1 - (SYM 79) Real-world Clinical Outcomes from Digital Behavioural Health Treatment: Evidence from a Large-scale Observational Analysis in Pediatric OCD

Background:

Obsessive-compulsive disorder (OCD) most commonly starts in childhood or adolescence. Untreated, it typically follows a chronic, disabling course and frequently presents with psychiatric comorbidities. While Exposure and Response Prevention (ERP) is an effective treatment, most cannot access specialized providers due to geographical barriers, limited availability of trained therapists, and resource constraints. Digital solutions can address these challenges by delivering specialized interventions remotely.

Methods:

We conducted a large-scale retrospective observational analysis examining real-world treatment outcomes for pediatric OCD using a digital behavioural health intervention with between-session support through NOCD, a virtual behavioural health provider. The analysis assessed remote video-delivered ERP outcomes in children and adolescents with OCD (N=2,173), ages 5-17. The treatment followed structured protocols with standardized assessments at baseline, mid-treatment, and endpoint (weeks 13-17), and longitudinal follow-up through 52 weeks. Primary outcomes were measured using the Dimensional Obsessive-Compulsive Scale (DOCS) for OCD.

Results:

Treatment of children and adolescents (mean age=13.44±2.77 years) resulted in a median 38.46% decrease in symptoms at 13-17 weeks, with 53.4% achieving full response criteria. There were similar improvements for individuals starting with mild (median 40.3%), moderate (median 38.4%), and severe (median 34.1%) symptoms. There were no significant differences in improvements based on age group, race, or ethnicity. Additionally, there were significant reductions in depression, anxiety, and stress symptoms. Treatment gains were maintained or enhanced during longitudinal follow-up. The median therapist's involvement was 13 appointments and 11.5 hours.

Conclusions:  

In this largest study of pediatric OCD to-date, virtual ERP demonstrated effectiveness in reducing symptoms and maintaining treatment gains in a real-world setting. The treatment produced meaningful clinical improvements across age groups and severity levels, while also reducing comorbid symptoms of depression, anxiety, and stress. These outcomes were achieved in a relatively small amount of therapist time. Virtual delivery of ERP through a technology-enabled platform demonstrates that specialized behavioural interventions can be effectively and efficiently implemented remotely, suggesting new possibilities for expanding access to evidence-based care.