Context

Treatments for obsessive-compulsive disorder (OCD) in children and adolescents.

Objective

Evaluate the comparative efficacy of behavioral and pharmacologic treatments.

Data Sources

Six databases and ClinicalTrials.gov registry; search last updated on 5/15/2024.

Study Selection

Dual screening augmented by Abstrackr machine learning algorithm.

Data Extraction/Analysis

Participant characteristics, intervention details and risk of bias.

Results

71 randomized controlled trials (RCTs). In the random effects network meta-analysis of OCD symptom severity, assessed by the Children’s Yale-Brown Obsessive Compulsive Scale Total (CY-BOCS), exposure and response prevention therapy (ERP) is more effective than waitlist (net mean difference [NMD] −10.5; 95% confidence interval [CI]: −12.6, −8.4) and probably more effective vs. behavioral control (NMD −5.3; 95% CI: −8.0, −2.7). Remote ERP is more effective than waitlist (NMD −9.4; 95% CI: −11.9, −7.0) and as effective as in-person ERP. Selective serotonin reuptake inhibitors (SSRIs) are more effective than placebo (NMD −4.4; 95% CI: −6.1, −2.6). Clomipramine is probably more effective than placebo (NMD −4.5; 95% CI: −6.8, −2.1). ERP is probably more effective than SSRI (NMD −2.7; 95% CI −5.4, −0.0) and combined ERP and an SSRI are probably more effective than SSRI alone (NMD −3.0; 95% CI: −5.1, −1.0). Overall, treatments including ERP (ERP+SSRI, ERP and remote ERP) comprise the 3 highest ranked interventions.

Limitations

Non CY-BOCS outcomes were sparsely reported.

Conclusions

ERP, delivered in-person or via telehealth, SSRIs and clomipramine are all effective treatments. ERP, alone or in combination with an SSRI, is probably more effective than SSRI alone.

Subjects:
Developmental/Behavioral Health
Topics:
obsessive-compulsive disorder
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Competing Interests

CONFLICT OF INTEREST DISCLOSURES: The authors have no conflicts of interest relevant to this article to disclose.

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