3.89 Distinct Trajectories of Long-Term Functional Impairment in Pediatric OCD During and After Stepped-Care Treatment

ObjectivesThe present study aimed to: 1) identify possible latent class trajectories of OCD-related functional impairment over 3 years after stepped-care treatment in children and adolescents with OCD; 2) describe these classes according to pretreatment characteristics; and 3) identify predictors of trajectory class membership.MethodsThe sample consisted of 246 children and adolescents (aged 7-17 years) with OCD participating in the Nordic long-term OCD treatment study (NordLOTS). Latent class growth analysis (LCGA) was conducted using Children’s Obsessive-Compulsive Impact Scale-Revised (COIS-R) data from children and parents on 7 points of assessment: pretreatment, week 7, week 14, 6-month follow-up, 12-month follow-up, 24-month follow-up, and 36-month follow-up.ResultsFor both the parent and child versions of the COIS-R, a 5-cluster quadratic solution had the best fit as determined by the Bayesian information criterion (BIC). For children and parents, the 2 largest clusters were comprised of participants who steadily declined in their levels of functional impairment throughout treatment and follow-up but had different levels of severity at baseline. For both parents and children, the 3 smaller clusters were comprised of participants who showed no or limited improvement in functional impairment as well as a class that improved initially and then relapsed during follow-up. Higher levels of contamination and cleaning symptoms, somatic and illness symptoms, and comorbid ADHD predicted membership for the nonresponse and relapse clusters.ConclusionsMost children and adolescents undergoing stepped-care treatment for OCD show improvements in functional impairment continuously throughout a 3-year follow-up period. However, distinct subgroups do not respond to treatment or relapse after treatment. These subgroups can be distinguished by symptom and comorbidity profiles.