Clinical considerations for implementing exposure and response prevention for pediatric OCD

Obsessive‐compulsive disorder (OCD) is a neurobehavioral disorder that impacts individuals across the lifespan. Cognitive behavioral therapy using exposure with response prevention (E/RP) has been identified as the first‐line and “gold standard” treatment for OCD and has been well‐studied in children and adolescents (Freeman et al., 2014). Exposure‐based treatment involves an individual purposefully facing anxiety‐provoking stimuli while refraining from engaging in rituals or avoidance. Research studies with youth (ages 8–17) and younger patients (under 8) have identified individual and family‐based E/RP to be an efficacious, well‐tolerated, and acceptable treatment for OCD (Freeman et al., 2014). Delivering exposure in a developmentally sensitive manner for youth is important to facilitate optimal treatment response. This article focuses on a few key considerations when using E/RP with a pediatric population. To exemplify the principles, we will give examples of E/RP with a 10‐year‐old female (“Julia”) presenting with a primary fear of contamination through toxic chemicals. Rituals involve checking, cleaning, reassurance seeking, counting, and avoidance measures.