National Trends in Pediatric Obsessive compulsive disorder Management: Insights from a Retrospective Cohort Study

Objectives: Obsessive compulsive disorder (OCD) is a chronic psychiatric condition that significantly impairs various domains, including social, academic, and overall functioning. While antidepressants and psychotherapy—specifically cognitive behavioral therapy—are the standard first-line treatments, there is considerable variability in the use of augmenting agents, particularly antipsychotics. This study examines treatment patterns in children and adolescents with OCD. Methods: This population-based retrospective cohort study utilized the TriNetX research network to identify patients aged 6–18 with an OCD diagnosis (F42, N = 37, 355). Treatment patterns were analyzed based on sociodemographic factors (age, gender, and race/ethnicity) and clinical settings (inpatient vs. outpatient). Odds ratios (ORs), hazard ratios (HRs), and 95% confidence intervals (CIs) were calculated, with Cox proportional hazards models used to adjust for potential confounders. Results: The average age of OCD diagnosis in youth was 10.9 years, with a balanced gender distribution. Psychiatric comorbidities were common, particularly anxiety disorders (53%), attention-deficit hyperactivity disorder (47%), and mood disorders (37%). Antidepressants were prescribed to 55% of patients, with sertraline and fluoxetine being the most common, while 22% were prescribed antipsychotics, primarily aripiprazole and risperidone. In addition, 31% had billable therapy codes. Racial and ethnic minority groups received less treatment overall, with lower odds of receiving antidepressants (OR 0.51–0.74) and therapy (OR 0.75) among Black youth. In contrast, Black youth were more likely to be prescribed antipsychotics (OR 1.18). Among those prescribed antipsychotics, 47% had prior antidepressant use, 22% had billed psychotherapy, and only one-sixth had both before starting antipsychotics. Inpatient hospitalization, as an indicator of symptom severity, was strongly associated with antipsychotic prescriptions (adjusted HR: 3.03, 95% CI: 2.85, 3.21). Conclusions: There is considerable variability in the pharmacological management of pediatric OCD, with frequent use of antipsychotics even before first-line treatments. The low utilization of psychotherapy suggests gaps in adherence to evidence-based care. These findings highlight the need for improved adherence to OCD treatment guidelines, with a focus on increasing access to psychotherapy.