Parent- and child-reported executive functioning and response to psychotherapy in pediatric obsessive-compulsive disorder: Results from the TECTO study.

Executive function (EF) difficulties in pediatric obsessive-compulsive disorder (OCD) are suggested to interact with psychotherapy response. We investigated the role of parent- and self-rated EF in a randomized trial comparing cognitive-behavioral therapy (CBT) and psychoeducation with relaxation training (PRT). We investigated the extent to which: (1) EF difficulties are evident in non-medicated pediatric OCD patients; (2) difficulties improve during psychotherapy; and (3) EF moderates symptom alleviation. We included 114 patients with OCD (aged 8–17 years), who received 14 sessions of CBT or PRT. EF was assessed before and after treatment with both the parent-rated (full age span) and self-rated (age 11–17 years) Behavior Rating Inventory of Executive Function, 2nd version (BRIEF-2). All BRIEF-2 subdomains were reported. OCD symptom severity was assessed with the Children’s Yale-Brown Obsessive-Compulsive Scale (CY-BOCS). We assessed seventy-four non-psychiatric control children within a similar time interval. Parent- and self-ratings indicated EF difficulties in OCD patients compared with non-psychiatric controls across BRIEF-2 subdomains. Self-rated flexibility difficulties were associated with more severe OCD symptoms pre-treatment. Parents and children reported EF improvement after psychotherapy across subdomains. Parent-rated self-monitoring improved after CBT but not PRT. EF improvement was not associated with symptom alleviation in patients. Finally, emotional control, working memory, and task-completion ability moderated OCD-symptom improvement. EF difficulties are evident at the group level in pediatric OCD and show improvement following psychotherapy with minimal differences between CBT and PRT. Although EF improvement is not associated with symptom alleviation, several subdomains of EF pre-treatment moderate the treatment effect. The online version contains supplementary material available at 10.1007/s00787-026-03013-7.