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Exposure and response prevention with or without parent management training for children with obsessive-compulsive

Denis G Sukhodolsky1, Bernard S Gorman, Lawrence Scahill

  • 1Yale University School of Medicine, Child Study Center, 230 S. Frontage Rd., New Haven, CT 06520, USA. denis.sukhodolsky@yale.edu

Journal of Anxiety Disorders
|April 23, 2013
PubMed

Insights

Treating disruptive behavior with parent management training (PMT) before exposure and response prevention (ERP) may improve treatment outcomes for children with obsessive-compulsive disorder (OCD). This combined approach showed greater symptom reduction in a small study.

Area of Science:

  • Child and Adolescent Psychiatry
  • Behavioral Therapy
  • Clinical Psychology

Background:

  • Comorbidity of disruptive behavior disorders with obsessive-compulsive disorder (OCD) can complicate exposure-based cognitive behavioral treatments.
  • Child noncompliance and parent-child conflict may impede exposure activities and homework, reducing treatment effectiveness.

Purpose of the Study:

  • To investigate if treating disruptive behavior first with parent management training (PMT) enhances response to exposure and response prevention (ERP) in children with OCD.
  • To evaluate the combined effects of PMT and ERP compared to ERP alone for pediatric OCD with disruptive behaviors.

Main Methods:

  • A multiple-baseline across-responses design was employed with six children (ages 9-14) diagnosed with OCD and disruptive behavior.
  • Children were randomly assigned to either a combined ERP-plus-PMT condition or an ERP-only condition after a baseline period.
  • Symptom severity was assessed weekly using the Child Yale-Brown Obsessive Compulsive Scale (CY-BOCS) by a blinded clinician.

Main Results:

  • Children in the ERP-plus-PMT group showed a 39% reduction in CY-BOCS scores.
  • Children in the ERP-only group demonstrated a 10% reduction in CY-BOCS scores.
  • The findings indicate a differential response based on the inclusion of PMT.

Conclusions:

  • Combining parent management training (PMT) with exposure and response prevention (ERP) appears feasible and beneficial for children with OCD and comorbid disruptive behaviors.
  • Pre-treatment of disruptive behaviors may improve the efficacy of ERP for this patient population.
  • Further research is warranted to confirm these findings in larger samples.

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