Family-Based Psychological Treatment for Obsessive Compulsive Disorder in Children and Adolescents: A Meta-analysis and Systematic Review.

Abstract

A significant number of children and adolescents with obsessive compulsive disorder (OCD) demonstrate poor response to the current gold standard treatment, cognitive behaviour therapy (CBT) with exposure and response prevention (ERP). Recent findings suggest that family variables affect treatment response highlighting the need for a meta-analytic review of the precise impact of family variables on OCD-related symptoms and processes. The current review and meta-analysis examined the effect of family-based interventions on OCD symptom and family factor outcomes for children and adolescents with OCD. The moderating effects of the degree of parental involvement and number of family factors targeted in treatment were investigated. An extensive literature search identified 37 eligible studies (1727 OCD participants). Large significant pooled mean effect sizes for OCD symptoms and Family Accommodation (FA), respectively, were obtained at posttest (g = 1.56; g = 1.00) and follow-up (g = 1.69; g = 1.98). Moderator analyses indicated that the number of family factors targeted in treatment significantly moderated outcomes on measures of FA (z = 2.21, p = 0.03), but not on Children's/Yale-Brown Obsessive Compulsive Scale (C/Y-BOCS) outcomes. FA has been significantly correlated with OCD symptom severity and poorer treatment outcomes, and there is data to suggest that FA may mediate OCD symptom outcomes (e.g., Piacentini et al. in J Am Acad Child Adolesc Psychiatry 50:1149-1161, 2011). Findings show that the greater the number of family factors targeted, the greater the reduction in FA at post, highlighting the importance of addressing a range of family factors in child OCD treatment to optimise outcomes.