Current state of the evidence on treatments for obsessive-compulsive disorder in children and adolescents: An umbrella review

Obsessive-compulsive disorder (OCD) is a frequent condition in the pediatric population, with significant clinical impact and high comorbidity. This umbrella review aimed to synthesize evidence from systematic reviews and meta-analyses on the efficacy of interventions for OCD in individuals under 18 years of age. Searches were conducted in five electronic databases up to July 2025. A total of 28 systematic reviews and meta-analyses published between 2003 and 2025 were included, assessing the efficacy of various treatments and encompassing a total of 24,762 participants. Cognitive behavioral therapy (CBT), particularly in the form of exposure and response prevention (ERP), emerged as the most effective intervention, with clinically significant and sustained effects. Selective serotonin reuptake inhibitors (SSRIs) showed moderate efficacy, and their combination with CBT may be useful in severe cases. Emerging interventions such as internet-delivered CBT were also reviewed. The evidence supports CBT as the first-line treatment for pediatric OCD, although longitudinal studies and population-specific adaptations are still needed. It is concluded that advancing toward developmentally appropriate and more accessible treatments is a priority. Clinical implications and future research directions are also discussed.