OCD in Children and Adolescents: A Cognitive-Behavioral Treatment Manual

OCD in Children and Adolescents: A Cognitive-Behavioral Treatment Manual

March JS, Mulle K

New York: The Guilford Press; 1998. 298 pp with index

ISBN 1-57230-242-9 (cloth)

This text is a good example of how clinical demand can prompt the synthesis and organization of a body of work into a useful guide for the practitioner. John March and Karen Mulle have extensive experience in the assessment and treatment of child and adolescent anxiety disorders in general, and obsessive-compulsive disorder in particular. Dr. March is particularly qualified to prepare this text, given that he is a co-author of the Expert Consensus Treatment Guidelines for Obsessive-Compulsive Disorder. The authors have prepared a treatment manual that guides the practitioner step-by-step through the cognitive-behavioural treatment of obsessive-compulsive disorder in children and adolescents.

The book is organized into 3 sections. The first provides a review of the various symptomatic presentations of obsessive-compulsive disorder and a description of the assessment protocol that the authors use in their program. The second provides a session-by-session guide to the cognitive-behavioural treatment of pediatric obsessive-compulsive disorder, with emphasis on treatment goals and means of evaluating outcomes. The third deals with tricky issues in pediatric obsessive-compulsive disorder, including common therapeutic roadblocks and difficult obsessive-compulsive disorder subtypes. It also includes suggestions for working with families and schools. In their appendices, the authors include copies of useful assessment materials as well as educational materials for parents and families.

Although this is a text on cognitive-behavioural treatment for obsessive-compulsive disorder, there are small nuggets of useful information on the pharmacological management of this disorder as well. The authors emphasize the importance of framing obsessive-compulsive disorder within a neurobehavioural framework from the outset. Another major strength of this text is that it reminds the clinician to consider the whole child or adolescent in the management of obsessive-compulsive disorder, recognizing that this disorder occurs in a context (home, school) that requires the coordinated efforts of many individuals (parents, teachers, therapist, patient). It views cognitive-behavioural treatment as one component of treatment that is often multi-modal.

Two minor shortcomings of this book are the limited presentation of empirical support for cognitive-behavioural treatment of obsessive-compulsive disorder in children and adolescents, and the generally child-oriented approach in describing techniques. Compared with the literature on adult obsessive-compulsive disorder, the controlled research on cognitive-behavioural treatment with children and adolescents is weak. Although the principal author is currently collaborating on a major trial comparing cognitive-behavioural treatment, medication, and combination treatment, results were not yet available for inclusion in this text. The authors do make a significant effort to include throughout the text comments on developmental considerations for the adaptation of their techniques to treating adolescents. Unfortunately, the majority of the scenarios and techniques presented target children.

Overall, this is a useful text for clinicians who are likely to see children with obsessive-compulsive disorder in their practice. It should not replace more comprehensive training in cognitive-behavioural treatment, but rather represents a focused application of these skills to a specific problem.