Stepped Care Cognitive Behavioral Therapy for Pediatric Obsessive Compulsive Disorder

Below is a summary of assessment and interventions as part of the study (separated by condition). Two thirds will receive SC-CBT, one-third standard CBT (determined at random following the initial phone screen).

A. Phone Screen (with parent)

B. Informed Consent and Initial Assessment

C. Randomization to either SC-CBT or Standard CBT

D. Treatment Phase (either 1 or 2 determined at random following 'C')

• SC-CBT

Children who are randomized into SC-CBT will receive Step One:

• 3-in-office sessions - 1 hour each (over 6 weeks)
• 6 weekly phone calls (15 minutes or less)
• Post assessment (at the end of the 6 weeks)
• 3-month follow up

Children are "stepped up" to Step Two of SC-CBT if we determine more therapy is needed (following the post assessment). Step Two is a continuation of therapy and will include:

• 9-in-office weekly sessions - 1 hour each (over 9 weeks)
• Post assessment (after session 9)
• 3-month follow up

OR

• Standard CBT

Children who are randomized into the standard CBT group will receive:

• 12-in-office weekly sessions - 1 hour each (over 12 weeks)
• Midpoint Assessment (after 6 weeks)
• Post assessment (at the end of the 12 weeks)
• 3-month follow up

Inclusion criteria

• Outpatient youth with obsessive-compulsive disorder between the ages 8-17 years.
• A Children's Yale-Brown Obsessive-Compulsive Scale score ≥ 16
• Child has a Full Scale IQ ≥ 80 as assessed on the WASI
• English speaking

Exclusion criteria

• Past adequate CBT with E/RP trial
• Initiation of antidepressant medication within 12 weeks before study enrollment, or an antipsychotic/mood stabilizer medication 6 weeks before study enrollment, or a stimulant/anxiolytic or alpha 2 agonist 4 weeks before study enrollment
• Established Treatment changes: Any change in dose of an established psychotropic medication (e.g., antidepressants) within 8 weeks before study enrollment (4 weeks for antipsychotic, mood stabilizer, alpha 2 agonist; 2 weeks for stimulant/anxiolytic). Alternative medications must be stable for 4 weeks prior to baseline. Any medications must remain stable during treatment; downward adjustments due to side effects may be acceptable with PI approval.
• Active child suicidality assessed by all available information (e.g., KSADS-PL, CDI).
• DSM-IV conduct disorder, autism, mental retardation, bipolar, schizophrenia/schizoaffective disorders; or substance abuse in past 6 months; or co-primary eating disorder; using all available information.
• Another behavioral/emotional problem or psychiatric disorder is considered to be more problematic than OCD.
• Non-English speaking.
• WASI-IQ SS <80.