Children's Yale-Brown Obsessive Compulsive Research Articles

Psychometric properties of the Children's Yale-Brown obsessive compulsive scale second edition in autistic youth

Autism affects as many as one in 36 children, a majority of whom experience comorbid anxiety or obsessive-compulsive disorder. Obsessive-compulsive symptoms share phenotypic similarities with autism characteristics (e.g., repetitive thoughts and behaviors) and some symptoms are difficult to disentangle (e.g., obsessions from specific interests/fixations). Hence, there is a need for OCD assessments that are validated to be used among autistic youth. This study evaluated the psychometric properties of the Children's Yale-Brown Obsessive Compulsive Scale - Second Edition (CY-BOCS-II) in 91 autistic youth seeking treatment for anxiety and/or obsessive-compulsive symptoms. The CY-BOCS-II demonstrated strong convergent and divergent validity, internal consistency, and treatment sensitivity. The CY-BOCS-II is a psychometrically sound measure of obsessive-compulsive symptoms in autistic youth, although it should be evaluated across larger and more diverse samples.

Psychometric Properties of the PANS 31-Item Symptom Rating Scale.

Objectives: Pediatric acute-onset neuropsychiatric syndrome (PANS) is characterized by sudden onset of obsessive-compulsive disorder and/or eating restriction with associated neuropsychiatric symptoms from at least two of seven categories. The PANS 31-Item Symptom Rating Scale (PANS Rating Scale) was developed to identify and measure the severity of PANS symptoms. The objective of this study was to define the psychometric properties of the PANS Rating Scale. Methods: Children with PANS (N = 135) and their parents participated. Parents completed the PANS Rating Scale and other scales on Research Electronic Data Capture. The PANS Rating Scale includes 31 items that are rated on a Likert scale from 0 = none to 4 = extreme. Pearson's correlations were run between the PANS Total score and scores on the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS), Yale Global Tic Severity Scale (YGTSS), Modified Overt Aggression Scale (MOAS), Columbia Impairment Scale (CIS), PANS Global Impairment Score (GIS), and Children's Global Assessment Scale (CGAS). Results: Convergent validity was supported by significant correlations between the PANS Total and scores on the CY-BOCS, YGTSS, MOAS, CIS, GIS, and CGAS. The largest correlations were with measures of functional impairment: PANS Total and CIS (r = 0.81) and PANS Total and GIS (r = 0.74). Cronbach's alpha was 0.89 which demonstrates strong internal consistency of the 31 items. PANS Total score was significantly higher in children in a flare of their neuropsychiatric symptoms compared to children who were not in a flare. Conclusions: This study provides preliminary support for the PANS Rating Scale as a valid research instrument with good internal consistency. The PANS Rating Scale appears to be a useful measure for assessing children with PANS.

Efficacy and acceptability of cognitive-behavioral therapy and serotonin reuptake inhibitors for pediatric obsessive-compulsive disorder: a network meta-analysis.

Cognitive-behavioral therapy (CBT) and serotonin reuptake inhibitors (SRIs) are recommended treatments for pediatric obsessive-compulsive disorder (OCD), but their relative efficacy and acceptability have not been comprehensively examined. Further, it remains unclear whether the efficacy of in-person CBT is conserved when delivered in other formats, such as over telephone/webcam or as Internet-delivered CBT (ICBT). PubMed, PsycINFO, trial registries, and previous systematic reviews were searched for randomized controlled trials (RCTs) comparing CBT (in-person, webcam/telephone-delivered, or ICBT) or SRIs with control conditions or each other. Network meta-analyses were conducted to examine efficacy (post-treatment Children's Yale-Brown Obsessive Compulsive Scale) and acceptability (treatment discontinuation). Confidence in effect estimates was evaluated with CINeMA (Confidence in Network Meta-Analysis). Thirty eligible RCTs and 35 contrasts comprising 2,057 youth with OCD were identified. In-person CBT was significantly more efficacious than ICBT, waitlist, relaxation training, and pill placebo (MD range: 3.95-11.10; CINeMA estimate of confidence: moderate) but did not differ significantly from CBT delivered via webcam/telephone (MD: 0.85 [-2.51, 4.21]; moderate), SRIs (MD: 3.07 [-0.07, 6.20]; low), or the combination of in-person CBT and SRIs (MD: -1.20 [-5.29, 2.91]; low). SRIs were significantly more efficacious than pill placebo (MD: 4.59 [2.70, 6.48]; low) and waitlist (MD: 8.03 [4.24, 11.82]; moderate). No significant differences for acceptability emerged, but confidence in estimates was low. In-person CBT and SRIs produce clear benefits compared to waitlist and pill placebo and should be integral parts of the clinical management of pediatric OCD, with in-person CBT overall having a stronger evidence base. The combination of in-person CBT and SRIs may be most efficacious, but few studies hinder firm conclusions. The efficacy of CBT appears conserved when delivered via webcam/telephone, while more trials evaluating ICBT are needed.

Remission and Relapse Across Three Years in Pediatric Obsessive-Compulsive Disorder Following Evidence-Based Treatments

To examine relapse rates following remission in a 3-year follow-up study in pediatric patients with obsessive-compulsive disorder (OCD) treated with cognitive-behavioral therapy (CBT) in a first step, and either continued CBT or sertraline (randomized selection) in a second step. Participants (N= 269) fulfilled DSM-IV OCD criteria with a mean severity on the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS) of 24.6 (SD= 5.1) and were included in analyses according to intent-to-treat principles. CBT used manualized exposure and response prevention (ERP) during both steps 1 and 2, and step 2 sertraline medication used flexible dosing. The follow-up schedules were timed to 6, 12, 24, and 36 months following step 1 CBT. Remission was defined as a CY-BOCS score≤10 and relapse as an elevated CY-BOCS score≥16 in those who had remitted. A good third of our patients were in stable and full remission at all examinations (n= 98, 36.4%). Further, some in remission following treatment (n= 36, 13.4%) had mild OCD at some examinations. Relapses during follow-up were not uncommon (n= 28, 10.4%), but in many patients these improved again (n= 10, 3.7%) and were in remission at the final 3-year follow-up. Furthermore, a considerable proportion (n= 50, 18.6%) of the patients were initial non-remitters to the treatment but achieved remission at some point during the follow-up. In addition, 11.5% (n= 31) had persistent OCD but reached remission by the last follow-up. Finally, a smaller segment of our sample (9.7%, n= 26), did not attain remission at any point during the study. Our outcome paints a more promising picture of pediatric OCD long-term outcome than previous studies have done. However, both relapse rates and the presence ofinitial non-remitters andpersistent OCD show that treatments need improvement, particularly for those who respond slowly, partially, or not at all. The lack of a general psychiatric interview at follow-up is a marked limitation. Nordic Long-term Obsessive compulsive disorder (OCD) Treatment Study; https://www.isrctn.com; ISRCTN66385119.

The Effects of Risperidone on Cognition in People With Autism Spectrum Disorder: A Systematic Review.

Autism spectrum disorder is made up of several disorders, which include autism, Asperger syndrome, and pervasive developmental disorder. Boys are four times more likely to be diagnosed than girls with autism spectrum disorder, and symptoms usually become apparent by the age of three. Autism spectrum disorders' core characteristic features are abnormal interaction, impairment in communication, and stereotyped behaviors with restricted activities and interests. There are also non-core features associated with autism spectrum disorder, and these are aggression, self-injurious behavior, and tantrums. To date, there is no one drug approved to treat the core symptoms of autism spectrum disorder, but antipsychotic drugs such as risperidone have been shown to be effective at treating both core and non-core symptoms in controlled trials using multiple behavioral rating scales such as the Aberrant Behavioral Checklist subscale, the Clinical Global Impression Improvement Scale, the Ritvo-Freeman Real Life Scale, the Children's Yale-Brown Obsessive Compulsive Scale, the Vineland Adaptive Behavior Scale, and the Social Withdrawal Subscale. The safety, efficacy, acceptability, and tolerability of risperidone were assessed in these studies, and weight gain was a common side effect observed, but the outcome was usually mild and self-limiting. The effect of risperidone on cognition was explored in this article. The studies selected for this article were of small sample size and short duration, which presented limitations for treatment with risperidone and an area that needs to be explored further for its contribution to clinical practice.

Moderating Role of Depression on the Association of Tic Severity With Functional Impairment in Children

BackgroundChronic tic disorders (CTDs) commonly co-occur with other psychiatric disorders. CTDs have been linked to functional impairment and reduction in quality of life. Insufficient research is available on depressive symptoms in patients with CTD, especially children and adolescents, yielding conflicting findings. To investigate the presence of depressive symptoms in a cohort of children and young adolescents with CTD and to test whether they moderate the link between tic severity and functional impairment. MethodsThe sample consisted of 85 children and adolescents (six to 18 years) with a CTD who were treated in a large referral center. Participants were evaluated using gold-standard self- and clinician-reporting instruments to measure tic symptom severity and tic-related functional impairment (Yale Global Tic Severity Scale), depression (Child Depression Inventory), and obsessive-compulsive symptoms (Children Yale Brown Obsessive Compulsive Scale). ResultsDepressive symptoms (mild to severe) were exhibited by 21% of our sample. Study participants with CTD and comorbid obsessive-compulsive disorder (OCD) and/or attention-deficit/hyperactivity disorder had higher rates of depressive symptoms compared with those without comorbidities. Significant correlations were found within and among all tic-related and OCD-related measures, yet depressive symptoms only correlated to tic-related functional impairment. Depression significantly and positively moderated the correlation between tic severity and tic-related functional impairment. ConclusionsFindings suggest that depression plays an important part as a moderator in the link between tic severity and functional impairment in children and adolescents. Our study highlights the importance of screening for and treating depression in patients with CTD.

Response inhibition in youth undergoing intensive treatment for obsessive compulsive disorder

Response Inhibition (RI) is the ability to suppress behaviors that are inappropriate for a given context. Obsessive-compulsive disorder (OCD) has been associated with impaired RI in adults as measured by the Stop Signal Task (SST). Conflicting results have been found in terms of the relationship between OCD severity and SST performance, and no studies to date have examined the relationship between SST and response to OCD treatment. Also relatively unknown is whether RI performance in OCD is associated with developmental or gender differences. This naturalistic study examined the relationship between SST performance, OCD severity, and OCD treatment response in a pediatric sample undergoing intensive treatment involving exposure and response prevention and medication management (n = 36). The SST and Children's Yale-Brown Obsessive Compulsive Scale (CYBOCS) were administered at admission and program discharge. OCD severity was not significantly related to stop signal reaction time (SSRT) in the whole sample and among subgroups divided by age and gender. Baseline SSRT and SSRT change did not predict CYBOCS change across treatment in the whole sample, but exploratory analyses indicated both were significant predictors among female adolescents. Results suggest there may be developmental gender differences in the relationship between RI and clinical improvement in pediatric OCD.

Predictors of Parental Accommodation and Response Treatment in Young Children With Obsessive-Compulsive Disorder

Background: Cognitive–behavioral family-based treatment (CBFT) is the treatment standard in very young children with obsessive–compulsive disorder (OCD), which includes the same core components of cognitive–behavioral therapy (CBT) with significant family involvement. Although the latter reports high rates of remission, some children do not improve with treatments. Therefore, it is necessary to identify possible moderating variables such as comorbidity, severity of disorder, years of onset, parental anxiety, and parental accommodation. This study has two main aims: (1) to propose a predictive model on family accommodation (father and mother), taking into account variables related to the children (severity of obsessive–compulsive responses, internalizing and externalizing symptoms, and comorbidity) and with the parents before intervention (worry, accommodation of one parental member over the other) and (2) to examine the mediating role of externalizing symptoms and mother's accommodation in the relation between initial severity and improvement of severity of obsessive–compulsive responses in children aged 5–8 years.Methods: Participants comprised 56 children with OCD [mean = 6.61 (SD = 0.76)] and their parents; 79% of the sample was men. Treatment was implemented by two clinicians specialized in OCD (>15 years of experience). Clinicians were trained to administer CBT protocol in the same way. They were doctors of clinical psychology and researchers at the OCD.Results: Mother's accommodation was associated with child variables (Child Behavior Checklist–Externalizing and Initial Severity, Children's Yale–Brown Obsessive–Compulsive Scale). Father's accommodation could be explained by parent variables (mother's accommodation and worry). Simple mediation model tested using the SPSS macro PROCESS supported the relation of the initial severity of symptoms with that following intervention, through the simple indirect effect of externalizing symptoms of the child.Conclusions: Comorbidities with externalizing symptoms, father's worry, and mother's accommodation were variables that should be controlled in treatment of pediatric OCD.

Changes in Symptoms and Severity of Obsessive Compulsive Disorder in Children and Adolescent Patients following the Covid-19 Pandemic

ABSTRACT The need to stay at home and follow the rules of personal hygiene for protection are generally stimuli that can increase the anxiety of obsessive compulsive disorder (OCD) patients during covid-19 pandemic. The aim of this study was to examine how this situation has changed the disorder severity and symptoms in OCD patients. This multi-centre study included 73 OCD patients aged 7-17 years, who had been followed up for at least 8 weeks before the pandemic. The range and severity of symptoms were evaluated with the Children's Yale-Brown Obsessive Compulsive Scale (CYB-OCS). The disorder severity scores evaluated in the 8th week of treatment were compared with disorder severity scores after the pandemic, and a statistically significant difference was determined (p=0.04). There was seen to be an increase in contamination, ilness and sexual obsessions after the pandemic compared to the 8th week of treatment. The study results showed that pandemic-origin stress had a negative effect on young OCD patients. There should be advance planning of how treatment processes will not be interrupted and how children with mental health problems can be helped in times of stress, such as natural disaster and pandemics, which affect the whole population and therefore, children

Brief intensive cognitive behavioral therapy for children and adolescents with OCD: Two international pilot studies

IntroductionThis article presents two international pilot studies examining brief intensive group cognitive behavioral therapy (BIG-CBT) for pediatric OCD. Aims1) to examine treatment outcome of BIG-CBT in two countries, 2) to explore the influence of potential predictors on treatment outcome. MethodsStudy 1 (n = 59) was a retrospective study executed in the Netherlands, study 2 (n = 17) was a prospective study performed in Switzerland (total: 76 participants). The pilot studies were carried out in academic centers for child and adolescent psychiatry. BIG-CBT consisted of 5-day CBT in a group format, with exposure and response prevention as the main element. ResultsBoth studies showed a significant decrease from pre-to post-treatment on the Children's Yale-Brown Obsessive Compulsive Scale mean scores. In study 1, 44% of participants met the criterion for treatment responder at post-treatment (≥35% improvement), in study 2 this was 59% at post-treatment and 41% at 3-month-follow-up. In both studies, age, gender and baseline OCD severity did not significantly predict treatment outcome. ConclusionThe results of these two international pilots of BIG-CBT indicate that brief, intensive treatment has the potential to become a valuable addition to standard clinical care for pediatric OCD.

Evaluation of Intravenous Immunoglobulin in Pediatric Acute-Onset Neuropsychiatric Syndrome.

Objectives: Pediatric acute-onset neuropsychiatric syndrome (PANS) is a clinical diagnosis in children who have an acute manifestation of varied neuropsychiatric symptoms, including obsessive compulsive disorder, eating disorders, tics, anxiety, irritability, and problems with attention/concentration. PANS may develop as a result of a postinfectious syndrome and may represent a new form of postinfectious autoimmunity. To test the hypothesis that multiple, consecutive infusions of intravenous immunoglobulin (IVIG) for PANS can be efficacious, a multisite, open-label study was designed.Methods: The primary endpoint was evaluation of the efficacy of IVIG [Octagam 5%] in PANS over a period of 6 months (six infusions) based on mean changes in psychological evaluation scores using 6 different assessments, including the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS), Clinical Global Impression of Severity, and the Parent-Rated Pediatric Acute Neuropsychiatric Symptom Scale (PANS Scale).Results: The final cohort consisted of 21 subjects (7 per site) with moderate to severe PANS. The mean age was 10.86 years (range: 4–16 years). Results demonstrated statistically significant reductions in symptoms from baseline to end of treatment in all six assessments measured. CY-BOCS results demonstrated statistically significant reductions in obsessive compulsive symptoms (p < 0.0001), resulting in >50% improvement sustained for at least 8 weeks after the final infusion and up to 46 weeks in a subset of subjects.Conclusions: In PANS, which may be associated with an underlying immune dysregulation, sequential infusions of IVIG [Octagam 5%] successfully ameliorated psychological symptoms and dysfunction, with sustained benefits for at least 8 weeks, and up to 46 weeks in a subset of subjects. In addition, baseline immune and autoimmune profiles demonstrated significant elevations in a majority of subjects, which requires further evaluation, characterization, and study to clarify the potential immune dysfunction by which PANS manifests and progresses.

Increased serum brain-derived neurotrophic factor and adrenocorticotropic hormone levels are associated with obsessive compulsive disorder in medication‑free children

This study aimed to investigate serum levels of neurotrophins, including brain-derived neurotrophic factor (BDNF), glial-derived neurotrophic factor (GDNF), nerve growth factor (NGF) and neurotrophin-3 (NTF3), and hypothalamic-pituitary-adrenal axis (HPA) members including adrenocorticotropic hormone (ACTH) and cortisol in children with obsessive-compulsive disorder (OCD). The possible relationships between serum neurotrophins and HPA axis members were also addressed. A total of 60 medication-free children with OCD and 57 controls aged 8-18years were enrolled in this study. The severity of OCD symptoms was determined by the Children's Yale-Brown Obsessive Compulsive Scale. The severity of anxiety and depression symptoms were assessed by self-report inventories. The serum levels of neurotrophins, ACTH, and cortisol were measured using enzyme-linked immunosorbent assay kits. Serum BDNF levels were significantly higher in the OCD group than in the control group for either sex and for the whole sample. Compared to controls, serum ACTH levels were significantly higher in the OCD group for the whole sample. An analysis of covariance was also conducted for the whole sample and indicated that, while controlling the potential confounders, including body-mass index percentile, age, sex, and the severity of depression and anxiety, the results did not change. Strong negative correlations between BDNF, NGF and NTF3, and HPA axis members were determined in the patient group for either sex and for the whole sample. These findings suggest that dysregulations of BDNF and ACTH may be associated with childhood OCD. Furthermore, there may be inverse relationships between certain neurotrophins and HPA axis members in these patients.

Decreased plasma intercellular adhesion molecule-3 levels are associated with obsessive compulsive disorder in medication-free children

The objective of this study was to evaluate whether the plasma levels of soluble intercellular adhesion molecule-1 (sICAM-1), intercellular adhesion molecule-3 (sICAM-3), vascular cell adhesion molecule-1 (sVCAM-1), and/or platelet endothelial cell adhesion molecule-1 (sPECAM-1) were associated with obsessive compulsive disorder (OCD) in childhood. A total of 42 (25 boys, 17 girls) medication-free children with OCD and 38 (18 boys, 20 girls) healthy controls aged 8–18 years were included in the study. The severity of the OCD symptoms was assessed using the Children's Yale–Brown Obsessive Compulsive Scale. The Children's Depression Inventory and the Screen for Child Anxiety-Related Emotional Disorders were used to measure the children's depression and anxiety levels. The sICAM-1, sICAM-3, sVCAM-1, and sPECAM-1 concentrations were measured using an enzyme-linked immunosorbent assay. A multivariate analysis of covariance revealed a significant main effect on both groups in terms of the concentrations of plasma adhesion molecules, which was independent of the severities of depression and anxiety, body mass index percentile, age, and sex. An analysis of covariance showed that plasma sICAM-3 concentrations were significantly lower in the OCD group than in the control group. These data suggest that sICAM-3 may play a role in the etiopathogenesis of OCD in children.

Repetitive and Self-injurious Behaviors in Children with Cornelia de Lange Syndrome.

Cornelia de Lange syndrome (CdLS) is associated with repetitive and self-injurious behaviors (RBs, SIB). Evaluating children with CdLS, this study: (1) characterizes the spectrum of RBs; (2) characterizes the impact and severity of RBs including SIB; (3) describes how age and adaptive functioning relate to RBs including SIB. Fifty children (5-17years) with CdLS were assessed with Children's Yale-Brown Obsessive Compulsive Scale Modified for PDD; Aberrant Behavior Checklist (ABC); Vineland Adaptive Behaviors Scales (VABS). All children had ≥ 1 type of RB; 44% had some form of SIB. 64% spent > 1h/day displaying RBs. Lower VABS adaptive functioning was associated with higher stereotypy and SIB scores (ABC). In children with CdLS, RBs including SIB are common, impactful, and associated with lower adaptive functioning.

Exacerbation of obsessive compulsive disorder symptoms in children and adolescents during COVID-19 pandemic

ObjectiveTo investigate the effects of COVID-19 pandemic and related home confinement on symptom profile, symptom severity and exacerbation of obsessive compulsive disorder (OCD) symptoms and related factors among young subjects with OCD. MethodYoung subjects who have been followed up with a primary diagnosis of OCD in a university hospital were reached by telephone or online programs to assess symptom profile, symptom severity and exacerbation during pandemic. Children's Yale-Brown Obsessive Compulsive (CY-BOCS) and Clinical Global Impression- Severity (CGI-S) Scales were used to rate symptom profile and severity before pandemic and during pandemic periods. ResultsThere was a significant increase in the frequency of contamination obsessions (p=0.008) and cleaning/washing compulsions (p=0.039) during pandemic period. CY-BOCS obsessions (p<0.001), compulsions subscales (p<0.001) and total scores (p<0.001), and CGI-S scores (p<0.001) during pandemic period were statistically higher than before pandemic period. There was a significant relationship between the change in CY-BOCS scores with talking/searching in the social environment about COVID-19, daily preoccupation about COVID-19, duration of OCD diagnosis and diagnosis of COVID-19 in someone familiar. ConclusionsYoung subjects with OCD may develop additional symptoms and worsen already existing symptoms of OCD during COVID-19 pandemic.

Temporal precedence of the change in obsessive-compulsive symptoms and change in depressive symptoms during exposure and response prevention for pediatric obsessive-compulsive disorders

The current study examined the temporal precedence of change in obsessive-compulsive symptoms and change in depressive symptoms during the course of an Exposure and Response Prevention (ERP) for pediatric OCD. Participants included 142 children and adolescents (7–17 years; mean age = 12.39, SD = 2.92; 51.40% female; 60.40% Non-Hispanic White) with a primary or co-primary diagnosis of OCD who received ERP in a two-site randomized controlled trial on d-cycloserine augmentation of CBT for pediatric OCD. Participants completed clinician-administered assessments of OC symptoms (Children's Yale-Brown Obsessive Compulsive Scale) and depressive symptoms (Children's Depression Rating Scale-Revised) from baseline to post-treatment follow-up. Lagged mediational analyses did not yield evidence in support of a mediating role for the change in OC symptoms in the effect of ERP on the change in depressive symptoms. In contrast, change in depressive symptoms mediated the effect of ERP treatment on the subsequent change in OC symptoms (95% confidence interval for indirect effect = −0.04 to −0.001), though the effect size was small. Controlling for the prior levels of the depressive symptoms this indirect effect became non-significant. Theoretical and clinical implications of the findings for the youth with OCD and comorbid depression are discussed.

Development of the Korean Form of the Premonitory Urge for Tics Scale: A Reliability and Validity Study.

ObjectivesThis study aimed to evaluate the reliability and validity of the Korean Form of the Premonitory Urge for Tics Scale (K-PUTS).MethodsThirty-eight patients with Tourette’s disorder who visited Jeonbuk National University Hospital were assessed with the K-PUTS. Together with the PUTS, the Yale Global Tic Severity Scale (YGTSS), the Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS), the attention-deficit/hyperactivity disorder (ADHD) rating scale (ARS), and the Adult ADHD Self-Report Scale (ASRS) were implemented to evaluate concurrent and discriminant validity.ResultsThe internal consistency of items on the PUTS was high, with a Cronbach’s α of 0.79. The test-retest reliability of the PUTS, which was administered at 2 weeks to 2 months intervals, showed high reliability with a Pearson correlation coefficient of 0.60. There was a significant positive correlation between the overall PUTS score and the YGTSS score, showing concurrent validity. There was no correlation between the PUTS, CY-BOCS, and ASRS scores, demonstrating the discriminant validity of the PUTS. Factor analysis for construct validity revealed three factors: “presumed functional relationship between the tic and the urge to tic,” “the quality of the premonitory urge,” and “just right phenomena.”ConclusionThe results of this study indicate that the K-PUTS is a reliable and valid scale for rating premonitory urge of tics.

Assessment of social skills in adolescents with obsessive compulsive disorder

Objective: The aim of this study is to compare social skills of adolescents diagnosed with obsessive compulsive disorder (OCD), with their healthy counterparts. Methods: Seventy adolescents aged between 12 and 18 years were included in this study. Case group comprised 33 adolescents meeting DSM-5 criteria for OCD at any certain period of their lives and control group comprised 37 healthy adolescents. Kiddie Schedule for Affective Disorders and Schizophrenia, Children's Yale-Brown Obsessive Compulsive Scale, Children’s Global Assessment Scale, sociodemographic data form, UCLA Loneliness Scale, submissive acts scale, shyness scale and social comparison scale (SCS) were applied. Results: Adolescents in the OCD group had lower SCS scores and higher shyness scores (p=0.003, p=0.043). Parents of adolescents with OCD reported higher rates of struggles on the part of their children in making friends as well as higher odds of being excluded by their peers (p=0.001, p=0.005). Parents of children in the case group reported less number of friends for their children, and higher levels of shyness; however this did not reach a statistically significant difference between two groups (p=0.212, p=0.368). Discussion: Lower SCS scores obtained in adolescents with OCD were thought to be related to their perfectionist nature and self-perceptions of not being good enough. Scoring significantly higher on shyness scale might be related to their tendencies to avoid social occasions and interactions in order to hide their symptoms.

The relationship between obsessive-compulsive symptoms and traumatic life events in adolescents

Objective: The primary aim of this study is to evaluate the possible relationship between obsessive-compulsive symptoms (OCS) and traumatic life events (TLEs) in this clinical sample of adolescents. The secondary objective is to evaluate the relationship between different clinical presentations and severities of OCS and specific TLEs. Methods: The study included 60 adolescents between 12-16 ages, with obsessive-compulsive disorder (OCD) ac-cording to DSM-V and 60 adolescents without any psychiatric diagnosis. Sociodemographic characteristics of cases were evaluated with detailed form; in addition, neuropsychological tests were applied to investigate development of intelligence and trauma characteristics of childhood. Turkish version of Schedule for Affective Disorders and Schizo-phrenia for School-Age-Children Present and lifetime version, Children's Yale-Brown Obsessive Compulsive Scale, Children's Depression Inventory and Childhood Trauma Questionnaire-short form were applied in order to assess psychopathology. Intelligence level of patients were assessed with Wechsler Intelligence Scale for Children-Re-vised. Results: It was determined that there was a strong relationship between TLEs and OCS in adolescents, especially in females. TLEs were associated with all OCS manifestations, most prominently with sexual, religious and harm obsessions. The sexual abuse showed stronger associations with OCS compared with other TLEs. Dis-cussion: Due to limited number of patients, our findings couldn’t be generalized to all adolescents with OCS; there-fore there is a need for more studies in this area.

Stepped Care Internet-Delivered vs Face-to-Face Cognitive-Behavior Therapy for Pediatric Obsessive-Compulsive Disorder

Internet-delivered cognitive behavior therapy is an effective treatment for children and adolescents with obsessive-compulsive disorder and has the potential to markedly increase access to treatment for patients while being cost-effective for health care organizations. To investigate whether internet-delivered cognitive behavior therapy implemented within a stepped care model is noninferior to, and cost-effective compared with, the gold standard of face-to-face cognitive behavior therapy for pediatric obsessive-compulsive disorder. Multicenter, single-blind, randomized clinical noninferiority trial implemented at 2 specialist pediatric obsessive-compulsive disorder clinics in Stockholm and Gothenburg, Sweden. Participants are 152 children and adolescents aged 7 to 17 years with obsessive compulsive disorder, recruited through the 2 clinics and online self-referral. Patients will be randomized 1:1 to the stepped care intervention or face-to-face therapy. Blind evaluations will be conducted after treatment and at 3-month and 6-month follow-ups. At the 6-month follow-up (primary end point), noninferiority will be tested and resource use will be compared between the 2 treatment groups. Data will be analyzed according to intention-to-treat principles. Patients randomized to stepped care will first receive internet-delivered cognitive behavior therapy for 16 weeks; patients who are classified as nonresponders 3 months after treatment completion will receive additional face-to-face therapy. The control group will receive 16 weeks of face-to-face cognitive behavior therapy immediately following randomization and nonresponders at the 3-month follow-up will, as in the stepped care group, receive additional face-to-face therapy. Noninferiority is defined as a 4-point difference on the primary outcome measure (Children's Yale-Brown Obsessive Compulsive Scale). Recruitment started October 6, 2017, and was completed May 24, 2019. Results from the primary end point will be available by May 2020. The naturalistic follow-ups (1, 2, and 5 years after the end of treatment) will continue to 2025. There are no interim analyses planned or stopping rules for the trial. ClinicalTrials.gov identifier: NCT03263546.