Cognitive, behavioural and familial maintenance mechanisms in childhood obsessive compulsive disorders: A systematic review

Brynjar Halldorsson,Carolina Guzman-Holst,Chloe Chessell,Cathy Creswell,Kate Harvey

doi:10.1177/20438087211036581

Abstract

Cognitive Behavioural Therapy (CBT) for preadolescent children with obsessive compulsive disorder (OCD) is typically derived from adult cognitive behavioural models of OCD; however, it is unknown whether these adult models apply to preadolescent children. This systematic review examined whether 11 cognitive, behavioural and familial maintenance mechanisms identified from adult cognitive behavioural models of OCD and descriptions of how family factors may maintain OCD applied to preadolescent children with obsessive compulsive symptoms/disorder (OCS/OCD; Prospero:CRD42019153371). PsycINFO, MEDLINE and Web of Science Core Collection were searched in March 2019, with forward citation handsearching conducted in March/April 2020. Twenty-nine studies were synthesised. Studies were identified for only six of the 11 proposed maintenance factors. Of the cognitive and behavioural factors, only inflated responsibility and meta-cognitive beliefs showed evidence of independent and/or specific associations with childhood OCS. Of the family factors, only less frequent displays of parental confidence, positive problem solving and rewarding of children’s independence showed some evidence of specificity to childhood OCD. Notably, findings across studies were inconsistent and existing studies have considerable methodological limitations. Experimental and prospective longitudinal studies are needed to determine whether the proposed factors maintain childhood OCS/OCD, to improve the effectiveness and efficiency of CBT for preadolescent children with OCD.

Highlights

Obsessive compulsive disorder (OCD) is a highly debilitating mental health disorder characterised by the presence of obsessions and/or compulsions
This review synthesised 29 studies examining the association between childhood obsessive compulsive symptoms (OCS)/OCD and proposed maintenance factors identified from adult cognitive behavioural models of OCD, and descriptions of how family factors may maintain childhood OCS/OCD
While there was some evidence of cross-sectional associations between childhood OCS/OCD and certain proposed maintenance factors, there is currently limited evidence that these associations are independently or associated with childhood OCS/OCD

Summary

Introduction

Obsessive compulsive disorder (OCD) is a highly debilitating mental health disorder characterised by the presence of obsessions (intrusive, unwanted thoughts, images or urges which cause significant distress or anxiety) and/or compulsions (repetitive behaviours or mental acts an individual feels compelled to perform to reduce distress or anxiety, or to prevent a feared outcome; American Psychiatric Association, 2013). Childhood OCD is commonly comorbid with other mental health disorders (Heyman et al, 2001; Pediatric OCD Treatment Study (POTS) Team, 2004) and often continues into adulthood if appropriate treatment is not provided (Pinto et al, 2006). Cognitive Behavioural Therapy (CBT) including Exposure and Response Prevention (ERP) is the recommended psychological treatment for childhood OCD (National Institute of Health and Care Excellence - NICE, 2005), and has been shown to be superior to pharmacological treatment (Ivarsson et al, 2015) and active psychological control conditions (Freeman et al, 2014). Up to 60% of children and adolescents do not experience clinical remission of obsessive compulsive symptoms (OCS) following CBT (Barrett et al, 2008; Pediatric OCD Treatment Study (POTS) Team, 2004). To improve the effectiveness of CBT for preadolescent children with OCD an understanding of the psychological processes which maintain the disorder in preadolescence is required

Objectives

Methods

Results

Discussion

Conclusion