Pediatric obsessive compulsive disorder: Family climate as a predictor of treatment outcome

Abstract

BackgroundMaternal Expressed Emotion (EE) is a poor prognostic indicator for multiple forms of child and adolescent psychopathology; however, there has been relatively little examination of its role in pediatric obsessive compulsive disorder (OCD). This study examined rates of high maternal EE in pediatric OCD, their cross-sectional parent and child correlates, and links to treatment outcome. MethodsParticipants included 58 youths (mean age=12.33 years; % male=59%) participating in a larger randomized control trial comparing family focused cognitive behavior therapy (FCBT) to psychoeducation and relaxation training (PRT) for pediatric OCD. Baseline measures of maternal EE were obtained using the Five-Minute Speech Sample (FMSS). Clinical outcomes were evaluated by independent evaluators using the Clinician's Global Impressions-Improvement Scale (CGI-I). ResultsOverall, 55% of mothers in this sample were rated high EE. High maternal EE at baseline was a significant predictor of poor treatment outcome, X2 (1, n=58)=5.32, p=.02. At baseline high EE was not related to child's OCD symptom severity, but was significantly associated with higher rates of comorbid child externalizing behavior problems and higher levels of parental depressive symptoms. Of the two dimensions of EE, maternal criticism correlated with parental blame and personal responsibility, whereas emotional over-involvement correlated with parental anxiety, depression, and OCD. ConclusionsThese results underscore the significance of family stress, as expressed in high-EE, as a predictor of poor treatment response among youths suffering from OCD.