Three-Year Follow-Up of children and adolescents with OCD Who Did Not Respond to Initial Cognitive-Behavioral Therapy (CBT): Outcomes of Continued CBT vs. Sertraline.

UNLABELLED: Cognitive-behavioral therapy (CBT) is the first-line treatment for pediatric obsessive-compulsive disorder (OCD), with selective serotonin reuptake inhibitors (SSRIs) recommended for non-responders. However, evidence on the long-term outcomes of these interventions is limited. This study examines outcomes over three years for youth with OCD who did not respond to initial CBT and were randomized to either continued CBT or sertraline. Fifty children and adolescents aged 7–17 years, with OCD according to DSM-IV criteria, were included in this randomized controlled trial conducted across Denmark, Sweden, and Norway. Participants who did not respond to 14 weeks of CBT were randomized to 16 weeks of continued CBT or sertraline. Outcomes included the Children’s Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) total scores and clinical remission (CY-BOCS < 11) at all follow-up points: 12, 24, and 36 months. Linear mixed effects showed significant reduction in the CY-BOCS total score over time across treatments. Planned pairwise comparison of the CY-BOCS total score did not reveal a significant difference between the treatments at 12-, 24-, or 36-month follow-up. At the three-year follow-up, 92% of participants showed considerable improvement: 77% achieved clinical remission and another 15% showed only mild OCD symptoms (CY-BOCS < 16). No serious AEs occurred. Continued CBT and sertraline both demonstrate long-term effectiveness for children and adolescents with OCD who do not respond to initial CBT, with durable outcomes observed across groups. These findings support the stepped-care model and the importance of individualized treatment planning, as both approaches can lead to sustained improvement.

SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00787-026-03009-3.