© 2003 Oxford University Press
Cognitive-Behavioral Therapy for Children and Adolescents with Obsessive-Compulsive Disorder
From the Division of Cognitive and Behavioral Neurology, Department of Neurology, University of Rochester School of Medicine and Dentistry.
Contact author: Aureen P. Wagner, OCD and Anxiety Disorder Consultancy, 35 Ryans Run, Rochester, NY 14624-1160. E-mail: awagner5{at}rochester.rr.com.
Selected by experts as the treatment of choice for youngsters, cognitive-behavioral therapy (CBT) has emerged as a safe, viable, and effective treatment for obsessive-compulsive disorder (OCD) among children and adolescents. Yet, most children with OCD do not receive CBT, at least in part due to the shortage of clinicians who are well versed in managing the unique challenges that arise in the treatment of children. This paper reviews developmental factors that complicate the diagnosis and treatment of OCD in youngsters; it discusses appropriate adaptations of CBT protocols for children; and it presents the application of CBT for children and adolescents, using a developmentally sensitive protocol that is flexible and feasible in clinical settings: RIDE Up and Down the Worry Hill. Illustrated is the use of this protocol with a 15-year-old girl with forbidden thoughts and praying rituals, and a 6-year-old boy with fears of harm and reassurance-seeking rituals. Future directions for making CBT available and accessible to children with OCD are discussed.
KEY WORDS: obsessive-compulsive disorder, cognitive-behavioral therapy, children and adolescents, exposure and response prevention, Worry Hill metaphor