Personalized Assessments for Childhood OCD
Recruiting in Palo Alto (17 mi)
Overseen ByJoseph F. McGuire, PhD
Age: < 18
Sex: Any
Travel: May be covered
Time Reimbursement: Varies
Trial Phase: Academic
Recruiting
Sponsor: Johns Hopkins University
No Placebo Group
Approved in 3 jurisdictions
Trial Summary
What is the purpose of this trial?The primary purpose of this study is to learn whether personalized assessment of obsessive-compulsive disorder (OCD) symptoms in childhood OCD using mobile health technology are feasible and acceptable for youth and parents. The investigators will also examine whether personalized cognitive-behavioral therapy (CBT) that is informed by personalized OCD assessments yields better clinical outcomes when compared to standard CBT for youth with OCD
How is the treatment Exposure with Response Prevention (ERP) unique for childhood OCD?
Exposure with Response Prevention (ERP) is unique for childhood OCD because it involves facing fears (exposure) without performing compulsive behaviors (response prevention), and it often includes family involvement to reduce family accommodation of OCD behaviors, which is not typically emphasized in other treatments.
34589Is Exposure with Response Prevention (ERP) safe for treating OCD in children?
ERP is generally considered safe for treating OCD in children, though it can be distressing, which sometimes leads to treatment dropout. Studies emphasize the importance of family involvement and addressing specific challenges to improve treatment success.
15689What data supports the effectiveness of the treatment Exposure with Response Prevention (ERP) for childhood OCD?
Research shows that ERP, a type of therapy where children face their fears without performing their usual rituals, is effective in reducing OCD symptoms in children. Studies highlight the importance of family involvement and suggest that combining ERP with parent management training can enhance its effectiveness, especially in children with additional disruptive behaviors.
25789Will I have to stop taking my current medications?
You can participate if you are not taking any medications or if you have been on a stable dose of your current medication for at least 8 weeks before joining the study.
Eligibility Criteria
This trial is for children and teens aged 8-17 with a primary diagnosis of OCD, as confirmed by an interview. They should have moderate OCD severity and be either medication-free or on a stable dose for at least 8 weeks. Participants must speak English but can't join if they're already in psychotherapy for OCD, have certain other mental health conditions, or are at immediate risk of harming themselves.Inclusion Criteria
I am between 8 and 17 years old.
I have been officially diagnosed with OCD.
I have not changed my medications in the last 8 weeks.
Exclusion Criteria
I cannot fill out forms or go to appointments by myself.
Participant Groups
The study is testing whether using mobile tech to assess OCD symptoms in kids leads to better treatment outcomes. It compares personalized cognitive-behavioral therapy (CBT), tailored based on these assessments, against standard CBT typically used to treat youth with OCD.
2Treatment groups
Experimental Treatment
Active Control
Group I: Personalized AssessmentsExperimental Treatment1 Intervention
12 sessions of exposure with response prevention (ERP) that is guided by personalized assessments.
Group II: Standard of CareActive Control1 Intervention
12 sessions of exposure with response prevention (ERP) that is guided using standard practice.
Exposure with Response Prevention is already approved in United States, European Union, Canada for the following indications:
🇺🇸 Approved in United States as Exposure with Response Prevention for:
- Obsessive-Compulsive Disorder (OCD)
🇪🇺 Approved in European Union as Exposure with Response Prevention for:
- Obsessive-Compulsive Disorder (OCD)
🇨🇦 Approved in Canada as Exposure with Response Prevention for:
- Obsessive-Compulsive Disorder (OCD)
Find A Clinic Near You
Research locations nearbySelect from list below to view details:
Johns Hopkins University School of MedicineBaltimore, MD
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Who is running the clinical trial?
Johns Hopkins UniversityLead Sponsor
References
Stepped care versus standard cognitive-behavioral therapy for obsessive-compulsive disorder: a preliminary study of efficacy and costs. [2021]Exposure and response prevention (ERP) for obsessive-compulsive disorder (OCD) is underutilized, in part because of costs and time requirements. This study extends pilot work investigating the use of a stepped care ERP administration, in which patients are first given a low-intensity, low-cost treatment and the more costly intervention is reserved for those who do not respond to the first intervention.
Exposure and response prevention with or without parent management training for children with obsessive-compulsive disorder complicated by disruptive behavior: a multiple-baseline across-responses design study. [2018]Comorbidity with disruptive behavior disorders may have important implications for exposure-based cognitive behavioral treatments of children with OCD. Child noncompliance and parent-child conflict may interfere with performance of exposure activities and completion of therapeutic homework assignments, thus diminishing response to treatment. We investigated whether response to exposure and response prevention (ERP) can be enhanced if disruptive behavior is treated first with parent management training (PMT). A multiple-baseline across-responses design was used to investigate the effects of ERP with or without PMT in six children (age range 9-14 years) with OCD and disruptive behavior. Weekly ratings of OCD were conducted for four weeks to establish baseline. After that, children were randomly assigned to receive six weekly sessions of PMT and then twelve weekly sessions of ERP (ERP-plus-PMT condition) or to receive ERP after a six week waiting period (ERP-only condition). The outcome assessments were conducted weekly using the Child Yale-Brown Obsessive Compulsive Scale (CY-BOCS) administered by an experienced clinician, who was blind to treatment assignment. Three subjects in the ERP-plus-PMT condition evidenced a 39 percent reduction in the CY-BOCS score versus a 10 percent reduction in three subjects in the ERP-only condition. The results of our single-subject study suggest the feasibility and positive effects of combining ERP with PMT for children with OCD complicated by disruptive behavior.
Family-based exposure and response prevention therapy for preschool-aged children with obsessive-compulsive disorder: a pilot randomized controlled trial. [2022]To examine the feasibility, acceptability and preliminary efficacy of family-based exposure/response prevention therapy (E/RP) versus treatment as usual (TAU) in a cohort of very young children with early onset obsessive-compulsive disorder (OCD).
Exposure and response prevention process predicts treatment outcome in youth with OCD. [2022]Recent research on the treatment of adults with anxiety disorders suggests that aspects of the in-session exposure therapy process are relevant to clinical outcomes. However, few comprehensive studies have been conducted with children and adolescents. In the present study, 35 youth diagnosed with primary obsessive-compulsive disorder (OCD; M age = 12.9 years, 49% male, 63% Caucasian) completed 12 sessions of exposure and response prevention (ERP) in one of two treatment conditions as part of a pilot randomized controlled testing of a family focused intervention for OCD. Key exposure process variables, including youth self-reported distress during ERP and the quantity and quality of ERP completed, were computed. These variables were examined as predictors of treatment outcomes assessed at mid-treatment, post-treatment, and three-month follow-up, partialing treatment condition. In general, greater variability of distress during ERP and completing a greater proportion of combined exposures (i.e., exposures targeting more than one OC symptom at once) were predictive of better outcomes. Conversely, greater distress at the end of treatment was generally predictive of poorer outcomes. Finally, several variables, including within- and between-session decreases in distress during ERP, were not consistently predictive of outcomes. Findings signal potentially important facets of exposure for youth with OCD and have implications for treatment. A number of results also parallel recent findings in the adult literature, suggesting that there may be some continuity in exposure processes from child to adult development. Future work should examine additional measures of exposure process, such as psychophysiological arousal during exposure, in youth.
Using Family-Based Exposure With Response Prevention to Treat Obsessive-Compulsive Disorder in Young Children: A Case Study. [2018]Cognitive-behavioral therapy (CBT) using exposure with response prevention (ERP) is the treatment of choice for obsessive-compulsive disorder (OCD); however, developmental modifications should be considered when treating young children. This article presents a case study illustrating family-based CBT using ERP with a 7-year-old boy. The delivery of ERP for this case was guided by 3 main principles: (a) family involvement with a focus on reducing family accommodation, (b) understanding the functional relation between the client's obsessions and compulsions, and (c) creating conditions to facilitate habituation during exposure. Outcomes for this case indicate significant improvement in functioning and OCD symptoms. Results highlight the importance of family involvement and the applicability of using a function-based habituation framework when delivering ERP to this unique population.
A meta-analysis of dropout rates from exposure with response prevention and pharmacological treatment for youth with obsessive compulsive disorder. [2022]Beliefs that exposure with response prevention (ERP) is excessively distressing and will result in client dropout from treatment are commonly-cited reasons for clinicians not providing evidence-based treatment. This meta-analysis examined treatment attrition for ERP for youth with obsessive compulsive disorder (OCD) compared with other treatment modalities.
[Intensive, short-term treatment for adolescents with persevering obsessive-compulsive disorder: three case-reports]. [2020]Approximately 40% of adolescents with obsessive-compulsive disorder (ocd) do not improve sufficiently from standard cognitive behavioral therapy, and are at risk for a chronic course of the symptomatology as well as stagnation in their development. There has hardly been any research into next step evidence-based treatments for adolescents with persevering ocd. We treated three adolescents with persevering ocd with an eight-day intensive, therapist-assisted exposure and response prevention (erp) in which family members were involved. Two out of the three patients showed an improvement in ocd-symptoms and for one of these two patients the symptoms went in full remission. These outcomes are promising, and these case studies prove that short erp therapy, which is more intensive and provides assisted erp, can be a possible second step in the treatment.
Clinician-reported barriers to using exposure with response prevention in the treatment of paediatric obsessive-compulsive disorder. [2021]Exposure techniques are underutilised in the treatment of anxiety disorders in routine practice, but little is known about the use of exposure with response prevention (ERP) for OCD, particularly in youth. The current study aimed to examine the utilisation of ERP for paediatric OCD via an anonymous online survey completed by clinicians (N = 107). Specifically, we explored the association of clinician characteristics and OCD symptom subtypes with ERP use, as well as clinician-reported barriers to ERP implementation. The majority of clinicians reported commonly using ERP when treating youth with OCD, and rates of ERP use were highest among clinical psychologists. Clinician-held negative beliefs about exposure were significantly associated with lower ERP use. Additionally, clinicians reported being less likely to use ERP to treat hoarding symptoms and taboo obsessions, compared to other OCD symptom subtypes. The most commonly endorsed barriers to successful ERP implementation were aspects of the phenomenology of OCD (e.g. covert compulsions, frequently changing rituals) as opposed to general barriers (e.g. insufficient time during sessions). Overall, our findings suggest that OCD presents unique challenges for clinicians delivering exposure-based therapy. Training should address these OCD-specific obstacles in order to promote dissemination of ERP for youth with OCD.
Engaging Preschool and Early Elementary School-Aged Children in Exposure and Response Prevention (ERP). [2022]Engaging children and caregivers in exposure and response-prevention (ERP) is a critical element in effective treatment of obsessive-compulsive disorder (OCD) in young children. Several clinical challenges pose barriers to participation and implementation of successful treatment such as specific parenting behaviors (e.g., accommodation of obsessions and compulsions) and child motivation for treatment. The authors offer strategies to address common clinical challenges in engaging young children with OCD and to promote effective implementation of ERP with children and caregivers.