Prevention of obsessive-compulsive disorder in at-risk children: A feasibility trial

Preventing obsessive-compulsive disorder (OCD) has long been considered a central, yet elusive, goal for the field of OCD. Achieving this will likely require identifying individuals at elevated risk and intervening during critical developmental periods before the onset of impairing symptoms. This trial evaluated the feasibility of a brief parent-guided online targeted prevention program for children at-risk of developing OCD. We enrolled 35 children aged 5–12 years with a first-degree relative with OCD and/or subclinical obsessive-compulsive symptoms. None met diagnostic criteria for OCD at baseline. The four-week intervention targeted known maintaining factors (compulsions, family accommodation and avoidance) and was delivered online without scheduled therapist contact. The outcomes included feasibility and acceptability measures, along with preliminary efficacy in reducing the targeted maintaining factors. Assessments were conducted at baseline, after the intervention, and at 6- and 12-month follow-ups. All families initiated the program, and 66% completed at least three of the four modules during the study period. Parents reported high credibility and satisfaction with the intervention. At the 12-month follow-up, 33 parents completed the assessment and statistically significant within-group improvements were observed for compulsions ( d  = 0.66, 95% CI 0.31–1.00), family accommodation ( d  = 0.75, 95% CI 0.43–1.07), and avoidance ( d  = 0.56, 95% CI 0.12 to 1.00). One child met diagnostic criteria for OCD at the 12-month follow-up. This study supports the feasibility and acceptability of a brief prevention program for children at-risk of developing OCD. A randomized controlled trial of this novel program is warranted.