Distinct trajectories of long-term symptom severity in pediatric obsessive-compulsive disorder during and after...

Area of Science:

• Child and Adolescent Psychiatry
• Clinical Psychology
• Behavioral Science

Background:

• First-line treatments for pediatric obsessive-compulsive disorder (OCD) include exposure-based cognitive-behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs).
• No prior studies have identified distinct classes and predictors of long-term symptom severity in pediatric OCD during and after treatment.
• Identifying such classes could enable more personalized treatment approaches for pediatric OCD.

Purpose of the Study:

• To identify distinct classes of long-term symptom severity trajectories in pediatric OCD patients undergoing treatment.
• To determine the baseline predictors associated with membership in these identified symptom severity classes.
• To inform personalized treatment strategies for children and adolescents with OCD.

Main Methods:

• Latent class growth analysis (LCGA) was used to identify symptom severity trajectories in 269 pediatric OCD patients (aged 7-17) from the Nordic Long-term OCD Treatment Study (NordLOTS).
• Participants received stepped-care treatment including manualized CBT, with nonresponders randomized to prolonged CBT or SSRIs.
• Symptom severity was assessed over seven time points from pre-treatment through a three-year follow-up; univariate and multivariate analyses identified predictors of class membership.

Main Results:

• Three distinct latent classes of symptom severity trajectories were identified: acute, sustained responders (54.6%); slow, continued responders (23.4%); and limited long-term responders (21.9%).
• Class membership was significantly predicted by baseline characteristics including age, overall symptom severity, and specific symptoms such as contamination/cleaning and anxiety.

Conclusions:

• The study identified three distinct trajectory classes for long-term symptom severity in pediatric OCD, each associated with different pretreatment clinical profiles.
• Adolescent patients with contamination/cleaning and anxiety symptoms who do not respond well to initial treatment require specific clinical attention, even if they meet response criteria.
• These findings support the development of personalized treatment plans for pediatric OCD based on identified symptom trajectories and baseline predictors.