Clinical Grand Round 3 - Navigating Treacherous Waters in Pediatric OCD: Common Clinical Problems and Empirically Informed Recommendations

Pediatric OCD is a psychiatric condition associated with substantive and clinically significant symptoms, comorbidity, and functional impairment that can extend into adulthood if untreated. Fortunately, the efficacy of treatments including cognitive-behavioral therapy (CBT) involving exposure plus response prevention (ERP), serotonin reuptake inhibitors (SRIs), and their combination is now well established. Drs. Franklin and Piacentini, both of whom have 30+ years of clinical and research expertise in developing, providing, evaluating, supervising, and disseminating ERP across the developmental spectrum, will focus on explicating common clinical barriers to achievement of optimal outcomes, including presentation of empirically supported strategies that should be brought to bear to mitigate the potentially pernicious effects of these factors. Specific pitfalls addressed will include low motivational readiness, unusual obsessional presentations (e.g., fears of being buried alive or trapped in someone else’s dream), psychiatric comorbidity, family factors including accommodation, and clinical presentations related to disgust and incompleteness. Case examples and role play demonstrations will be emphasized throughout to highlight and demonstrate the core clinical procedures recommended to navigate these challenges. Moreover, ample time will be provided for questions and discussion, after which the floor will be opened to audience members to discuss theoretical and clinical issues including detailed case presentations and audience clinical examples. Particular emphasis will be placed on provision of concomitant pharmacotherapy plus ERP services for pediatric OCD patients and their families who have already demonstrated prior partial or non-response to cognitive-behavioral, pharmacological, or combined treatment approaches. Other novel interventions will also be addressed.