**10. Addressing treatment obstacles and future directions**

Factors associated with poorer treatment response in children with OCD include lower insight, higher family accommodation, comorbid disorders, and greater symptom severity [48, 49, 61]. Researchers are exploring ways to improve the efficacy and accessibility of OCD treatments. Potentially, strategies aimed at enhancing readiness in children may facilitate increased engagement in therapy such as motivational interviewing strategies [66]. In fact, a pilot study explored the usefulness of adjunctive motivational interviewing sessions (MI) compared to adjunctive psychoeducation sessions; results indicated the MI condition led to faster reduction in symptoms (though scores posttreatment were not significantly different from the control condition), and on average, treatment was completed three sessions earlier than those in the control group [46]. Incorporating technology may allow CBT researchers and clinicians to reach a wider audience of individuals who otherwise may not have access to treatment due to location and other logistics (e.g., childcare for other siblings, transportation availability). One pilot study found significant treatment outcomes for a web-based CBT intervention, leading to the suggestion that web-based CBT may be considered in cases where in-person sessions are not feasible [67]. Additionally, as discussed above in prior sections, family members are increasingly being included and targeted in standard CBT therapy protocols for children with OCD with substantially positive outcomes [46, 58].
