Addressing treatment gaps in early-onset OCD and specific phobias in young children

Tell us about your research area. 

We use a cognitive-behaviour intervention program for children aged 3-6 with specific phobias, which cause profound impairments at home, school and with peers.

Imogene Calteaux

Clinical Psychology Registrar, Clinical PhD Candicate and Project Coordinator, Griffith University

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What was the purpose of your research? 

The purpose of this research is to address significant treatment gaps in early-onset Obsessive-Compulsive Disorder (OCD) and specific phobias in young children. This program aims to empower parents by training them in Exposure and Response Prevention (ERP) techniques to support their children with OCD and specific phobias.

How was your research conducted? 

The FAST-CBT program is being evaluated through a nationwide randomised controlled trial, comparing its efficacy, and cost effectiveness against a waitlist condition for children with clinical and subthreshold OCD. This scalable, digitally enabled intervention combines web-based modules and video-conference group sessions, aiming to determine its potential or complementary treatment with stepped-care models for OCD.

The POP! study, funded nationally, focused on young children (aged 3-6) with specific phobias. This randomised controlled trial tested a brief intervention proven effective in older children and adults (OST), while also exploring the developmental course of childhood fears. Participants receive a comprehensive psychological assessment, are randomly assigned to one or two treatment conditions or a wait list monitoring condition, and are followed for 24 months through regular progress check-ins.

Why was the research conducted in this manner?

The research was designed to maximise accessibility, effectiveness, and scalability of evidence-based treatments for children with OCD and specific phobias. For FAST-CBT, a nationwide randomised controlled trial was chosen to rigorously evaluate its efficacy and cost-effectiveness compared to a waitlist control. By leveraging digital technologies and training parents as “ERP coaches,” the study aims to address treatment gaps, reduce delays in accessing care, and empower families to implement therapy in their own environments. For POP!, a randomised controlled trial was selected to test the effectiveness of a brief cognitive-behavioural intervention tailored for children aged 3–6. This design allowed for a controlled comparison of outcomes across treatment, education support and waitlist conditions, while long-term follow-up captures the developmental trajectory of childhood fears.

What were the outcomes of the research?

FAST-CBT is currently underway and POP outcomes are currently being looked at.

What does this research mean for the people of Queensland? 

OCD affects approximately 3% of Australians, with many cases beginning in childhood, while specific phobias impact around 10% of the population, including children as young as 3 years old. These conditions cause significant disruptions to daily life, yet in Australia, access to specialised, evidence-based treatments like the One Session Treatment and Exposure and Response Prevention remains limited due to long wait times, geographic barriers, shortage of trained professionals, and cost. This treatment gap leaves many families without the support they need, contributing to poorer long-term outcomes.

Research initiatives such as FAST-CBT aim to address these challenges by offering innovative, accessible interventions that empower parents to deliver effective therapy for their children with OCD, while the Preschoolers Overcoming Phobias (POP!) program focuses on providing brief, evidence-based interventions tailored for young children to reduce the impact of specific phobias and improve their quality of life. By leveraging digital tools and focusing on early intervention, these programs are working to reduce the burden of untreated OCD, ensuring Queensland families receive the care they need to improve their mental health and overall quality of life.

Does this open the door to any further research topics?

This research opens avenues for further exploration, particularly in expanding the application of Exposure and Response Prevention training beyond parent-led interventions to include clinician training within hospitals and mental health agencies. Currently, there is a significant gap in specialised ERP training among psychologists in Australia; notably, up to 95% of therapists identify a lack of specialist training and supervision as a barrier to offering ERP.

Additionally, as part of my PhD research, I am developing a parent training intervention for childhood specific phobias. This initiative aims to improve the accessibility of evidence-based treatments and promote early intervention, thereby overcoming structural barriers that families often face in traditional face-to-face therapy settings.

Do you have any advice for aspiring mental health researchers?

Seek guidance from experienced researchers and clinicians. Working under mentors like I do with Professor Lara Farrell has been invaluable for learning research methodologies, navigating challenges, and expanding professional networks. Also while pursuing innovative ideas, remain grounded in feasibility, particularly regarding funding, scalability, and ethical considerations.

Is there anything else about this research you feel would be beneficial for people in the mental health sector to know?

Empowering families to support their children through evidence-based treatments like ERP goes beyond teaching skills; it’s about instilling hope and building confidence in parents’ abilities. For many families, the idea of taking on such a critical role in their child’s mental health journey can feel overwhelming and daunting.

Parents often turn to professionals because they feel unequipped to handle the challenges their child is facing, and the responsibility of becoming a key part of the therapeutic process can be intimidating. That’s why an equally important aspect of working with families is fostering a sense of belief in their capacity to make a difference. By creating a supportive and encouraging environment, we can help parents realise their strengths, celebrate their small victories, and embrace their role as an integral part of their child’s recovery. This not only empowers parents but also provides children with a secure foundation of love, hope, and resilience as they face their fears together.

Are there any other related studies you’d recommend people to read?

Farrell, L.J., Waters, A.M., Storch, E.A., Simcock, G., Perkes, I.E., Grisham, J.R., Dyason, K.M., & Ollendick, T.H. (2023). Closing the Gap for Children with OCD: A staged-care model of cognitive behavioural therapy with exposure and response prevention. Clinical Child and Family Psychology Review. link.springer.com/article/10.1007/s10567-023-00439-2

Farrell LJ, Nabinger de Diaz NA, Mathieu S, McKenzie ML, Miyamoto T, Donovan CL, Waters AM, March S, Bothma N, Kroon R, Simcock G, Ware RS, Selles RR, Storch EA, Ollendick T. FAST CBT for pediatric OCD: A multiple-baseline controlled pilot trial of parent training in exposure and response prevention delivered via telehealth. Front Psychol. 2022 Dec 13;13:1009735. doi: 10.3389/fpsyg.2022.1009735. PMID: 36591101; PMCID: PMC9795832.

Farrell, L. J., Kershaw, H., & Ollendick, T. (2018). Play-modified one-session treatment for young children with a specific phobia of dogs: A multiple baseline case series. Child Psychiatry & Human Development, 49(2), 317-329.
Kershaw, H., Farrell, L. J., Donovan, C., & Ollendick, T. (2017). Cognitive behavioural therapy in a one-session treatment for a preschooler with specific phobias. Journal of Cognitive Psychotherapy, 31(1), 7-22.