Childhood Obsessive-compulsive Disorder Research Articles

Topological properties of white matter network in first untreated children and adolescents with obsessive-compulsive disorder

Objective: To investigate the topological properties of the white matter network in the drug-naive first-episode children and adolescent with obsessive-compulsive disorder (OCD). Methods: This study was a case-control study. First-episode OCD childhren and adolescents(OCD group) who were treated in the outpatient or inpatient department of the Second Affiliated Hospital of Xinxiang Medical University from July 2018 to October 2023 were collected as the research subjects. Healthy controls (control group)matched by gender, age and education level were used as controls. Deterministic tractography technique was used to construct the whole brain white matter structural network, and graph theory analysis method was used to analyze the topological attributes of the whole brain white matter structure network in OCD children and adolescents. A network-based statistical method was used to examine the inter-group differences in the functional connectivity strength of the whole brain network. Results: Finally, 31 cases were included in the obsessive-compulsive disorder group, including 22 males and 9 females, with an age of (13.5±1.6) years; There were 34 cases in the control group, including 22 males and 12 females, with an age of (12.7±1.4) years. The global efficiency and local efficiency of the OCD group (0.62±0.03, 0.70±0.07) were significantly higher than those of the control group (0.50±0.06, 0.54±0.21) [both P<0.01, false discovery rate(FDR)correction]; while the characteristic path length (1.77±0.08) was significantly smaller than that of the control group (2.10±0.23) (P<0.01, FDR correction).The centrality comparison of nodal betweenness centrality showed that in the OCD group, the connections were enhanced in the left lateral orbitofrontal gyrus, right dorsal agranular insula, left dorsal granular insula, right granular insula, right posterior central gyrus main area of parietal lobe, left ventral granular insula, granular insula, left ventral granulosa, left granular insula, and left dorsal agranular insula [all P<0.001, family wise error (FWE) correction], while the connection of right thalamic was weakened (P<0.001, FWE correction), There were sub-networks characterized by significantly enhanced connection strength of relevant nodes in subcortical, visual network, and default mode network (P<0.05, permutation test 5 000 times). Conclusions: The topological properties of the brain's functional network in children and adolescents with OCD exhibit abnormalities, indicating an immature state of brain functional connectivity.

Exploring the impact of pediatric OCD on family impairment: A consideration of parent, sibling, and affected-child perspectives

BackgroundPrevious studies have examined the perspectives of both affected children/adolescents and their parents on family functioning impacts of obsessive-compulsive disorder (OCD). While siblings play an integral role within the family system, their perspectives have been largely overlooked in the literature. This study examined sibling, parent, and child perspectives of family functioning in pediatric OCD and assessed demographic and clinical factors associated with family functioning. MethodsParticipating families were identified from a larger research registry of 398 patients referred between 2012 and 2020 to the Provincial OCD Program. A total of 185 families who provided data on family functioning from the perspectives of OCD-affected children, siblings and parents were included for study. All family members completed the OCD Family Functioning scale. ResultsThe extent of perceived impairment differed by family member type, with parents reporting the greatest impacts, followed by OCD-affected children, and then siblings. Predictors of OCD-imposed family dysfunction included family accommodation from all perspectives, clinician-reported child OCD severity, and family blame from parent perspectives. LimitationsData are cross-sectional, and we cannot conclude that the observed associations reflect causal effects. Missing data were evident and differed by variable item and family member type. ConclusionsBy providing sibling perspectives within the same family unit, this study expands upon previous findings that accommodation predicts family impairment from parent and child perspectives. Our study highlights factors relevant to family-based interventions in the treatment of pediatric OCD. Clinicians should be aware of the ongoing impacts OCD has on all family members.

Clinical Features, Psychiatric Comorbidities and Treatments in Childhood OCD in terms of OCD Severity, Age and Gender

Objective: The aim of this study was to investigate the clinical features, psychiatric comorbidities, and treatments of childhood obsessive-compulsive disorder (OCD), with consideration given to OCD severity, gender and age. Method: The study included 104 children and adolescents between the ages of 6 and 17 who were diagnosed with OCD and followed up in Child and Adolescent Psychiatry outpatient clinics between 2016 and 2023. The study examined the sociodemographic characteristics, clinical features, comorbid psychiatric disorders, and treatment approaches of children and adolescents with OCD. Results: The sample had a mean age of 13.1 ± 2.7 years, and the mean age at onset of OCD was 11.9 ± 2.7 years (range: 5-17 years). Those with mild OCD had a significantly lower mean age at presentation and onset of OCD compared to those with moderate and severe OCD (p=0.012, p=0.02, respectively). Patients with severe OCD had longer illness duration (p=0.009) and outpatient follow-up (p=0.004) compared to those with moderate OCD. Boys had significantly higher rates of family history of psychiatric disorders (p=0.006), attention-deficit/hyperactivity disorder/oppositional defiant disorder (p=0.003), and tic disorder (p=0.035) comorbidity rates than girls, while girls had higher rates of anxiety disorders (p=0.022) comorbidity. The study found that repeating and counting compulsions were more common in adolescents than in preadolescents (p=0.003, all). Conclusion: These results suggest that clinical presentation and comorbidity may vary with disease severity, gender and age, in children and adolescents with OCD. Early intervention is crucial to prevent clinical progression, worsening, and mental health sequelae.

OCD in children: phenomenology, impairment, and psychiatric co-morbidity—an experience from Kashmir

IntroductionObsessions are recurrent ego-dystonic thoughts, images, or urges followed by compulsion to reduce them. The phenomenology of obsessive–compulsive disorder (OCD) along with comorbidities is essential for understanding treatment response. This study aimed to assess phenomenology, impairment, and psychiatric co-morbidity associated with OCD in children and adolescents.MethodologyA cross-sectional study was done among 36 patients suffering from OCD. Socio-demographic and clinical details were collected with the application of Children’s Yale-Brown Obsessive Compulsive Scale for severity of illness, Children’s Global Assessment Scale for impairment assessment, and Kiddie-Sads-Present and Lifetime Version for comorbidity.ResultThirty-six patients, comprising 20 male and 16 female subjects, with a mean age ± SD of 11 ± 3.4 years and a mean duration of illness of 12.30 months, were included in the study. A positive family history was noted in 30.6% of subjects. Mean C-YBOCS score was 24.44 (moderate to severe OCD) and the mean C-GAS score was 47.86, with 55.6% of subjects suffering from other comorbidities. Fear of contamination with washing and cleaning was among the most common themes in the population. Data was analyzed and presented as mean ± SD, frequencies, and percentages.ConclusionConsidering the increased prevalence of OCD in children and adolescent populations, a thorough symptom evaluation and any co-morbidities related to OCD should be considered by clinicians.

Advances in Pediatric Obsessive-Compulsive Disorder (OCD) Treatment: A Comprehensive Narrative Review.

Obsessive-compulsive disorder (OCD), characterized by persistent, intrusive thoughts (obsessions) and repetitive behaviors or mental acts (compulsions), can significantly impact a child's daily functioning, academic performance, and overall quality of life. As the prevalence of pediatric OCD continues to rise, there is a critical demand for evidence-based treatments that not only alleviate symptoms but also enhance the quality of life for affected children and adolescents. By identifying gaps in knowledge and suggesting directions for future research, this narrative review contributes to the ongoing discourse on pediatric OCD treatments. Ultimately, the synthesis of evidence aims to enhance our understanding and inform best practices in the compassionate and effective management of OCD in children and adolescents.The aim of this study is to provide a comprehensive overview of current trends and emerging strategies in the treatment of pediatric obsessive-compulsive disorder (OCD) and highlights the significance of tailoring treatment approaches to individual patient needs, considering factors such as symptom severity and treatment response. Concentrating on interventions supported by empirical evidence, the review delves into cognitive-behavioral therapy (CBT), pharmacotherapy, the synergistic effects of these modalities, and inventive therapeutic approaches, all while considering the distinctive developmental aspects pertinent to pediatric populations.We conducted this review by searching for titles in the PubMed database from 2013 to present. Our comprehensive literature review focused on advancements in treating pediatric OCD, using keywords like "Obsessive-compulsive disorder," "Pediatric," "treatment," "CBT," "SSRI," "Pharmacotherapy," and "combination therapy." While both pharmacotherapy and CBT show individual efficacy, the combination of these approaches appears to be more effective, especially for medication non-responders with no prior exposure to CBT, despite some mixed findings. These findings contribute significantly to the ongoing discussion on optimizing combined therapy strategies tailored to the complexities of pediatric OCD.

Features of the clinic and diagnosis of obsessive-compulsive disorder in children and adolescents

The purpose of the review is to identify the features of the course and diagnosis of obsessive — compulsive disorder (OCD) in children and adolescents based on literature data. OCD is a mental illness with a chronic, potentially disabling course. The main symptoms are obsessions (obsessive thoughts, ideas or fears), which contribute to the development of compulsions (forced, often illogical actions or rituals that help reduce anxiety and help the patient calm down). OCD in children and adolescents has a number of differences from the course of the disease in adults. In young children, pathology is rarely diagnosed due to the physiological, neurological and psychoemotional characteristics of a child's growing body on the one hand, and the lack of effective diagnostic tests and alertness in the patient's environment on the other. Adolescent OCD is characterized by a stage-by-stage process, a compulsive-obsessive variant of the course with rapid development of depression and complications up to a suicidal outcome is more often detected.

From Zero to Overwhelm: PANS and PANDAS as Culprits Behind Sudden OCD in Pediatrics

Pediatric autoimmune neuropsychiatric disorders (PANDAS) and patient neuropsychiatric syndrome (PANS) are psychiatric illnesses characterized by a rapid onset of symptoms, including obsessive-compulsive disorder (OCD), behavioral symptoms and poor motor functions in children. The rapid onset and severity of OCD symptoms prompted investigations to provide an evidence-based intervention. This case series investigates the causes, diagnosis and treatment of the disease among children presenting with neuropsychiatric symptoms and acute-onset OCD. The diagnostic procedures provided grounds for the indication of medication. Methods: Bacterial infections, autoimmune cases and viral infections among 12 children with PANDAS and PANS were retrospectively studied. Pre- and post-treatment symptomatology were examined to monitor the effectiveness of interventions, following laboratory diagnostic approaches, including the Cunningham panel, serology, stool sample analysis, polymerase chain reaction (PCR), and bacterial cultures to determine the cause of the disorder. Diagnostic results informed treatments like non-steroidal anti-inflammatory drugs (NSAIDs), intravenous immunoglobulin (IVIG), fluid therapy, antibiotics, antivirals, steroids, and selective serotonin reuptake inhibitors (SSRIs) in each child. Post-treatment diagnostic results revealed remarkably improved symptoms of PANDAS and PANS, like inflammation and viral or bacterial infection. A combined therapy of antibiotics and NSAIDs or steroids was used to clear bacterial infections and manage inflammation. SSRIs and antiviral or fluid therapy were indicated for OCD and viral infections, respectively. Conclusions: OCD is a common comorbid disorder among children with PANS and PANDAS. Despite the severity and prevalence, OCD in children raises health concerns. The case series demonstrated the effectiveness of antibiotic therapy, RRIs, cognitive behavioral therapy, IVIG, steroids and NSAIDs in managing OCD in PANDAS and PANS, with a unique rationale of indication to every child. Keywords: PANS, PANDAS, Sudden Onset OCD, Pediatric OCD, Autoimmune Neuropsychiatric Disorders

Implementation of Cognitive Behavioral Therapy in a Child with Obsessive - Compulsive Disorder: A Case Study

Obsessive-Compulsive Disorder (OCD) is a prevalent child and adolescent psychiatric condition characterized by substantial functional impairments. Cognitive Behavioral Therapy (CBT) has emerged as the primary therapeutic approach for managing mild to moderate cases of OCD in children and adolescents. Significant advancements have been made in applying CBT specifically to this age group in the past decade. Exposure and response prevention (ERP) is a core therapeutic technique grounded in the principle that anxiety tends to diminish through repeated exposure to anxiety-inducing stimuli, leading to a gradual reduction in anxiety response. In the present study, we present the case of a 9-year-old boy with OCD who was treated with CBT. Τhe evaluation of this case highlights the necessity for rigorous behavior analysis to precisely implement exposure therapy and the significance of multidisciplinary intervention in the child's daily life. In the discussion that follows the analysis of the case, parameters such as the differentiation of ERP in children compared to adults, the control of OCD over the rest of the family members and the OCD phenomenology of parents have been discussed. Additionally, the effect of the patient's comorbidity on the treatment outcome and his compliance with homework were also addressed.

Episodic Bout of Shouting: A Rare Variant of Childhood Obsessive Compulsive Disorder (OCD)

Childhood obsessive-compulsive disorder (OCD) is characterized by recurrent intrusive thoughts associated with anxiety or fear and/or repetitive purposeful mental or behavioral actions aimed at reducing fears and tensions caused by obsessions. Among the commonly reported obsessions in children are fears of contamination, exposure to germs or disease followed by worries related to harm befalling on them, their family members or fear of harming others due to losing control over aggressive impulses. We are reporting a rare presentation of childhood OCD in which the child has repetitive intrusive urge to shout, producing lot of anxiety when being suppressed, followed by compulsive shouting to relieve the anxiety. Keywords: obsessive-compulsive disorder, shouting, anxiety, sense of relief

Similarities and differences between eating disorders and obsessive-compulsive disorder in childhood and adolescence: a systematic review.

The developmental age, comprising childhood and adolescence, constitutes an extremely important phase of neurodevelopment during which various psychiatric disorders can emerge. Obsessive-Compulsive Disorder (OCD) and Eating Disorders (ED) often manifest during this critical developmental period sharing similarities but also differences in psychopathology, neurobiology, and etiopathogenesis. The aim of this study is to focus on clinical, genetic and neurobiological similarities and differences in OCD and ED. This study is based on a PubMed/MEDLINE and Cochrane Central Register for Controlled Trial (CENTRAL). The research adhered to the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The aforementioned search yielded an initial collection of 335 articles, published from 1968 to September 2023. Through the application of inclusion and exclusion criteria, a total of 324 articles were excluded, culminating in a final selection of 10 articles. Our findings showed both differences and similarities between OCD and ED. Obsessive-compulsive (OC) symptoms are more prevalent in ED characterized by a binge/purge profile than in those with a restrictive profile during developmental age. OC symptomatology appears to be a common dimension in both OCD and ED. When presents, OC symptomatology, exhibits transversal characteristic alterations in the anterior cingulate cortex and poorer cognitive flexibility. These correlations could be highlighted by genetic overlaps between disorders. A comprehensive definition, integrating psychopathological and neurobiological aspects could significantly aid treatment selection and thereby influence the prognosis of these patients.

Prevalence and Correlates of the Concurrence of Autism Spectrum Disorder and Obsessive Compulsive Disorder in Children and Adolescents: A Systematic Review and Meta-Analysis.

Autism spectrum disorder (ASD) and obsessive compulsive disorder (OCD) are two common and impairing neurodevelopmental conditions with partial symptomatic overlap. The aim of this study is to systematically and meta-analytically examine the following: (i) the prevalence of an OCD diagnosis among young people with ASD, (ii) the prevalence of an ASD diagnosis among young people with OCD, and (iii) the clinical and therapeutic implications of such comorbidity. A multistep literature search was performed from database inception until 17 November 2023. This PRISMA/MOOSE-compliant systematic review, registered in PROSPERO (CRD42023480543), identified studies reporting on the prevalence, sociodemographic, psychopathologic, prognostic, and therapeutic correlates of OCD and ASD concurrence in children and adolescents. A quantitative meta-analysis with random effects was conducted to analyse the pooled prevalence of OCD among samples with a mean age of < 18 years old with ASD and the prevalence of ASD among individuals under 18 with OCD. Sensitivity analyses were performed to investigate the effect of diagnostic criteria and different continents. Meta-regression analyses were conducted to examine the effect of gender, age, IQ, and OCD severity scores. A narrative review of the clinical and therapeutical implications of the comorbidity was provided. 42 studies were selected for the systematic review (SR), and 31 of them were also included in one of the meta-analyses. The pooled prevalence of OCD among ASD youth samples (n = 8916, mean age = 10.6 ± 1.6; 16.4% female) was 11.6% (95% confidence intervals [CI] = 6.9%; 18.8%), and the pooled prevalence of ASD among OCD children and adolescent samples (n = 6209, mean age = 14.1 ± 1.4; 45.7% female) was 9.5% (95% CI = 6.0%; 14.7%). Meta-regressions found a statistically higher prevalence of ASD among samples with a lower prevalence of females (β = -4.7; 95%CI = -8.6; -0.8). Children with both OCD and ASD present higher rates of functional impairment, psychopathology, and other comorbidities, compared to youth with either of the disorders alone. OCD and ASD are highly concurrent conditions in youth, with symptomatic, prognostic, severity, and therapeutic implications. Future research should focus on conducting longitudinal cohort studies prospectively to determine development trajectories, along with randomized controlled trials to assess the efficacy of specific therapeutic interventions.

Habit Learning in OCD: Preliminary Data from a Spanish Sample

IntroductionInstrumental learning involves goal-directed and habitual systems. The Slips-of-Action Task (SOAT) is extensively used to measure habit tendencies and the likelihood of making erroneous responses for devalued outcomes. The SOAT provides a Devaluation Sensitivity Index (DSI), a measure of the balance between relative goal-directed and habitual learning. Individuals with Obsessive-Compulsive Disorder (OCD) often engage in repetitive actions, suggesting a potential deficit in goal-directed control and an increased reliance on habitual learning. Previous literature has shown that medicated OCD adults performed worse on the SOAT task than healthy controls.ObjectivesTo compare habit learning performance in an unmedicated sample:-Goal 1: Between OCD and Healthy Controls (HC)-Goal 2: Across four groups: adult OCD, adult HC, children OCD, and children HC MethodsParticipants: Eighty-three participants (44 OCD patients and 38 healthy controls) completed the study with usable task data. The 44 OCD patients comprised 17 adults (mean age: 26.76 years, SD: 8.61 years) and 27 children/adolescents (mean age: 12.84 years, SD: 2.59 years). The 38 healthy controls included 17 adults (mean age: 30 years, SD: 7.49 years) and 21 children/adolescents (mean age: 14.1 years, SD: 2.19 years). All participants were unmedicated. Measures: Participants completed an adapted version of the “Fabulous Fruit Game”, which included an instrumental training phase to learn Stimulus-Response-Outcomes (S-R-O) associations and a SOAT to assess the strength of learned S-R-O associations. DSI was calculated by subtracting the percentage of responses made toward devalued outcomes from the percentage of responses made toward still valuable outcomes. Behavioral Analyses: Student’s t-test comparing individuals with OCD to HC and a ONEWAY ANOVA to examine group differences across multiple categories.ResultsGoal 1: DSI comparison between individuals with OCD and HC revealed a significant difference, with HC demonstrating superior performance (t (60.9) = 2.60, p = .012, Cohen’s d = .546). Goal 2: The overall DSI comparison across adult OCD, adult HC, children OCD, and children HC showed a non-significant difference (F(3) = 3.407, p = 0.22). However, post hoc analysis revealed significant differences between Adult HC and Youth OCD (I-J Scheffe = 28.82, p = .033), indicating superior performance in adult HC.ConclusionsThis study highlights altered Habit Learning in unmedicated OCD individuals, supported by significant DSI differences compared to HC. Age-related distinctions were observed, emphasizing the need for age-sensitive interventions in understanding and addressing habit-related challenges in OCD.Disclosure of InterestNone Declared

The association between childhood trauma and motor structure in obsessive-compulsive rituals: An ethological and evolutionary approach.

Ethological models have highlighted a specific motor structure of compulsions in obsessive-compulsive disorder (OCD), based on the rigid repetitions of acts, and with the adaptive significance of facing unpredictable conditions. Such an evolutionary mechanism might explain the robust association between childhood traumatic experiences (CTEs) and OCD. However, a relationship between CTEs and the motor structure of compulsions has not been investigated yet. The first objective of the study was to confirm a specific motor structure of OCD compulsions with respect to control behaviors; the second objective was to assess a possible association between the motor structure of compulsions and CTEs severity. Thirty-two OCD outpatients (13 female, Mage = 44.50 years, SE = 19.71) and 27 healthy controls (10 female, Mage = 37.62 years, SE = 16.20), matched for sex and age, provided a videotape of their compulsions and corresponding ordinary acts, respectively. Behavior was scored with the software "Observer." Participants were administered the Yale-Brown Obsessive Compulsive Scale and the Childhood Trauma Questionnaire. A dependent t test was used to compare the motor structure of behavior between the groups; Pearson's correlations to investigate associations between motor parameters and CTEs. Compulsions showed a specific motor structure due to the repetition of functional and nonfunctional acts. CTEs severity was especially associated with the repetition of functional acts, independently from OCD severity. Our findings, in confirming a peculiar motor structure for OCD compulsions, hint for the first time at a link between CTEs and compulsive repetition of functional acts, which would represent a plastic developmental response to CTEs unpredictability. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Paradigms and Practice Shifts: A Topical Narrative Review of the Evolving Face of Exposure-Based Treatment for Youth

Abstract: Exposure therapy is the gold standard treatment for anxiety and obsessivecompulsive disorders in children, adolescents, and adults. Inhibitory Learning Theory offers a nuanced and advanced perspective on exposure treatment positing that violating threat expectancies is more important than habituation. This paper highlights the effectiveness of inhibitory learning theory-guided exposure procedures for youth with anxiety and OCD, chronic pain, and eating disorders. A topical review focusing on the theoretical foundations of inhibitory learning theory, crucial augmentations of the approach, and outcomes with pediatric patients diagnosed with anxiety, eating, and pain disorders is presented. The literature review indicated that inhibitory learning theory-driven exposure produced beneficent outcomes in the identified populations. Various limitations and future directions were discussed. Limitations notwithstanding, inhibitory learning theory-led exposure represents a viable treatment option for pediatric patients with anxiety, eating, and chronic pain disorders.

Obsessive-Compulsive Disorder in Children and Adolescents.

Obsessive-compulsive disorder (OCD) in children and adolescents is a neurobehavioral condition that can lead to functional impairment in multiple domains and decreased quality of life. We review the clinical presentation, diagnostic considerations, and common comorbidities of pediatric OCD. An overview of the biological and psychological models of OCD is provided along with a discussion of developmental considerations in youth. We also describe evidence-based treatments for OCD in childhood and adolescence, including cognitive behavioral therapy (CBT) with exposure and response prevention (ERP) and pharmacotherapy. Finally, research evaluating the delivery of CBT in different formats and modalities is discussed, and we conclude with suggestions for future research directions.

Pathways to suicidal risk in patients with OCD: The role of childhood abuse, cognitive vulnerabilities, OCD symptomology, and depression

Childhood maltreatment (CM) and its associated cognitive vulnerabilities, such as early maladaptive schemas (EMSs), have been identified as dysfunctional and risk factors for obsessive-compulsive disorder (OCD) and its related clinical outcomes, including obsessive-compulsive (OC) symptoms, depression, and suicidality. However, the combined effects of these variables on suicidal risk have not been investigated yet. This study aimed to examine the relationships between CM and suicidal risk through the paths of EMS domains, OCD symptoms, and depression in patients with OCD (n = 300). Participants completed a series of self-report scales assessing the psychological and clinical variables. The results showed a significant relationship between childhood emotional abuse and suicidal ideation, which was mediated by the paths of disconnection/rejection, unacceptable obsessional thoughts, and depression. These findings suggest that individuals with OCD who have experienced childhood emotional abuse may exhibit heightened levels of disconnection/rejection, frequent repugnant obsessions, and depressive mood, possibly contributing to an increased risk of suicide. Therefore, it is crucial for therapeutic settings, such as schema therapy, to carefully assess and monitor these risk factors in order to prevent suicidal risk in individuals with OCD.

Calcification of the Pineal Gland and Psychopathology in Obsessive-Compulsive Disorder in Children and Adolescents: A Clinical Case Study

While it is generally believed that they result from the interaction of genetic and environmental factors, some cases of obsessive-compulsive disorder (OCD) can be attributed to specific neurological etiologies. Hence, the interest of this article, which discusses the case of a 13-year-old child, who has been experiencing sleep disturbances since early childhood and is seeking treatment for an obsessive syndrome with severe symptoms and a poor therapeutic response. An assessment revealed the presence of pineal gland calcification. Despite the patient being placed on a suitable treatment for obsessive-compulsive disorder, their symptoms only improved after the addition of melatonin, resulting in a significant enhancement in both their sleep and obsessive-compulsive symptoms on the Yale-Brown Scale. Thus, this article highlights the role of the pineal gland in melatonin secretion and also discusses the role of this hormone in the occurrence of mental disorders as well as its therapeutic attributes in psychiatry.

Therapist guided, parent-led cognitive behavioural therapy (CBT) for pre-adolescent children with obsessive compulsive disorder (OCD): a non-concurrent multiple baseline case series.

Cognitive behavioural therapy (CBT) including exposure and response prevention (ERP) is an effective treatment for preadolescent children with obsessive compulsive disorder (OCD); however, there is a need to increase access to this treatment for affected children. This study is a preliminary evaluation of the efficacy and acceptability of a brief therapist-guided, parent-led CBT intervention for pre-adolescent children (5-12 years old) with OCD using a non-concurrent multiple baseline approach. Parents of 10 children with OCD were randomly allocated to no-treatment baselines of 3, 4 or 5 weeks before receiving six to eight individual treatment sessions with a Psychological Wellbeing Practitioner. Diagnostic measures were completed prior to the baseline, 1-week post-treatment, and at a 1-month follow-up, and parents completed weekly measures of children's OCD symptoms/impairment. Seventy percent of children were 'responders' and/or 'remitters' on diagnostic measures at post-treatment, and 60% at the 1-month follow-up. At least 50% of children showed reliable improvements on parent-reported OCD symptoms/impairment from pre- to post-treatment, and from pre-treatment to 1-month follow-up. Crucially, the intervention was acceptable to parents. Brief therapist-guided, parent-led CBT has the potential to be an effective, acceptable and accessible first-line treatment for pre-adolescent children with OCD, subject to the findings of further evaluations.

Comorbid OCD and ADHD in youth: Clinical implications and treatment recommendations

Obsessive compulsive disorder (OCD) affects up to 4% of children and adolescents (Nazeer et al., 2020). Childhood OCD impairs overall quality of life, particularly in familial, social and academic settings. For individuals with OCD, obsessions — unwanted, intrusive thoughts, images, or impulses that cause distress are subsequently reduced by compulsions — behaviors that are designed to assuage the distress of the obsessions, according to set rules or senses of completion (American Psychiatric Association, 2013). Common obsessions surround core fears of harm avoidance, disgust and/or a sense of incompleteness, leading to common compulsions of repeating, checking, avoidance, and/or other rituals.

Parents’ experience and views on the assessment and treatment of children with OCD within the public mental health system in Iceland: a qualitative study

Purpose Obsessive-compulsive disorder (OCD) in children can lead to long-lasting symptoms and access to evidence-based evaluation and treatment is crucial for its prevention. In Iceland, the law guarantees public access to the highest quality healthcare services. To date, no study has evaluated the services available for children with OCD within the national healthcare system (NMHS). This qualitative study explored the experiences of parents navigating the Icelandic NMHS for their children with OCD. Method and materials Seven parents who had sought services within the NMHS for their children diagnosed with OCD at private clinics were interviewed using a semi-structured interview. The responses were analyzed using thematic framework analysis. Results Nineteen themes were identified, including three overarching themes and eight overarching sub-themes, and eight sub-themes within them. A prevalent theme was the giving up on the national mental healthcare system due to parents’ experiences of accessing mental healthcare for their children being challenging. Other issues faced by parents included a lack of knowledge on where to seek help, inadequate evaluation of the issue, and the lack of access to psychotherapy for their children. The healthcare workers’ responses and recommendations also resulted in parents seeking treatment at private clinics. Conclusions These findings underscore the need for clearer pathways for seeking help, improved access to trained healthcare workers, and a more centralized evaluation process. These insights can potentially guide future research and policy decisions to better support families dealing with childhood OCD in Iceland.