Study: Young children benefit from CBT

Children ages five to eight with obsessive compulsive disorder (OCD) can benefit from family-based cognitive behavioral therapy, according to a study from the Bradley Hasbro Children’s Research Center.

Jennifer Freeman, Ph.D., staff psychologist at the center and clinical co-director of Bradley’s Intensive Program for OCD, led the five-year project which was conducted at three academic medical centers (Bradley, Duke, University of Pennsylvania) over 14 weeks in 2006-2011.

Freeman explains that 127 children in that age range with a primary diagnosis of OCD and their parents were randomized to 12 sessions of either family-based cognitive behavior treatment or family-based relaxation treatment. “The CBT emphasized exposure with response prevention – facing fears and learning how to tolerate stress – as well as behavioral parental strategies,” Freeman says. The second group’s treatment involved relaxation as a more general coping tool for anxious feelings.

Researchers found that the cognitive behavioral program was more effective in reducing OCD symptoms and functional impairment in young children than the relaxation approach. Using the Clinical Global Impression-Improvement scale, 72 percent of the children were rated as very much improved or much improved with family-based CBT versus 41 percent for those in the similarly structured relaxation program.

“These findings have significant public health implications and support the idea that these very young children with OCD can benefit from behavioral treatment,” Freeman says.

She adds that the results support the use of this treatment model as “the first line choice” for young children. “They can benefit from an approach that is uniquely tailored to their developmental needs and family context,” Freeman says.

In addition, she points out that the group included children with differences of OCD severity (as a group, they were in the moderate-severe range) and co-occurring psychiatric conditions. Youngsters with PDD, psychosis or suicidality did not participate because of their need for other interventions.

Freeman, also an associate professor of research at the Warren Alpert Medical School at Brown University, says she was surprised by the severity of symptoms in this age range as well as the small number of children in the sample who were on medication for OCD.

“Prior research showed far higher numbers of kids on meds. It could coincide with the Black Box warnings. Those were encouraging findings – 7.1 percent were on any medications and less than 2 percent took SRIs,” she explains.

Freeman notes that the study demonstrates that young children have “real” and impairing OCD. “It warrants more than a watch and wait approach.”

“Earlier intervention may better address the chronic issues many children have with OCD as well as the impact it can have on their overall development,” Freeman says. The family-based cognitive behavioral treatment model is successfully used in Bradley’s Intensive Outpatient Program as well as at the Pediatric Anxiety Research Clinic, where Freeman serves as co-director.

She hopes family-based CBT becomes more broadly used in practices and at mental health centers when children are very young.

Freeman intends to pursue future research that includes longer term follow up with this study’s participants to gauge the durability of treatment as well as the development of more intensive treatment models. She also plans research to determine the best ways to disseminate these techniques more extensively in the community.

A National Institute of Mental Health grant funded the study.