OCD is a disorder of early onset characterized by recurrent obsessions or compulsions severe enough to be time-consuming or result in marked distress or significant impairment. Obsessions are defined as recurrent and persistent thoughts, images or impulses that are egodystonic and intrusive. Compulsions serve to alleviate dysphoric affects associated with obsessions. Costello et al. reported a prevalence of less than 1% in prepubertal children. Lifetime prevalence rates for adolescents range from 1.9% to 3.6%.

OCD has received much attention from investigators seeking efficacious pharmacological therapy for children and adolescents. There is much more in the literature examining the use of SSRI’s in the treatment of OCD than of any other anxiety disorder (Generic Desyrel used for relief of an anxiety disorder) in children; however, there are few double-blind, controlled studies. In one study, DeVeaugh-Geiss and colleagues found that 60% of patients that received clomipramine treatment showed significant improvement. In a study completed by March et al, generic sertraline was found to be effective for treatment of pediatric OCD. Riddle et al. found that Generic Prozac was significantly better than placebo on major outcome variables and was generally well-tolerated. Geller and colleagues also conducted a study to determine the efficacy of generic fluoxetine in the treatment of pediatric OCD. Fluoxetine tabletes was found to be significantly more effective than placebo as evidenced by greater reductions in Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS) scores. Riddle and colleagues also conducted a 10-week, multicenter, randomized, double-blind, placebo-controlled trial examining the efficacy of fluvoxamine. The results indicate that the decrease in symptom severity was significant when compared with placebo and was comparable to the rates of response in other studies. Children were found to have a higher rate of response than adolescents in this particular study. Both sertraline medication and flu-voxamine have been approved for the treatment of OCD in children and adolescents. The tricyclic drug clomipramine has also been approved for treatment of OCD but is considered a second-line agent due to its side-effect profile.

De Haan and colleagues conducted the first study comparing a psychosocial treatment to drug treatment for OCD in children. Twenty-two children aged 8-18 years were assigned to one of two groups: behavior therapy or clomipramine therapy. The behavior therapy consisted of 12 weekly sessions incorporating exposure and response prevention. The drug therapy group also met weekly. Initial dose of clomipramine was 25 mg for the first week and was titrated to a maximum of 200 mg/day. In the behavior therapy condition, the mean improvement was 59.9% as compared to 33.4% in the clomipramine condition. The results for the behavior therapy condition are comparable to those from March’s study. In his study, the mean improvement was 50%; however, most of those children received concomitant medication. Improvement in the clomipramine condition was rather low compared to other studies.

Behavioral treatment for OCD has emerged as the treatment of choice; however, there is a lack of rigorous randomized controlled trials examining the efficacy of CBT versus control or other comparison treatments. March and colleagues have conducted a number of open trials and case studies investigating the use of CBT for children with OCD. Those studies will not be discussed here since the focus of this paper is to review controlled studies.