Prevention of obsessive-compulsive disorder in at-risk children: Planning of a large scale randomized controlled trial

Research idea and purposeObsessive-compulsive disorder (OCD) is a prevalent, childhood onset condition associated with substantial adversity, school failure, suicide risk, and societal costs.

While reasonably effective treatments for the disorder exist, these are often offered too late, once the disorder has fully developed and has had a devastating impact on the young person’s development, education, social life and physical health. There is broad consensus in the field that we should move towards early interventions and prevention.

To our knowledge, preventive approaches have never been developed for, or evaluated in, children at risk of developing OCD.

The proposed project builds upon the applicant’s ongoing research on the prevention of OCD in at-risk children previously funded by a Forte postdoc grant (number 2022-00831).

A feasibility study has provided encouraging preliminary results, and we are now ready to start planning a large-scale randomized controlled trial (RCT) in collaboration with prevention experts, health economists, interest organisations and stakeholders.

Work plan, methods and project realizationThe overall aim is to design and prepare for the world’s first prevention trial for children at risk of developing OCD.

The specific aims are to:  1) complete the follow-up assessments and analysis of qualitative data from our feasibility study, 2) find collaboration partners with expertise in prevention, statistics and health economics, 3) form a Research Steering Group together with the Swedish OCD association and persons with lived experience of OCD, and 4) plan a large scale RCT, securing recruitment sites, performing power calculations, detailed analysis plans, study protocol and ethical application.

The planning grant funding is essential to ring-fence the necessary time to put together a team of experts, and carefully design a very ambitious trial which will likely involve hundreds of families across Sweden.Societal relevance and utilizationIf we can reduce the incidence of OCD and associated impairments (e.g. school failure) in these at-risk children, it would not only have obvious direct benefits for the individuals but also result in enormous cost savings on a societal level, such as healthcare costs, and parental lost work.