Potential for Harm in the Treatment of Pediatric Obsessive-Compulsive Disorder: Pitfalls and Best Practices

Area of Science:

• Psychiatry
• Child Psychology
• Clinical Psychology

Background:

• Pediatric obsessive-compulsive disorder (OCD) requires early, effective intervention to prevent chronic debilitation.
• Cognitive-behavioral therapy (CBT) with exposure and response/ritual prevention (ERP) is the established first-line treatment for pediatric OCD.
• Many children with OCD remain undertreated due to various challenges in applying evidence-based interventions.

Purpose of the Study:

• To identify and describe potentially harmful and ineffective treatment practices for pediatric OCD.
• To address common misconceptions surrounding exposure and response/ritual prevention (ERP) that may lead to its underuse.
• To provide recommendations for improving the quality and efficacy of pediatric OCD interventions.

Main Methods:

• This review synthesizes existing literature on pediatric OCD interventions.
• It critically examines the application of CBT and ERP principles in clinical practice.
• It identifies and analyzes non-evidence-based treatments lacking empirical support.

Main Results:

• Misconceptions about ERP can lead clinicians to underuse or misapply it.
• Generic CBT techniques or non-evidence-based interventions may be used instead of ERP, proving ineffective or harmful.
• Ineffective treatments can worsen symptoms, waste resources, and erode public trust in psychotherapy.

Conclusions:

• Addressing misconceptions about ERP is vital for its effective implementation in pediatric OCD treatment.
• Clinicians must adhere to evidence-based practices, primarily ERP, to ensure optimal outcomes for children with OCD.
• Recommendations are provided for clinicians, researchers, training programs, and policymakers to enhance pediatric OCD care.