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Practice Parameter for the Assessment and Treatment of Children and Adolescents With Obsessive-Compulsive Disorder

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Research in etiology, neurobiology, genetics, clinical correlates, and evidence-based treatments in children and adolescents with obsessive-compulsive disorder indicate a need for the revision of the Practice Parameters for the Assessment and Treatment of Children and Adolescents with Obsessive-Compulsive Disorder first published a decade ago. The present article highlights the clinical assessment and reviews and summarizes the evidence base for treatment. Based on this evidence, specific recommendations are provided for assessment, cognitive behavioral therapy, pharmacotherapy, combined treatment, and other interventions.

Key Words

Practice Parameter
obsessive-compulsive disorder
child and adolescent psychiatry
assessment
treatment

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This Parameter was developed by Daniel A. Geller, M.B.B.S., John March, M.D., and the AACAP Committee on Quality Issues (CQI): Heather J. Walter, M.D., M.P.H., and Oscar G. Bukstein, M.D., M.P.H., Co-Chairs, and R. Scott Benson, M.D., Allan Chrisman, M.D., Tiffany R. Farchione, M.D., John Hamilton, M.D., Helene Keable, M.D., Joan Kinlan, M.D., Ulrich Schoettle, M.D., Matthew Siegel, M.D., and Saundra Stock, M.D. AACAP liaison: Jennifer Medicus.

The American Academy of Child and Adolescent Psychiatry (AACAP) Practice Parameters are developed by the AACAP CQI in accordance with American Medical Association policy. Parameter development is an iterative process between the primary author(s), the CQI, topic experts, and representatives from multiple constituent groups, including the AACAP membership, relevant AACAP Committees, the AACAP Assembly of Regional Organizations, and the AACAP Council. Details of the Parameter development process can be accessed on the AACAP Web site. Responsibility for Parameter content and review rests with the author(s), the CQI, the CQI Consensus Group, and the AACAP Council.

The AACAP develops both patient-oriented and clinician-oriented Practice Parameters. Patient-oriented Parameters provide recommendations to guide clinicians toward best assessment and treatment practices. Recommendations are based on the critical appraisal of empirical evidence (when available) and clinical consensus (when not), and are graded according to the strength of the empirical and clinical support. Clinician-oriented Parameters provide clinicians with the information (stated as principles) needed to develop practice-based skills. Although empirical evidence may be available to support certain principles, principles are based primarily on clinical consensus. This Parameter is a patient-oriented Parameter.

The primary intended audience for the AACAP Practice Parameters is child and adolescent psychiatrists; however, the information contained therein may also be useful for other mental health clinicians.

The authors wish to acknowledge the following experts for their contributions to this Parameter: Marco Grados, M.D., Gregory Hanna M.D., Aude Henin Ph.D., Isobel Heyman, M.B.B.S., James Leckman, M.D., Gabriella Masi, M.D., Euripides Miguel, M.D., Janardhan Reddy, M.D., D.P.M., Maria Conceição do Rosario, M.D., Aline Sampaio, M.D., S. Evelyn Stewart, M.D., Eric Storch Ph.D., and Karen Wagner, M.D.

This Parameter was reviewed at the Member Forum at the AACAP in October 2008.

From September 2010 to May 2011, this Parameter was reviewed by a Consensus Group convened by the CQI. Consensus Group members and their constituent groups were as follows: Heather J. Walter, M.D., M.P.H., chair, Ulrich Schoettle, M.D., shepherd, and Christopher Bellonci, M.D. and Saundra Stock, M.D., members (CQI); Marco Grados, M.D., M.P.H., and Greg Hanna, M.D. (topic experts); Efrain Bleiberg, M.D., (AACAP Psychotherapy Committee); Johnny Lops, D.O., and Catherine Anne Steele, M.D. (AACAP Assembly of Regional Organizations); and Christopher Kratochvil, M.D., and Paramjit Joshi, M.D. (AACAP Council).

This Practice Parameter was approved by the AACAP Council on August 11, 2011.

This Practice Parameter supersedes the Practice Parameters for the Assessment and Treatment of Children and Adolescents With Obsessive-Compulsive Disorder, published in the Journal of the American Academy of Child and Adolescent Psychiatry, 1998;37(suppl):27S-45S.

This Practice Parameter is available on the Internet (www.aacap.org).

Disclosures: Dr. Geller receives or has received research funding from Otsuka and Boehringer Inglheim and has served as a consultant for and received honoraria from Eli Lilly and Co. Dr. March receives or has received industry support from MedAvante, Pfizer, Eli Lilly and Co., Bristol-Myers Squibb, and Johnson and Johnson; royalties from Multihealth Systems, Guilford Press, and Oxford University Press; is a scientific advisor for Pfizer, Eli Lilly and Co., Scion, and Psymetrix; and has federal affiliation with the Treatment for Adolescents with Depression Study, the Child/Adolescent Anxiety Multimodal Study, the Pediatric Obsessive-Compulsive Disorder Treatment Study I and II and Junior, the Research Units on Pediatric Psychopharmacology and Psychosocial Interventions, the Child and Adolescent Psychiatry Trials Network, and K24. Dr. Walter has no financial relationships to disclose. Dr. Bukstein receives or has received research support, acted as a consultant, and/or served on a speaker's bureau for McNeil Pediatrics and Novartis Pharmaceuticals Corporation. Disclosures of potential conflicts of interest for all other individuals named earlier are provided on the AACAP Web site on the Practice Parameters page.

Correspondence to the AACAP Communications Department, 3615 Wisconsin Avenue, NW, Washington, D.C. 20016.