TY - JOUR
T1 - Distinct trajectories of long-term symptom severity in pediatric obsessive–compulsive disorder during and after stepped-care treatment
AU - Jensen, Sanne
AU - Højgaard, Davíð R.M.A.
AU - Hybel, Katja A.
AU - Mortensen, Erik Lykke
AU - Skarphedinsson, Gudmundur
AU - Melin, Karin
AU - Ivarsson, Tord
AU - Nissen, Judith Becker
AU - Weidle, Bernhard
AU - Valderhaug, Robert
AU - Torp, Nor Christian
AU - Dahl, Kitty
AU - Compton, Scott
AU - Thomsen, Per Hove
N1 - Funding Information: The NordLOTS was supported by grants from TrygFonden, Aarhus University, Central Region Denmark's Research Fund, Stiftelsen Clas Groschinskys Minnesfond, the Lundbeck Foundation, The Center for Child and Adolescent Mental Health of Eastern and Southern Norway (RBUP), the Norwegian Research Council, and the Norwegian Extra Foundation. The authors would like to thank the participating children and parents, as well as the clinical staff. T.V. has served on the speaker's bureau of Shire Sweden. The remaining authors have declared that they have no competing or potential conflicts of interest. Key points Publisher Copyright: © 2019 Association for Child and Adolescent Mental Health
PY - 2020/9/1
Y1 - 2020/9/1
N2 - Background: First-line treatments for pediatric obsessive–compulsive disorder (OCD) include exposure-based cognitive-behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs). No studies have thus far identified distinct classes and associated predictors of long-term symptom severity during and after treatment. Yet, these could form the basis for more personalized treatment in pediatric OCD. Method: The study included 269 OCD patients aged 7−17 years from the Nordic Long-term OCD Treatment Study (NordLOTS). All participants received stepped-care treatment starting with 14 weekly sessions of manualized CBT. Nonresponders were randomized to either prolonged CBT or SSRIs. Symptom severity was assessed using the Children's Yale-Brown Obsessive-Compulsive Scale at seven time points from pre- to post-treatment and over a three-year follow-up. Latent class growth analysis (LCGA) was performed to identify latent classes of symptom severity trajectories. Univariate and multivariate analyses were used to detect differences between classes and identify predictors of trajectory class membership including several clinical and demographic variables. Trial registry: Nordic Long-term Obsessive-Compulsive Disorder (OCD) Treatment Study; www.controlled-trials.com; ISRCTN66385119. Results: Three LCGA classes were identified: (a) acute, sustained responders (54.6%); (b) slow, continued responders (23.4%); and (c) limited long-term responders (21.9%). Class membership was predicted by distinct baseline characteristics pertaining to age, symptom severity, contamination/cleaning and anxiety symptoms. Conclusions: The LCGA suggests three distinct trajectory classes of long-term symptom severity during and after treatment in pediatric OCD with different clinical profiles at pretreatment. The results point to required clinical attention for adolescent patients with contamination/cleaning and anxiety symptoms who do not show convincing responses to first-line treatment even though they may have reached the established cutoff for treatment response.
AB - Background: First-line treatments for pediatric obsessive–compulsive disorder (OCD) include exposure-based cognitive-behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs). No studies have thus far identified distinct classes and associated predictors of long-term symptom severity during and after treatment. Yet, these could form the basis for more personalized treatment in pediatric OCD. Method: The study included 269 OCD patients aged 7−17 years from the Nordic Long-term OCD Treatment Study (NordLOTS). All participants received stepped-care treatment starting with 14 weekly sessions of manualized CBT. Nonresponders were randomized to either prolonged CBT or SSRIs. Symptom severity was assessed using the Children's Yale-Brown Obsessive-Compulsive Scale at seven time points from pre- to post-treatment and over a three-year follow-up. Latent class growth analysis (LCGA) was performed to identify latent classes of symptom severity trajectories. Univariate and multivariate analyses were used to detect differences between classes and identify predictors of trajectory class membership including several clinical and demographic variables. Trial registry: Nordic Long-term Obsessive-Compulsive Disorder (OCD) Treatment Study; www.controlled-trials.com; ISRCTN66385119. Results: Three LCGA classes were identified: (a) acute, sustained responders (54.6%); (b) slow, continued responders (23.4%); and (c) limited long-term responders (21.9%). Class membership was predicted by distinct baseline characteristics pertaining to age, symptom severity, contamination/cleaning and anxiety symptoms. Conclusions: The LCGA suggests three distinct trajectory classes of long-term symptom severity during and after treatment in pediatric OCD with different clinical profiles at pretreatment. The results point to required clinical attention for adolescent patients with contamination/cleaning and anxiety symptoms who do not show convincing responses to first-line treatment even though they may have reached the established cutoff for treatment response.
KW - Obsessive–compulsive disorder
KW - children and adolescents
KW - latent class growth analysis
KW - longitudinal study
KW - outcome predictors
KW - stepped-care treatment
KW - trajectories
UR - https://www.scopus.com/pages/publications/85075347016
U2 - 10.1111/jcpp.13155
DO - 10.1111/jcpp.13155
M3 - Article
C2 - 31736082
SN - 0021-9630
VL - 61
SP - 969
EP - 978
JO - Journal of Child Psychology and Psychiatry and Allied Disciplines
JF - Journal of Child Psychology and Psychiatry and Allied Disciplines
IS - 9
ER -