Innovative treatment approaches for paediatric obsessive-compulsive disorder.

INTRODUCTION: Pediatric obsessive-compulsive disorder is a chronic and often under-diagnosed condition with onset in childhood or adolescence, leading to marked functional impairment. While current first-line treatments, cognitive-behavioral therapy and selective serotonin reuptake inhibitors, are effective in many cases, a substantial proportion of patients remain refractory, especially those with early onset.

AREAS COVERED: This review explores the emerging etiopathogenetic models of pediatric OCD, emphasizing neurodevelopmental, glutamatergic, and immune-inflammatory mechanisms. A literature search was conducted using PubMed and ClinicalTrials.gov, focusing on controlled and observational studies on pediatric OCD, including novel therapeutic targets. Special attention is given to the PANDAS/PANS subgroup, which has helped shift the paradigm beyond monoaminergic dysfunction. New pharmacological strategies, such as glutamate modulators and anti-inflammatory agents, are critically examined alongside established psychotherapeutic approaches.

EXPERT OPINION: OCD remains the only psychiatric disorder in which a childhood syndrome, PANDAS, has led to immune-based hypotheses that influenced adult research and treatment. Despite promising signals from small trials and case studies, robust pediatric data are scarce. Future efforts should prioritize large-scale, age-specific trials, early stratification based on immune profiles, and mechanistically guided interventions to advance personalized care in pediatric OCD.