**8. Treatment practice guidelines**

Evidence-based treatment modalities for pediatric obsessive compulsive disorder comprise cognitive behavior therapy (CBT), specifically exposure and response prevention (ERP), as well as psychiatric medication (selective serotonin reuptake inhibitors, SSRIs) [17, 45, 60, 61]. CBT is recommended as the first-line treatment for mild-to-moderate cases of OCD in children [17]. A combination of psychotropic medication and CBT is recommended for moderate-to-severe OCD in children, with serotonin reuptake inhibitors considered the first-line medication [62]. Additionally, medication can be helpful in cases where children are having difficulties engaging in treatment or have co-occurring disorders that cause additional functional impairment. Medication augmentation may also be considered for individuals with treatment resistance (i.e., nonresponsive to empirically based interventions) who experience persistent OCD symptoms despite adequate treatment interventions.
