Cognitive Behavior Therapy for Pediatric Obsessive-Compulsive Disorder—Reply

In Reply: We concur with Mr Wang regarding the importance of examining the Pediatric OCD Treatment Study II (POTS II) trial data for potential predictors and moderators, including effects associated with psychiatric comorbidity and SRI medication. The study was a focused examination of primary outcomes; attempting to address moderation would have resulted in giving this important issue short shrift. Examination of moderators in POTS II is currently under way and will include the potential effects of comorbidity and specific SRI medication. The methodological and statistical approach taken in the POTS I moderators study¹ will be closely followed. In the POTS I moderators study, findings from a comprehensive review² served as the starting point for identifying variables shown to predict or moderate treatment outcome. These included demographic factors, severity of illness indicators, comorbidity, and family factors. Several predictors of outcome did emerge from POTS I: lower initial OCD symptom severity and impairment, better insight, fewer externalizing symptoms, and lower rates of family accommodation were associated with better response regardless of treatment assignment. However, only family history of OCD moderated outcome (ie, was specifically associated with attenuated response to a specific treatment condition).