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Pediatric OCD responds to both cognitive-behavior therapy and medication, with much of the research focusing on children with few additional diagnoses or complications. However, in everyday practice there are many considerations that lead to poorer treatment response. This panel will discuss methods for addressing the major factors that contribute to poorer outcomes. Topics will include comorbid presentations, complex/atypical symptoms, violent and sexual thoughts, treatment noncompliance, and barriers to effective parental involvement in treatment. Presenters will discuss the application of ERP, as well as additional augmentation strategies.