TY - JOUR
T1 - Systematic Review and Meta-Analysis
T2 - Cognitive-Behavioral Therapy for Obsessive-Compulsive Disorder in Children and Adolescents
AU - Uhre, Camilla Funch
AU - Uhre, Valdemar Funch
AU - Lønfeldt, Nicole Nadine
AU - Pretzmann, Linea
AU - Vangkilde, Signe
AU - Plessen, Kerstin Jessica
AU - Gluud, Christian
AU - Jakobsen, Janus Christian
AU - Pagsberg, Anne Katrine
PY - 2020/1
Y1 - 2020/1
N2 - Objective: To assess benefits and harms of cognitive-behavioral therapy (CBT) versus no intervention or versus other interventions for pediatric obsessive-compulsive disorder (OCD). Method: We searched for randomized clinical trials of CBT for pediatric OCD. Primary outcomes were OCD severity, serious adverse events, and level of functioning. Secondary outcomes were quality of life and adverse events. Remission from OCD was included as an exploratory outcome. We assessed risk of bias and evaluated the certainty of the evidence with the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results: Nine trials (N = 645) were included comparing CBT with no intervention and 3 trials (N = 146) comparing CBT with selective serotonin reuptake inhibitors (SSRIs). Compared with no intervention, CBT decreased OCD severity (mean difference [MD] = −8.51, 95% CI = −10.84 to −6.18, p < .00001, low certainty), improved level of functioning (patient-rated: standardized MD [SMD] = −0.90, 95% CI = −1.19 to −0.62, p < .00001, very low certainty; parent-rated: SMD = −0.68, 95% CI = −1.12 to −0.23, p = .003, very low certainty), had similar proportions of participants with adverse events (risk ratio = 1.06, 95% CI = 0.93−1.22, p = .39, GRADE: low certainty), and was associated with reduced risk of still having OCD (risk ratio = 0.50, 95% CI = 0.37−0.67, p < .00001, very low certainty). We had insufficient data to assess the effect of CBT versus no intervention on serious adverse events and quality of life. Compared with SSRIs, CBT led to similar decreases in OCD severity (MD = −0.75, 95% CI = −3.79 to 2.29, p = .63, GRADE: very low certainty), and was associated with similar risk of still having OCD (risk ratio = 0.85, 95% CI = 0.66−1.09, p = .20, very low certainty). We had insufficient data to assess the effect of CBT versus SSRIs on serious adverse events, level of functioning, quality of life, and adverse events. Conclusion: CBT may be more effective than no intervention and comparable to SSRIs for pediatric OCD, but we are very uncertain about the effect estimates.
AB - Objective: To assess benefits and harms of cognitive-behavioral therapy (CBT) versus no intervention or versus other interventions for pediatric obsessive-compulsive disorder (OCD). Method: We searched for randomized clinical trials of CBT for pediatric OCD. Primary outcomes were OCD severity, serious adverse events, and level of functioning. Secondary outcomes were quality of life and adverse events. Remission from OCD was included as an exploratory outcome. We assessed risk of bias and evaluated the certainty of the evidence with the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results: Nine trials (N = 645) were included comparing CBT with no intervention and 3 trials (N = 146) comparing CBT with selective serotonin reuptake inhibitors (SSRIs). Compared with no intervention, CBT decreased OCD severity (mean difference [MD] = −8.51, 95% CI = −10.84 to −6.18, p < .00001, low certainty), improved level of functioning (patient-rated: standardized MD [SMD] = −0.90, 95% CI = −1.19 to −0.62, p < .00001, very low certainty; parent-rated: SMD = −0.68, 95% CI = −1.12 to −0.23, p = .003, very low certainty), had similar proportions of participants with adverse events (risk ratio = 1.06, 95% CI = 0.93−1.22, p = .39, GRADE: low certainty), and was associated with reduced risk of still having OCD (risk ratio = 0.50, 95% CI = 0.37−0.67, p < .00001, very low certainty). We had insufficient data to assess the effect of CBT versus no intervention on serious adverse events and quality of life. Compared with SSRIs, CBT led to similar decreases in OCD severity (MD = −0.75, 95% CI = −3.79 to 2.29, p = .63, GRADE: very low certainty), and was associated with similar risk of still having OCD (risk ratio = 0.85, 95% CI = 0.66−1.09, p = .20, very low certainty). We had insufficient data to assess the effect of CBT versus SSRIs on serious adverse events, level of functioning, quality of life, and adverse events. Conclusion: CBT may be more effective than no intervention and comparable to SSRIs for pediatric OCD, but we are very uncertain about the effect estimates.
KW - cognitive-behavioral therapy
KW - obsessive-compulsive disorder
KW - systematic review
U2 - 10.1016/j.jaac.2019.08.480
DO - 10.1016/j.jaac.2019.08.480
M3 - Review
C2 - 31589909
AN - SCOPUS:85075875098
VL - 59
SP - 64
EP - 77
JO - American Academy of Child and Adolescent Psychiatry. Journal
JF - American Academy of Child and Adolescent Psychiatry. Journal
SN - 0890-8567
IS - 1
ER -