TMS + Exposure Therapy for Pediatric OCD: Second Phase (NExT)

Inclusion Criteria:

• Between the ages of 12 and 21 years.
• Presence of OCD, as indicated by a score of > 16 on the Children's Yale-Brown Obsessive Compulsive Scale, indicating moderate or greater OCD symptoms.
• Presence of motor compulsions on CY-BOCS compulsion checklist
• English fluency to ensure comprehension of informed consent and study measures and instructions.

Exclusion Criteria:

• Decline to provide informed consent.
• Has a personal history, or a family history in a first-born relative, of any medical or psychiatric disorder, disease, condition, injury, symptoms or circumstance that, in the opinion of the principal investigator, may: (1) impact the risk profile of TMS; (2) reduce the subject's ability to fulfill the study requirements as per protocol; or (3) adversely impact the integrity of the data or the validity of the study results." Some examples include: epilepsy or seizure disorder(s), bipolar disorder or any psychiatric disorder associated with a risk of mania, intracranial pathology, traumatic brain injury, brain tumor, stroke, implanted medical devices or metallic objects in the head, or moderate-severe heart disease
• Pregnant according to the medical history or a urine pregnancy test; and menstruating females who are heterosexually active and not using a highly effective form of contraception (tubal ligation, FDA-approved hormonal contraceptive, or an IUD)
• Inability to undergo MRI.
• Is deemed to be at imminent risk of suicide according to the Ask Suicide-Screening Questions (ASQ) (i.e. answers YES to ≥ one (1) of the four screening questions) and/or in the medical opinion of the investigator
• History of, or risk factors for, neurocardiogenic syncope (history of syncope/ presyncope related to noxious stimuli, anxiety, micturation, or posture).
• Concurrent psychotherapy of any kind for OCD.
• Concurrent TMS or receipt of any TMS experimental or clinical treatment less than 3 months prior to enrollment.
• Taking a medication deemed to pose high seizurogenic potential per physician review
• Taking a medication that has not reached stability criterion (same medication and dose for 6 weeks with no planned changes over the study period)