One in two hundred youths suffers from Obsessive-Compulsive Disorder (OCD), yet relatively few receive appropriate treatment. Both cognitive-behavior therapy (CUT) and medication appear beneficial in controlled studies; however, the relative efficacy of CUT and medication, alone and in combination (COMB), is unknown. Thus, well-designed treatment outcome studies are necessary to improve care for youth with OCD. This revised proposal constitutes one half of a (two-center) Multi-Institutional Collaborative Research Project focused on the treatment of pediatric OCD, resubmitted jointly but separately by Drs. John March at Duke University and Edna Foa at Allegheny University (AU). Using a volunteer sample of 120 (60/site) youth age 8-16 with a DSM-IV diagnosis of OCD, the proposed 5 year treatment outcome study contrasts the degree and durability of improvement obtained across six treatment conditions: 3 active treatments, sertraline alone (SER), OCD-specific cognitive behavior therapy (CUT), both SER and CUT (SER + CUT), and 3 control treatments, pill PBO, pill PBO + Educational Support (ES) and SER + ES. The experimental design covers two phases. Phase I is a 2 (site) x 2 (sertraline or pill PBO) x 3 (CUT, ES or no psychosocial treatment) x 5 (repeated measures) factorial 12 week comparison of SER, CUT, COMB and the control conditions. In Phase II, responders advance to a 16 week discontinuation study to assess treatment durability. The primary outcome measure is the Yale-Brown Obsessive-Compulsive Scale. Assessments blind to treatment status take place at week 0 (pretreatment); weeks 1, 4, 8, 12 (Phase I treatment); and weeks 16, 20, 24, 28 (Phase II discontinuation). Besides addressing comparative efficacy and durability of the specified treatments, we also examine time-action effects, differential effects on specific aspects of OCD, including functional impairment, and predictors of response to treatment.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Unknown (R10)
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Child Psychopathology and Treatment Review Committee (CPT)
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Vitiello, Benedetto
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Duke University
Schools of Medicine
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Flessner, Christopher A; Freeman, Jennifer B; Sapyta, Jeffrey et al. (2011) Predictors of parental accommodation in pediatric obsessive-compulsive disorder: findings from the Pediatric Obsessive-Compulsive Disorder Treatment Study (POTS) trial. J Am Acad Child Adolesc Psychiatry 50:716-25
Garcia, Abbe Marrs; Sapyta, Jeffrey J; Moore, Phoebe S et al. (2010) Predictors and moderators of treatment outcome in the Pediatric Obsessive Compulsive Treatment Study (POTS I). J Am Acad Child Adolesc Psychiatry 49:1024-33; quiz 1086
Flessner, Christopher A; Sapyta, Jeffrey; Garcia, Abbe et al. (2009) Examining the Psychometric Properties of the Family Accommodation Scale-Parent-Report (FAS-PR). J Psychopathol Behav Assess 31:38-46
March, John S; Franklin, Martin E; Leonard, Henrietta et al. (2007) Tics moderate treatment outcome with sertraline but not cognitive-behavior therapy in pediatric obsessive-compulsive disorder. Biol Psychiatry 61:344-7
Giulino, Lisa; Gammon, Patricia; Sullivan, Kevin et al. (2002) Is parental report of upper respiratory infection at the onset of obsessive-compulsive disorder suggestive of pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection? J Child Adolesc Psychopharmacol 12:157-64
March, J S; Franklin, M; Nelson, A et al. (2001) Cognitive-behavioral psychotherapy for pediatric obsessive-compulsive disorder. J Clin Child Psychol 30:8-18