Prepubertal OCD
First line for mild prepubertal OCD: CBT first
First line for severe prepubertal OCD: CBT first
Second line for mild prepubertal OCD: CBT + SRI, SRI first
Second line for severe prepubertal OCD: CBT + SRI, SRI first
In this set of guidelines, the authors describe mild OCD as causing distress but not necessarily dysfunction; this diagnosis is associated with a score of 10 to 18 on the Yale Brown Obsessive Compulsive Scale. Moderate OCD causes both distress and functional impairment (YBOCS score of 18 to 29). Severe OCD causes serious functional impairment requiring significant help from others (YBOCS score of 30 or above).
The following information is also included:
These experts recommend combined use of cognitive therapy and exposure response prevention as the “optimal treatment” for OCD. They add that cognitive therapy may provide “additional benefit” by directly targeting distorted OCD “beliefs,” meaning pathological doubt, aggressive obsessions, and scrupulosity or other OCD beliefs, as contrasted with an OCD “urge-like symptom” such as arranging, or touching rituals, where they suggest ERP treatment as most helpful.
When comorbid conditions are present with OCD, other classes of medications may be used, including the classes known as psychostimulants and mood stabilizers.
Guidelines suggest thirteen to twenty weekly individual CBT sessions for the typical patient, with home exposures done between sessions; in severe cases, they suggest a daily regime of CBT sessions for a three-week period.
For the maintenance phase of treatment, CBT visits can be reduced to a monthly basis. Medication can be discontinued gradually under a doctor's supervision. If severe relapses occur, medication use can be reconfigured on a long-term basis.
These guidelines are presented here to give parents an overview of what are considered “best practices” in the treatment of childhood OCD, not as a substitute for consultation or treatment with a medical professional. The complete “Patient-Family Handout” is available online at
