Pediatric obsessive-compulsive disorder (OCD) can be a debilitating illness that interferes with the child’s normative developmental trajectory. Although evidence supports exposure and response prevention (ERP) as the most effective treatment for childhood OCD (Cervin et al., 2024; McGuire et al., 2024), the heterogeneity of OCD symptoms can present unique challenges in the application of ERP in clinical practice. Whereas intrusive "bad thoughts" with violent, sexual, suicidal or religious content are relatively common among youth (Fernandez et al., 2013), there is a notable gap in the treatment literature, especially for very young children, under age 8.
Access to treatment is impacted by both clinician and client variables. The child and family may be reluctant to engage in ERP due to great distress about frightening or distasteful taboo thoughts. Clinicians may also struggle with their own discomfort with these topics. Negative beliefs about the safety and tolerability of ERP may lead clinicians to underutilize ERP (Whiteside et al., 2016) and overutilize ineffective techniques such as relaxation (Keleher et al., 2020). They may be unsure of how to design suitable exposures, how far to take exposures, and how to persuade youth and families to engage in a very counterintuitive process.
Access is also impacted when clinicians find it challenging to effectively address family accommodation of OCD, which is a barrier to successful treatment (Lebowitz et al., 2016). With almost 90% of parents reporting accommodation of their child’s OCD (Storch et al., 2007), collaboration with parents is central to achieving positive outcomes (Guo et al., 2024).
This workshop aims to disseminate evidence-based strategies by offering clinicians in a variety of practice settings a roadmap to navigate the challenges that reduce access to treatment for youth with intrusive thoughts. We will present a systematic ERP approach that highlights developmental flexibility, cultivating treatment readiness, and collaboration with parents, within a culturally-sensitive context. Through case examples, we will illustrate the use of age-appropriate language, metaphors, ERP “brave challenges,” scripts, and parent-coaching. Treatment for older youth emphasizes empowerment and self-efficacy, while modifications for preschool children focus primarily on parent coaching.
Continuing Education Objectives:
After attending this presentation, attendees will be able to:
1. identify challenges in the treatment of intrusive thoughts in children and teens.
2. describe strategies for implementing ERP for intrusive thoughts for different developmental stages, from preschool children to teens.
3. describe family-based interventions to collaborate and partner effectively with parents in their child's treatment.
About Presenters
Aureen Pinto Wagner, Ph.D. is a clinical child psychologist and expert in cognitive-behavioral therapy (CBT) who developed the child-friendly Worry Hill® CBT approach. She is a member of the Scientific and Clinical Advisory Board of the International Obsessive-Compulsive Disorder Foundation (IOCDF) and was the recipient of its Patricia Perkins Service Award in 2026.
At The Anxiety Wellness Center, Dr. Wagner provides both in-person and HIPAA-compliant telehealth services to children, teens, and adults with anxiety, OCD, and related conditions.
Dr. Wagner is a sought-after international speaker who presents on-site, virtual and streamable workshops and consultation for parents, clinicians and school professionals. As a faculty presenter and supervisor for the IOCDF’s Behavior Therapy Training Institute (BTTI), and the Pediatric BTTI, Dr. Wagner has been training clinicians for over 25 years.
The Association of Behavioral and Cognitive Therapies has awarded Dr. Wagner the Self-Help Book Recommendation for providing the highest level of evidence-based best practices for her books: Worried No More: Help and Hope for Anxious Children, Up and Down the Worry Hill: A Children's Book about Obsessive-Compulsive Disorder, and What to do when your Child has Obsessive-Compulsive Disorder: Strategies and Solutions. The latter two books, along with her highly-acclaimed resource for professionals, Treatment of OCD in Children and Adolescents: Professional's Kit, comprise the only integrated set of resources for children with OCD, their parents, and their therapists. Dr. Wagner has also developed a suite of resources for professionals who work with anxious youth, including Worried No More: Teaching Tools and Forms on CD, and CDs of her live workshops for parents and school professionals.
Dr. Wagner received her education at St. Agnes College, the University of Iowa, Yale University Child Study Center and Brown University. Prior to founding The Anxiety Wellness Center, Dr. Wagner was Clinical Associate Professor of Neurology (1998-2010) and Assistant Professor of Psychiatry (1991-1998) at the University of Rochester School of Medicine & Dentistry. She also served as Adjunct Associate Professor of Psychiatry at the University of North Carolina School of Medicine. She was voted Outstanding Psychologist of the Year by the Genesee Valley Psychological Association, Rochester, NY in 2007.
Lynne Siqueland, PhD, is a psychologist at the Children’s and Adult Center for OCD and Anxiety, specializing in the treatment of anxiety disorders in children and adolescents for over 25 years. She has extensive experience working with children of all ages, beginning in the preschool years with a special interest in transition into adolescence and young adulthood. Dr. Siqueland received her doctoral degree in the Temple University Clinical Psychology Program under the direction of Dr. Philip Kendall, where she was part of the initial treatment manual development and clinical trials of the CBT treatment of child anxiety disorders. She was an assistant professor at the University of Pennsylvania Medical School and Center for Psychotherapy Research for 8 years before entering private practice full time in 2001. Dr Siqueland's clinical work and research publications focus on integrating individual CBT approaches with family work. She has a special interest in collaborating with parents to guide their children to cope with their anxiety, to develop competence and autonomy, and to improve family connection and communication. Dr Siqueland also thoroughly enjoys providing training and consultation for professionals on the treatment of anxiety and OCD and for parents locally, nationally, and internationally. For more about Dr. Siqueland's practice visit drlynnesiqueland.com
Target Audience
This workshop is designed for licensed professionals & advanced graduate students with clinical experience who anticipate seeking licensure as mental health professionals. The instructional level of this presentation is INTERMEDIATE.
Continuing Education
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PBTA is also an authorized provider of CE credits for Professional Counselors, Marriage and Family Therapists, and Clinical Social Workers licensed in the state of Pennsylvania. Non-psychologist licensees in other states should confirm with their respective boards that this training meets criteria for CE in their specific non-PA states or provinces.
Suggested Readings
Cervin, M., McGuire, J.F., D'Souza, J.M., De Nadai, A.S., Aspvall, K., Goodman, W.K., Andrén, P., Schneider, S.C., Geller, D.A., Mataix-Cols, D. and Storch, E.A. (2024), Efficacy and acceptability of cognitive-behavioral therapy and serotonin reuptake inhibitors for pediatric obsessive-compulsive disorder: a network meta-analysis. J Child Psychol Psychiatr, 65: 594-609. https://doi.org/10.1111/jcpp.13934
de la Cruz, F, Barrow, L Bolhuis F, K, Krebs, G, Volz, C, et al. (2013) Sexual obsessions in pediatric obsessive compulsive disorder: Clinical characteristics and treatment outcomes. Depression and Anxiety https://doi.org/10.1002/da.22097
Keleher, J., Jassi, A., & Krebs, G. (2020). Clinician-reported barriers to using exposure with response prevention in the treatment of paediatric obsessive-compulsive disorder. Journal of Obsessive-Compulsive and Related Disorders, 24, 100498. https://doi.org/10.1016/j.jocrd.2019.100498
Lebowitz, E. R., Panza, K. E., & Bloch, M. H. (2016). Family accommodation in obsessive-compulsive and anxiety disorders: a five-year update. Expert Review of Neurotherapeutics, 16(1), 45–53. https://doi.org/10.1586/14737175.2016.1126181
Storch, E. A., Guzick, A. G., Ayton, D. M., Palo, A. D., Kook, M., Candelari, A. E., Maye, C. E., McNeel, M., Trent, E. S., Garcia, J. L., Onyeka, O. C., Rast, C. E., Shimshoni, Y., Lebowitz, E. R., & Goodman, W. K. (2024). Randomized trial comparing standard versus light intensity parent training for anxious youth. Behaviour Research and Therapy, 173, 104451. https://doi.org/10.1016/j.brat.2023.104451
