitive-behavioral therapy (CBT).
  
  
  METHODS
  The association of 20 potential predictors, identified by literature review, along with their outcomes, was evaluated using the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) posttreatment. A CY-BOCS total score of ≤15 was the primary outcome measure.
  
  
  RESULTS
  The univariate analyses showed that children and adolescents who were older had more severe OCD, greater functional impairment, higher rates of internalizing and externalizing symptoms, and higher levels of anxiety and depression symptoms before treatment had significantly poorer outcomes after 14 weeks of treatment. However, only age was a significant predictor in the multivariate model.
  
  
  CONCLUSIONS
  In the multivariate analysis, only age predicted better treatment outcome. Using univariate analysis, a variety of predictors of poorer treatment outcome after CBT was identified. The high impact of comorbid symptoms on outcome in pediatric OCD suggests that treatment should address comorbidity issues. The lack of a family predictor may be related to high family involvement in this study. Future research strategies should focus on optimizing intervention in the presence of these characteristics to achieve greater benefits for patients with OCD. Clinical trial registration information-Nordic Long-term Obsessive compulsive disorder (OCD) Treatment Study; www.controlled-trials.com; ISRCTN66385119.
authors.affiliation: Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo; Division of Mental Health and Addiction, Vestre Viken Hospital, Drammen, Norway. Electronic address: nor.christian.torp@r-bup.no.
authors.forename: Nor Christian
authors.initials: NC
authors.lastname: Torp
authors.affiliation: Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo.
authors.forename: Kitty
authors.initials: K
authors.lastname: Dahl
authors.affiliation: Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo.
authors.forename: Gudmundur
authors.initials: G
authors.lastname: Skarphedinsson
authors.affiliation: Duke University Medical Center, Durham, NC.
authors.forename: Scott
authors.initials: S
authors.lastname: Compton
authors.affiliation: Aarhus University Hospital, Regional Center for Child and Adolescent Psychiatry, Risskov, Aarhus, Denmark.
authors.forename: Per Hove
authors.initials: PH
authors.lastname: Thomsen
authors.affiliation: Regional Centre for Child and Youth Mental Health and Child Welfare, Faculty of Medicine, NTNU, Trondheim, Norway.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Weidle
authors.affiliation: Aarhus University Hospital, Regional Center for Child and Adolescent Psychiatry, Risskov, Aarhus, Denmark.
authors.forename: Katja
authors.initials: K
authors.lastname: Hybel
authors.affiliation: Regional Centre for Child and Youth Mental Health and Child Welfare, Faculty of Medicine, NTNU, Trondheim, Norway.
authors.forename: Robert
authors.initials: R
authors.lastname: Valderhaug
authors.affiliation: Specialmottagningen, Queen Silvia Children's Hospital, Gothenburg, Sweden.
authors.forename: Karin
authors.initials: K
authors.lastname: Melin
authors.affiliation: Aarhus University Hospital, Regional Center for Child and Adolescent Psychiatry, Risskov, Aarhus, Denmark.
authors.forename: Judit Becker
authors.initials: JB
authors.lastname: Nissen
authors.affiliation: Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo.
authors.forename: Tord
authors.initials: T
authors.lastname: Ivarsson
mesh_terms: D000293:Adolescent; D002648:Child; D003071:Cognition; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D015897:Comorbidity; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009771:Obsessive-Compulsive Disorder / Q000628:therapy*; D011569:Psychiatric Status Rating Scales; D012537:Scandinavian and Nordic Countries; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D017367:Selective Serotonin Reuptake Inhibitors
keywords: cognitive-behavioral therapy; pediatric OCD; predictors