Childhood Obsessive-compulsive Disorder Research Articles

Impaired executive functions in paediatric obsessive-compulsive disorder patients.

Isık Taner Y, Erdogan Bakar E, Oner O. Impaired executive functions in paediatric obsessive-compulsive disorder patients.Objective: There are only few studies which investigated the neuropsychological performances of paediatric patients with obsessive-compulsive disorder (OCD). Previous studies show that most of adult OCD patients had an onset of their first symptoms before the age of 15. Our objective was to evaluate the neuropsychological functions in paediatric patients with OCD.Methods: We compared the executive functions and general intelligence of child and adolescent OCD patients (n = 20) with age- and gender-matched healthy controls (n = 20). To compare mentioned skills, a neuropsychological test battery including Wechsler Intelligence Scale for Children-Revised (WISC-R), Wisconsin Card Sorting Test (WCST), Stroop Test and Verbal Fluency Test was performed.Result: Performances of the OCD and control subjects on neuropsychological tests were statistically analysed by using multivariate analysis of covariance (MANCOVA), in which Full Scale Intelligence Quotient (FSIQ) results were taken into consideration as a covariate to observe FSIQ's effect on test scores. Our results showed that the differences in WISC-R Picture Arrangement and Coding scores remained significant when co-analysed with FSIQ scores. In a similar manner, the OCD group exhibited worse performances on STR1-duration, STR3-duration, STR3-error, STR4-duration, STR4-error, STR5-correct response, and STR5-error as compared with the control group when FSIQ scores were taken into calculation. Some variables of the WCST (perseverative responses, percent errors, abstraction-flexibility and categories completed) also yield lower test scores in the OCD group. There was no significant difference between the groups regarding Verbal Fluency Test scores.Conclusion: Our results suggested that paediatric OCD patients had worse abstraction-flexibility, mental set-shifting, verbal comprehension and visuospatial/construction abilities.

Cognitive Biases and Obsessive-Compulsive Symptoms in Children: Examining the Role of Maternal Cognitive Bias and Child Age

Objective: Multiple cognitive biases associated with adult obsessive-compulsive disorder (OCD) were tested in a clinical sample of children (ages 7–11) and adolescents (12–17) and their mothers. This study examined (a) the associations between child cognitive biases and OCD severity, (b) maternal cognitive biases and child OCD severity, and (c) maternal cognitive bias and child cognitive bias. It was hypothesized that age would significantly moderate these relationships, with stronger associations with OCD severity for cognitive bias in adolescents (relative to children), and maternal cognitive bias in younger children (relative to adolescents). Method: Forty-six children and adolescents diagnosed with OCD and their mothers completed questionnaires assessing responsibility bias, thought–action fusion (TAF), thought suppression, and metacognitive beliefs. OCD symptoms were assessed using structured diagnostic interviews and semistructured symptom interviews. Results: As predicted, age significantly moderated associations between (a) child cognitive variables and OCD severity—specifically between child responsibility and child metacognition, which were associated with OCD severity for adolescents only; (b) maternal cognitive biases and child OCD severity—specifically for maternal responsibility and thought suppression, which were significantly and positively associated with child OCD severity but not adolescent OCD severity; and (c) maternal cognitive biases and child cognitive bias—such that significant associations were evident only in the younger child sample, and only between maternal TAF self and metacognition, with child suppression and child TAF moral, respectively. Conclusion: Maternal cognitive biases are more consistently linked to greater OCD severity among younger children, whereas personal cognitive biases are associated with greater OCD symptoms in adolescents. Treatments for pediatric OCD are likely to be improved by age-specific considerations for the role of maternal and child cognitive biases associated with OCD.

Obsessive-Compulsive Neurosis in Psychoanalytical Terms

It seems odd that with regard to the causes of obsessive-compulsive disorders in children and adolescents and obsessive-compulsive disorder in general, only neurobiological and cognitive-behavioral findings and models are deemed to exist. The behavioral analysis and diagnostic evaluation set out in the review article described as an obsessive-compulsive neurosis precisely the pathological entity that psychoanalysis has defined and described as an obsessive-compulsive neurosis for a long time. The interpretational pattern that is presented as dysfunctional in the article is also found in psychoanalytical ideas, where it is further differentiated, right down to the term “conflict.” Any further therapeutic approach depends exactly on whether this is done or not. Cognitive-behavioral, pharmacological, and neurosurgical methods want to eliminate the dysfunctional interpretational pattern in its entirety, but in doing so they run the risk of also eliminating parts that are really normal and healthy or suppress these owing to the risk of symptom displacement. However, psychoanalytic therapy—which was not mentioned in the review article—aims to (dis)solve the entire complex of the dysfunctional interpretation by enabling its actual constituents: Normal but intrusive negative thoughts, and accompanying unhappy emotions including fears, which are themselves accompanied by other intrusive thoughts, sto become fully expressed in such a way that that one category of thoughts come to the fore while the other moves into the background, and the conflict with its symptoms of compulsion, resistance, and discomfort resolves by itself. In a scenario where all approaches mentioned are identical in terms of understanding and therapy of the obsessive-compulsive disorder down to the last item—which relates to the therapeutic objective—why does a review article not mention psychoanalysis, at least in one word? Might professional and educational reasons and economic-therapeutic considerations hamper the scientific, unprejudiced, and disinterested perspective?

Use of Torin (sertraline) in the Treatment of Depressive and Obsessive-Compulsive Disorders in Children

Thirty-seven patients, aged from 7 to 12 years, with depressive and obsessive-compulsive disorders have been examined. Patients were treated with torin (sertraline) in dosage 25-50 mg daily during 4 weeks. Drug efficacy was evaluated using a children neurotic questionnaire and the Spilberger-Khanin anxiety scale. In the end of therapy, the complete reduction of obsessive and depressive symptoms was reached in 37,5% of patients, the improvement - in 51,9%. No side-effects have been observed. The authors recommend torin for treatment of depression in children.

Mother-Child Interactions and Childhood OCD: Effects of CBT on Mother and Child Observed Behaviors

This waitlist-controlled study investigates the impact of a group-based cognitive-behavioral therapy with family involvement (CBT-F) on observed mother and child behaviors in children with obsessive-compulsive disorder (OCD). Forty-four children and adolescents with OCD and their mothers were observed during family discussions before and after treatment/waitlist. Participants were rated on behavioral dimensions of criticism, overinvolvement, doubt, avoidance, warmth, confidence, positive problem solving, and rewarding independence. Significant differences between treatment and waitlist condition occurred from pretreatment to posttreatment, with ratings of negative behaviors decreasing and ratings of positive behaviors increasing in the treatment group. Findings suggest that CBT-F has the potential to improve mother and child interactions in families with a child diagnosed with OCD.

Responsibility Beliefs, Memory Confidence, Intolerance of Uncertainty and the Urge to Check in Childhood Obsessive-Compulsive Disorder: An Examination of Cognitive Theory

AbstractObjective: This study aimed to extend current research into cognitive models of obsessive–compulsive disorder (OCD) in a pediatric sample by examining the impact of perceived responsibility on memory confidence, intolerance of uncertainty (IU) and checking urge using an experimental design to manipulate perceived responsibility. It was hypothesised that the high responsibility condition would result in higher ratings of responsibility, lower memory confidence and higher IU, which would also result in higher ratings on urge to check. Moreover, it was hypothesised that adolescents would report significantly higher ratings of responsibility than children. Finally, it was hypothesised that the effect of perceived inflated responsibility on the urge to check in a high responsibility condition would be mediated by IU.Method: Twenty-seven children and adolescents diagnosed with OCD completed an experimental cognitive appraisal task (CAT) in which they heard two standardised vignettes presented in counterbalanced order; one in which participants were responsible and one in which they were not responsible for preventing harm to a friend's pet cat. Memory confidence, IU and checking urge were assessed after each scenario using Likert scales.Results: The manipulation of perceived responsibility was successful with children and adolescents rating increased responsibility in the high compared with the low responsibility scenario. There were no differences across high and low responsibility conditions, however, in ratings of memory confidence, IU or the urge to check. There were no significant age-related differences; however, there was a trend for adolescents to report higher ratings across all variables. Finally, the relationship between perceived inflated responsibility and the urge to check was not mediated by IU.Conclusions: Responsibility is not related to ratings of memory confidence, IU or the urge to check in a pediatric sample, suggesting that biases of responsibility may not be central to the formulation of childhood OCD. Results are discussed in terms of implications for cognitive formulations and cognitive approaches to treatment in pediatric OCD.

Pilot study on HTR2A promoter polymorphism, −1438G/A (rs6311) and a nearby copy number variation showed association with onset and severity in early onset obsessive–compulsive disorder

A previous study showed that a single nucleotide polymorphism (SNP), -1438G/A (rs6311), found in the transcriptional control region of the gene that encodes the serotonin-receptor 2A (HTR2A) was associated with obsessive-compulsive disorder (OCD) in a sample of children and adolescents. In this study, we reanalyzed the association of this SNP with OCD in an enlarged population of 136 cases (55 previous + 81 new cases) and compared them to 106 newly recruited, healthy, age-matched controls. We also investigated whether this SNP or its copy number variations (CNV) was associated with OCD severity and age of onset. The CNV was analyzed in a DNA region located near rs6311. The results confirmed the association between the A-allele and early onset OCD in children and adolescents, with an odds ratio (OR) of 1.69 [95% CI (1.17, 2.46); p = 0.005]. Strikingly, we found that carriers of one copy (deletion) of the CNV were associated with a very early onset OCD (2.5 years earlier than the typical onset), and they had increased CY-BOCS scores (8.7 points higher compared to "normal" CNV and duplications); which is related to increased severity of OCD symptoms (p = 0.031; p = 0.004, respectively). Compared to the normal CNV and duplications, the association between the deletion and OCD showed an OR of 7.56 [95% CI (1.32, 142.84); p = 0.020]. These results pointed to the functional importance of this promoter region of HTR2A; it influenced the occurrence, the onset, and the severity of OCD.

Evaluation of Genetic Variations in Organic Cationic Transporter 3 in Depressed and Nondepressed Subjects

Organic cationic transporter 3 (OCT3, SLS22A3) has only recently emerged as one of the regulators of monoaminergic neurotransmission, which plays a critical role in the pathogenesis of depression and is a potential new antidepressant drug target. OCT3 single-nucleotide polymorphisms (SNPs) have been investigated for their association with psychiatric disorders such as methamphetamine use disorder and obsessive-compulsive disorder in children and adolescents, but not depression. This study was designed to evaluate the allele frequencies of seven OCT3 SNPs in a US Caucasian depressed population and compare these frequencies with a control group of nondepressed subjects. Informed consent and a DNA sample were obtained from 157 subjects and analysis was performed using real-time PCR. Allele and genotype frequencies were compared using a t-test and the Pearson chi-square analysis, respectively. There were no significant differences in OCT3 allele or genotype frequencies between the depressed and non-depressed groups for all seven SNPs evaluated.

A Structural Equation Analysis of Family Accommodation in Pediatric Obsessive-Compulsive Disorder

Family accommodation of symptoms is counter to the primary goals of cognitive-behavioral therapy for pediatric obsessive-compulsive disorder (OCD) and can pose an obstacle to positive treatment outcomes. Although increased attention has been given to family accommodation in pediatric OCD, relatively little is known about associated child and parent characteristics, and their mediating/moderating effects. This study examined a structural equation model of parent and child variables related to parent reports of family accommodation. Sixty-one children with OCD (ages 6-17years, 39% female) and their parents were recruited from a university-based clinic. They were administered clinician- and parent-rated measures of child OCD symptom severity, OCD-specific impairment, internalizing problems, and externalizing problems as well as parent anxiety, depression, empathy, consideration of future consequences, and accommodation. Results generally supported the hypothesized model. Family accommodation mediated the relationship between OCD symptom severity and parent-rated functional impairment; child internalizing problems mediated the relationship between parent anxiety and family accommodation; and parent empathy and consideration of future consequences interacted to predict family accommodation. Child externalizing problems were significantly associated with family accommodation but neither of these two variables was associated with parent depression. Findings suggest that reductions in family accommodation might be maximized by routinely screening for comorbid psychopathology in children with OCD and their parents, and using prescriptive or modular approaches to intervention. Directions for future research are discussed.

Concurrent Treatment of Early Childhood OCD and ODD

A total of 12% of young children with obsessive compulsive disorder (OCD) present with comorbid oppositional defiant disorder (ODD), yet empirically based treatment packages are designed for implementation with monodiagnostic cases. The current case illustrates treatment of both disorders using concurrent exposure with response prevention and behavioral parent training. A 6-year-old male child is presented with significant obsessions and compulsions. To accommodate his OCD, his parents set limits inconsistently and used consequences infrequently. In addition, the child often was aggressive and defied adults. Treatment focused on training the child’s mother to differentiate anxiety-related behavior from oppositional behavior. The mother was also trained to conduct exposure and response prevention for compulsive behaviors and to increase positive parental attention, use a token economy for compliance, and implement time-out for aggressive behavior.

The role of treatment expectancy in youth receiving exposure-based CBT for obsessive compulsive disorder

The purpose of this investigation was to examine correlates of parent, child, and therapist treatment expectations and their role in the exposure-based treatment of childhood obsessive compulsive disorder (OCD). Treatment expectations were assessed among 49 youth with primary OCD, their parents, and therapists as part of the baseline evaluation and post-treatment clinical outcomes were determined by blind evaluators. Baseline depressive symptoms, child/parent-rated functional impairment, externalizing behavior problems, number of comorbid psychiatric disorders, and a lower perception of control were associated with lower pre-treatment expectations. Parent expectation was associated with parental OCD symptoms, child depressive symptoms and child-reported impairment. Therapist expectations inversely correlated with child depressive symptoms, externalizing problems, and child-rated impairment. Pre-treatment OCD severity and prior treatment history were not linked to expectancy. Finally, higher treatment expectations were linked to better treatment response, lower attrition, better homework compliance, and reduced impairment.

Parent experiences of attending a specialist clinic for assessment of their child's obsessive compulsive disorder.

There are few published studies that have examined parental satisfaction with child mental health assessment. This study reports parental satisfaction with assessment in a national and specialist Child and Adolescent Mental Health Service for obsessive-compulsive disorder (OCD) and related disorders. Forty parents completed a specially developed questionnaire designed to assess expectations and experiences of attending a specialist assessment. High levels of satisfaction were reported. Common expectations of the assessment included: advice or information about the treatment of OCD, a diagnosis or understanding of the child's problems, and an offer of treatment. The majority of parents reported that their expectations were met, and some suggestions for improvement to the service were noted.

Is childhood OCD a risk factor for eating disorders later in life? A longitudinal study

It has been suggested that childhood obsessive-compulsive disorder (OCD) may be a risk factor for the development of an eating disorder (ED) later in life, but prospective studies are lacking. We aimed to determine the prevalence of ED at follow-up and clinical predictors in a longitudinal clinical sample of adolescents/young adults diagnosed with OCD in childhood. All contactable (n=231) young people with OCD assessed over 9 years at a national and specialist paediatric OCD clinic were included in this study. At follow-up, 126 (57%) young people and parents completed the ED section of the Developmental and Well-being Assessment. Predictors for ED were investigated using logistic regression. In total, 16 participants (12.7%) had a diagnosis of ED at follow-up. Having an ED was associated with female gender and persistent OCD at follow-up. There was a trend for family history of ED being predictive of ED diagnosis. Five (30%) of those who developed an ED at follow-up had ED symptoms or food-related obsessions/compulsions at baseline. A difference in predictors for an ED versus other anxiety disorders at follow-up was identified. This study provides initial evidence that baseline clinical predictors such as female gender and family history of ED might be specific to the later development of ED in the context of childhood OCD. Clinicians should be alert to ED subthreshold symptoms in young girls presenting with OCD. Future longitudinal studies are needed to clarify the relationship between childhood OCD and later ED.

Distinguishing Between Major Depressive Disorder and Obsessive-Compulsive Disorder in Children by Measuring Regional Cortical Thickness

Cortical abnormalities have been noted in previous studies of major depressive disorder (MDD). To hypothesize differences in regional cortical thickness among children with MDD, children with obsessive-compulsive disorder (OCD), and healthy controls. Cross-sectional study of groups. Children's Hospital of Michigan in Detroit. A total of 24 psychotropic drug-naive pediatric patients with MDD (9 boys and 15 girls), 24 psychotropic drug-naive pediatric outpatients with OCD (8 boys and 16 girls), and 30 healthy controls (10 boys and 20 girls). Magnetic resonance imaging. Cortical thickness. In the right hemisphere of the brain, the pericalcarine gyrus was thinner in patients with MDD than in outpatients with OCD (P = .002) or healthy controls (P = .04), the postcentral gyrus was thinner in patients with MDD than in outpatients with OCD (P = .002) or healthy controls (P = .02), and the superior parietal gyrus was thinner in patients with MDD than in outpatients with OCD (P = .008) or healthy controls (P = .03). The outpatients with OCD and the healthy controls did not differ in these regions of the brain. The temporal pole was thicker in patients with MDD than in outpatients with OCD (P < .001) or healthy controls (P = .01), both of which groups did not differ in temporal pole thickness. The cuneus was thinner in patients with MDD than in outpatients with OCD (P = .008), but it did not differ from that in healthy controls. In the left hemisphere, the supramarginal gyrus was thinner in both patients with MDD (P = .04) and outpatients with OCD (P = .01) than in healthy controls, and the temporal pole was thicker in patients with MDD than in both healthy controls and outpatients with OCD (P < .001). To our knowledge, this is the first study to explore cortical thickness in pediatric patients with MDD. Although differences in some regions of the brain would be expected given neurobiological models of MDD, our study highlights some unexpected regions (ie, supramarginal and superior parietal gyri) that merit further investigation. These results underscore the need to expand exploration beyond the frontal-limbic circuit.

Cognitive-Behavioral Therapy for Obsessive-Compulsive Disorder in Children and Adolescents

Obsessive-compulsive disorder (OCD) is a common, chronic, and impairing condition in youth. Cognitive-behavioral therapy (CBT), now widely recognized as the gold standard intervention for childhood OCD, relies on exposure and response prevention, and also includes psychoeducation, creation of a symptom hierarchy, imaginal exposures, cognitive interventions, and a contingency management system. This article reviews the theoretical underpinnings of current CBT approaches, key components of treatment, developmental considerations specific to childhood OCD, and evidence supporting the use of this psychosocial intervention. The current state of knowledge will be aided by further study of predictors and mechanisms of CBT treatment response.

Obsessive-Compulsive Disorder in Children and Adolescents

Early-onset obsessive-compulsive disorder (OCD) is one of the more common mental illnesses of children and adolescents, with prevalence of 1% to 3%. Its manifestations often lead to severe impairment and to conflict in the family. In this review, we summarize the manifestations, comorbidity, pathophysiology, and course of this disease as well as current modes of diagnosis and treatment. We selectively review the relevant literature and the German-language guidelines for the diagnosis and treatment of mental illnesses in children and adolescents. Obsessive-compulsive manifestations are of many types and cause severe impairment. Comorbid mental disturbances are present in as many as 70% of patients. The disease takes a chronic course in more than 40% of patients. Cognitive behavioral therapy is the treatment of first choice, followed by combination pharmacotherapy including selective serotonin reuptake inhibitors (SSRI) and then by SSRI alone. OCD often begins in childhood or adolescence. There are empirically based neurobiological and cognitive-behavioral models of its pathophysiology. Multiaxial diagnostic evaluation permits early diagnosis. Behavioral therapy and medications are highly effective treatments, but the disorder nonetheless takes a chronic course in a large percentage of patients.

Trastorno obsesivo compulsivo en niños y adolescentes

BackgroundObsessive-compulsive disorder (OCD) in children and adolescents is a complex disease. It is considered the fourth most common psychiatric disorder in the world, with relevant biopsychosocial morbidity and a prevalence of 1–3% of the world population; it is defined by the World Health Organization as the tenth most disabling illness. ObjectiveTo review approaches in the scientific literature and updates on natural history, course, diagnosis, and treatment of OCD in children and adolescents. MethodSearch in PubMed and LILACS databases, from 2005. ResultsNo Colombian update articles dealing with this subject were found and international articles showed inconclusive results on the various topics of natural history, course, diagnosis, and treatment of obsessive compulsive disorder in children and adolescents. Conclusions: This is a chronic disorder with intense anxiety, high comorbidity, and no accurate predictors of prognosis. The social image of the perfect child and the lack of awareness about their condition restricts their care and improvement.

Childhood trauma in obsessive compulsive disorder: The roles of alexithymia and attachment

The aim of this study was to investigate the interrelationships between childhood trauma, attachment, alexithymia, and the severity of obsessive compulsive disorder (OCD) in a cohort of participants with OCD. There is a growing body of research linking traumatic experiences in childhood with the development of OCD. The mechanisms involved in this association are not yet clear. The sample was comprised of 82 people with OCD and 92 comparison participants. A cross-sectional design was used, utilizing internet-mediated administration of the Childhood Trauma Questionnaire - revised (CTQ-R); the Yale-Brown Obsessive Compulsive Scale - Self-Report (Y-BOCS-SR); the Experiences in Close Relationships Scale (ECR); and Toronto Alexithymia Scale (TAS-20). Partial least squares (PLS) analysis was used to determine significant paths between the constructs. Results of PLS analysis supported all of the hypotheses made: there was a significant positive correlation between childhood trauma and attachment avoidance, which in turn was significantly positively associated with alexithymia. Alexithymia was significantly associated with the severity of OCD symptoms and the number of OCD symptoms. Mediational analysis showed that alexithymia significantly carried an influence from attachment avoidance to the severity of obsessions and the number of obsession symptoms. There is a relationship between childhood trauma and OCD, however this relationship is not direct in nature but is influenced by peoples' past experiences with significant others and associated difficulties in emotional processing.

The Children’s Yale-Brown Obsessive Compulsive Scale: Reliability and Validity for Use Among 5 to 8 Year Olds with Obsessive-Compulsive Disorder

The Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS) is the instrument of choice for assessing symptom severity in older children (i.e., 8-18 years) diagnosed with obsessive-compulsive disorder (OCD). The reliability and validity of this measure for use among younger children (i.e., 5-8 years of age), however, has never been examined. The primary aim of this study was to examine this scale's use among those presenting with early childhood OCD. Forty-two children with OCD between the ages of 4 and 8 years of age were recruited as part of a larger treatment outcome study, and the reliability and validity of the CY-BOCS was examined. Results revealed questionable reliability for the measure's 5-item Obsessions subscale but good reliability (i.e., internal consistency, temporal stability) for the 5-item Compulsions subscale and 10-item total scale. Results also revealed that the CY-BOCS total scale demonstrated mixed discriminant validity but strong convergent validity and sensitive to change. Collectively, the 10-item, CY-BOCS total score yields a reliable and valid scale for the assessment of symptom severity in early childhood OCD. However, we urge caution in use of the Obsessions subscale in isolation for either clinical or research purposes. Limitations and future areas of research are discussed including the potential benefit of developing a measure of OCD-related symptom severity specifically for younger children with greater attention to developmental differences among children within this population.

Trials and tribulations: Conducting research in routine NHS child and adolescent mental health services

The following gives a brief overview of an ongoing randomised control trial (RCT) for childhood obsessive compulsive disorder (OCD). It then discusses some of the practical difficulties involved in doing research in non-research cultures and the impacts of the research.