Treatment of Obsessive Compulsive Disorder in Children

The vast majority of children with obsessive compulsive disorder (OCD) are given serotonin
reuptake inhibitor (SRI) drugs as initial treatment. However, recommended doses of these
medications leave many children with clinically significant residual symptoms. Health care
experts typically recommend augmenting SRI treatment with cognitive behavioral therapy
(CBT), yet this recommendation is seldom followed. This study will contrast two CBT
augmentation strategies to continued medication management alone: CBT administered by a
psychologist and instructional CBT (I-CBT)administered by a psychiatrist in the context of
ongoing medication management.

All patients in the trial will be eligible to receive a full course of CBT by study end.
Participants in this study will be randomly assigned to receive CBT, I-CBT or continued
medication management. All participants will continue their SRI treatment for 12 weeks.
After the 12-week treatment period, participants who received I-CBT or medication
management alone and who remain symptomatic will be given CBT as will participants who are
asymptomatic but relapse within 6 months after treatment. Assessments will be conducted at
Weeks 0, 4, 8, and 12. Follow-up assessments will be conducted at 3 and 6 months
post-treatment.