Child and adolescent obsessive–compulsive disorder (OCD) is a chronic and debilitating condition that accrues significant concurrent and long-term risk to affected youth (Bolton, Luckie, & Steinberg, 1995; Hanna, 1995; Piacentini, Bergman, Keller, & McCracken, 2003; Pine, Cohen, Gurley, Brook, & Ma, 1998). More common than once thought, the disorder affects between 0.5% and 2% of children and adolescents (Flament et al., 1988; Heyman et al., 2003;Rapoport et al., 2000; Zohar, 1999), thus paralleling the prevalence rates reported within the adult population (Torres et al., 2006; Weissman et al., 1994). Growing awareness of the scope and impact of the disorder has been met with heightened research activity focused on identifying effective interventions, both psychosocial and  psychopharmacological, for youth with OCD. Such work has generated an emerging evidence base and has spurred the publication of expert consensus guidelines (March, Frances, Kahn, & Carpenter, 1997) and practice parameters (American Academy of Child and
Adolescent Psychiatry, 1998) for the treatment of this disorder. Both sets of guidelines recommend exposurebased cognitive behavioral therapy (CBT), either alone or in conjunction with a serotonin reuptake inhibitor (SRI) as a frontline intervention for youth with OCD. Although not empirically based, such guidelines undoubtedly mark a big step forward for enhancing treatment for youth with OCD; however, there is still much to be done to further understand and improve the available treatments for these youngsters. In this article, we provide a brief discussion of the phenomenology of child and adolescent OCD and the theory underlying current treatment approaches. We then review the current state of the psychosocial treatment research literature, evaluating the specific studies comprising this literature base relative to the criteria for classification as an evidence-based intervention. We discuss mediators, moderators, and predictors of treatment outcome as well as the implications and clinical generalizability of findings to date. We conclude with a discussion of recommendations for best practice and future directions that stem from this body of work.