The relationship between homework adherence and outcome in family-based cognitive-behavioral therapy for early-onset obsessive compulsive disorder

Family-based cognitive behavioral therapy (CBT) is an effective treatment for obsessive compulsive disorder (OCD), but not all children respond. Children with early-onset OCD may exhibit poorer outcomes, possibly due to developmental factors that affect treatment engagement and distress tolerance, which may ultimately affect treatment dose. Homework adherence between sessions can increase treatment dose and predict improved outcome. However, no studies have specifically examined the effect of homework adherence on treatment outcome for early-onset OCD. This study examined homework adherence during family-based CBT for young children (N = 63) with early-onset OCD. Caregiver and child homework adherence were rated weekly by clinicians and symptom change was assessed at multiple timepoints across treatment. Caregivers and children were both rated as highly adherent with homework, although caregivers were rated as more adherent than children. Structural equation modeling indicated that early homework adherence predicted later homework adherence, which predicted improved treatment outcome.