The efficacy of cognitive-behavior therapy (CBT) alone and medical management with the selective serotonin reuptake inhibitor sertraline alone, or CBT and sertraline combined, as initial treatment for children and adolescents with obsessive-compulsive disorder (OCD), was evaluated by a randomized controlled trial conducted at Duke, Penn and Brown Universities. A volunteer outpatient sample of 97 patients with OCD, aged 7 through 17 years, and recruited between 1997 and 2002, received treatment or placebo for 12 weeks. Clinical remission was defined as a Children’s Yale-Brown OC scale score less than or equal to 10. Statistically significant benefits were measured with CBT alone (p=.003), sertraline alone (p=.007), and combined treatment (p=.001) compared with placebo. Combined treatment was superior to CBT alone (p=.008) and to sertraline alone (p=.006). The rates of clinical remission were 53.6% for combined treatment, 39.3% for CBT alone, 21.4% for sertraline alone, and 3.6% for placebo. The remission rate for combined treatment was not significantly different from that for CBT alone (p=.42) but was superior to sertraline alone (p=.03) and placebo (p<.001). The remission rates for CBT alone and sertraline alone were not different (p=.24) from each other but were different from placebo (p-.002). Sertraline adverse events occurred in 5% of patients, 2 times that with placebo, and included decreased appetite, diarrhea, enuresis, motor overactivity and impulsivity, nausea, and stomachache. None was suicidal. Treatment should begin with combination CBT and SSRI (sertraline) or CBT alone. 
COMMENT. The authors note that OCD affects approximately 1 in 200 young patients and most are initially treated with SSRIs. Duke and Penn University have favored management with CBT , and the results of the present study establish the superiority of CBT or CBT combined with SSRI to SSRI alone. A greater availability of CBT should benefit and improve the quality of life of patients with OCD.
Quality of life in children with ADHD. A survey conducted in the ADHD Clinic in British Columbia, Canada, that included 165 respondents, showed that children with ADHD have more parent-reported problems with emotional behavior, mental health, and self-esteem than normal. These effects have an impact on the parents’ emotional health and family activities. The adverse effect on health-related quality-of-life (HRQL) correlates with parent-reported inattentive, hyperactive, and combined symptoms of ADHD. Children with more severe symptoms of ADHD and comorbidities had poorer psychosocial HRQL. Research and management of ADHD should include measurement of broader domains of family impact and child health. 
Negativity in the mother-infant interaction and early family adversity each contribute to later hyperkinetic symptoms in a study of the effects of regulatory problems in infancy.