An overall treatment plan for an OCD patient, according to a previously discussed model for mental health treatment, might look like the following:
• Education. Discuss diagnosis of OCD with children and family. Let them know about support organizations such as the OC Foundation.
• Individual therapy. Referral to a cognitive-behavioral therapist for exposure and response prevention.
• Parents. Screen parents for their own OCD or other psychopathology and refer if positive. Parental guidance regarding how best to approach the child will occur within cognitive-behavioral therapy.
• School. (This is indicated if the child’s symptoms are affecting school.) Consider a request for evaluation at school to assess the need for a 504 or individualized education plan (IEP).
• Environment. Discuss minimizing OCD triggers at home.
• Medications. Begin fluoxetine 5 mg per day. Informed consent is important, including suicide warnings. (You might delay this step if a therapist is available to begin ERP first.)
• Follow-up should take place in 2 weeks, with a possible increase of fluoxetine to 10 mg and reassessment with CY-BOCS.
When to consult? Many patients with relatively uncomplicated OCD can be effectively managed in the primary care setting. Consultation may be useful for instances of poor treatment response, other occurring psychiatric disorders (such as autism, attention-deficit/hyperactivity disorder), family conflict and resistance, or diagnostic uncertainty with other conditions, such as a psychotic disorder.
Dr. Rettew is an associate professor of psychiatry and pediatrics at the University of Vermont, Burlington. He is the author of "Child Temperament: New Thinking About the Boundary between Traits and Illness." Follow him on Twitter @pedipsych.