Internet-delivered, family-based treatment for early-onset OCD: a preliminary case series

Abstract

Given the burdens of early-onset obsessive-compulsive disorder (OCD), limitations in the broad availability and accessibility of evidence-based care for affected youth present serious public health concerns. The growing potential for technological innovations to transform care for the most traditionally remote and underserved families holds enormous promise. This article presents the rationale, key considerations, and a preliminary case series for a promising behavioral telehealth innovation in the evidence-based treatment of early-onset OCD. We developed an Internet-based format for the delivery of family-based treatment for early-onset OCD directly to families in their homes, regardless of their geographic proximity to a mental health facility. Videoteleconferencing (VTC) methods were used to deliver real-time cognitive-behavioral therapy centering on exposure and response prevention to affected families. Participants in the preliminary case series included 5 children between the ages of 4 and 8 (M Age = 6.5) who received the Internet-delivered treatment format. All youth completed a full treatment course, all showed OCD symptom improvements and global severity improvements from pre- to posttreatment, all showed at least partial diagnostic response, and 60% no longer met diagnostic criteria for OCD at posttreatment. No participants got worse, and all mothers characterized the quality of services received as "excellent." The present work adds to a growing literature supporting the potential of VTC and related computer technology for meaningfully expanding the reach of supported treatments for OCD and lays the foundation for subsequent controlled evaluations to evaluate matters of efficacy and engagement relative to standard in-office evidence-based care.

FIGURE 1

Screen capture of the Create an OCD Worry Monster interactive online activity. (Figure appears in color online.)

FIGURE 2

Screen capture from Bravery Mission—an interactive online game that teaches children the importance of exposures for ultimately reducing anxiety in a fun and developmentally engaging manner game. (Figure appears in color online.)

FIGURE 3

Screen capture of Bravery Mission—an interactive desktop sharing tool that allows the therapist and family to collaboratively build a fear and avoidance hierarchy. (Figure appears in color online.)

FIGURE 4

Global severity response, by case. Note: CGI = Clinical Global Impression Scale; CGI-Severity 1 = normal, not at all ill; CGI-Severity 2 = borderline mentally ill; CGI-Severity 3 = mildly ill; CGI-Severity 4 = moderately ill; CGI-Severity 5 = markedly ill; CGI Severity 6 = severely ill; CGI-Severity 7 = extremely ill.

FIGURE 5

Global functioning response, by case. Note: CGAS = Children’s Global Assessment Scale. See Shaffer et al. (1983) for CGAS anchors.