Cognitive behavioral therapy can reduce the severity of obsessive compulsive disorder in children and adolescents in terms of both symptom intensity and effect on daily functioning, according to an article in issue 4 (2006) of the Cochrane Database of Systematic Reviews.

Further, the evidence indicates that cognitive behavioral therapy and medication are equally effective in treating pediatric patients, said researcher Richard O’Kearney and colleagues.

“When cognitive behavioral therapy is combined with medication, treatment is more effective than medication alone. Health professionals need to consider this therapy ? particularly in view of the controversy about prescribing psychotropic medications to children and teens,” said O’Kearney, director of clinical training for psychology at the Australian National University, in Canberra.

Obsessive compulsive disorder is can start at a very early age ? review participants were as young as 7 years old. The disorder affects an estimated 0.5 percent to 4 percent of children and adolescents.

Cognitive behavioral therapy, which has been shown to work for adults, now appears to benefit children as well. The treatment includes a variety of techniques to help children challenge some of their unhelpful thoughts about threat, danger or the importance of controlling thoughts.

Exposure with response prevention technique is a core aspect of contemporary treatment. Children with compulsive washing, for example, would be required in a graded way to touch objects that they fear lead to contamination, and prevent the washing, which neutralizes their fear.

O’Kearney said he was surprised to find so few high-quality studies that evaluated the effectiveness of pediatric cognitive behavioral therapy. The final review comprised four studies of randomized controlled trials or quasi-randomized trials, and three of these suggested at least some risk of bias.

In all, the studies looked at 222 children and adolescents ranging in age from 7 to 18 years, with about an equal number of boys and girls. The participants were Australian, Dutch or American. Interventions ranged from 12 hours to 30 hours.

There was no direct assessment of negative effects in these studies, which were funded entirely by The Australian National University. The low drop-out rate of participants suggests that the intervention may have been an acceptable approach to families involved, the researchers say.

“This study shows convincingly that cognitive behavioral therapy (CBT) is superior to placebo, not only in reducing the number of symptoms, but also in effecting remission in many cases. The study also shows that CBT plus medication is more effective than medication alone in children ? an important confirmation of what has been believed clinically, but never proven,” said Carol A. Mathews, MD, who was not involved with the study.

“The results of this paper provide clinicians and parents with an additional effective treatment option ? CBT or CBT plus medication ? a treatment that involves only about 14 to 21 hours, in general,” Mathews said.