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CONTEXT: Treatments for obsessive-compulsive disorder (OCD) in children and adolescents. OBJECTIVE: Evaluate the comparative efficacy of behavioral and pharmacologic treatments. DATA SOURCES: Six databases and ClinicalTrials.gov registry; search last updated on 5/15/2024. STUDY SELECTION: Dual screening augmented by Abstrackr machine learning algorithm. DATA EXTRACTION/ANALYSIS: Participant characteristics, intervention details and risk of bias. RESULTS: 71 randomized controlled trials (RCTs). In the random effects network meta-analysis of OCD symptom severity, assessed by the Children's Yale-Brown Obsessive Compulsive Scale Total (CY-BOCS), exposure and response prevention therapy (ERP) is more effective than waitlist (net mean difference NMD -10.5; 95% confidence interval CI: -12.6, -8.4) and probably more effective vs. behavioral control (NMD -5.3; 95% CI: -8.0, -2.7). Remote ERP is more effective than waitlist (NMD -9.4; 95% CI: -11.9, -7.0) and as effective as in-person ERP. Selective serotonin reuptake inhibitors (SSRIs) are more effective than placebo (NMD -4.4; 95% CI: -6.1, -2.6). Clomipramine is probably more effective than placebo (NMD -4.5; 95% CI: -6.8, -2.1). ERP is probably more effective than SSRI (NMD -2.7; 95% CI -5.4, -0.0) and combined ERP and an SSRI are probably more effective than SSRI alone (NMD -3.0; 95% CI: -5.1, -1.0). Overall, treatments including ERP (ERP+SSRI, ERP and remote ERP) comprise the 3 highest ranked interventions. LIMITATIONS: Non CY-BOCS outcomes were sparsely reported. CONCLUSIONS: ERP, delivered in-person or via telehealth, SSRIs and clomipramine are all effective treatments. ERP, alone or in combination with an SSRI, is probably more effective than SSRI alone.
Steele et al. (2024) studied this question.