Obsessive-compulsive Disorder In Youth Research Articles

A Family Genetic Study of Obsessive Compulsive Disorder in Youth

Objective: To use a family genetic study to evaluate familial risk of obsessive compulsive disorder (OCD) and common comorbid illnesses in first-degree relatives of pediatric-onset probands with primary OCD. Method: One hundred and thirty youth with OCD and their 133 siblings and 241 parents and 49 pediatric controls were directly evaluated along multiple domains including psychopathology using structured diagnostic interviews and clinical corroboration. Results: Rates of anxiety, mood, disruptive behavior, and tic disorders were markedly elevated in the probands while rates in siblings were elevated at rates between the probands and controls. Twenty six percent of first-degree relatives had clinical OCD, 9% had chronic tics or Tourette’s disorder, and 21% met criteria for ADHD. Conclusion: Rates of familial transmission of OCD and common comorbid illnesses were significantly higher in our pediatric-onset probands than rates reported in the literature in relatives of those with adult-onset OCD.

Predicting Obsessive-Compulsive Disorder Events in Children and Adolescents in the Wild using a Wearable Biosensor (Wrist Angel): Protocol for the Analysis Plan of a Nonrandomized Pilot Study.

Physiological signals such as heart rate and electrodermal activity can provide insight into an individual's mental state, which are invaluable information for mental health care. Using recordings of physiological signals from wearable devices in the wild can facilitate objective monitoring of symptom severity and evaluation of treatment progress. We designed a study to evaluate the feasibility of predicting obsessive-compulsive disorder (OCD) events from physiological signals recorded using wrist-worn devices in the wild. Here, we present an analysis plan for the study to document our a priori hypotheses and increase the robustness of the findings of our planned study. In total, 18 children and adolescents aged between 8 and 16 years were included in this study. Nine outpatients with an OCD diagnosis were recruited from a child and adolescent mental health center. Nine youths without a psychiatric diagnosis were recruited from the catchment area. Patients completed a clinical interview to assess OCD severity, types of OCD, and number of OCD symptoms in the clinic. Participants wore a biosensor on their wrist for up to 8 weeks in their everyday lives. Patients were asked to press an event tag button on the biosensor when they were stressed by OCD symptoms. Participants without a psychiatric diagnosis were asked to press this button whenever they felt really scared. Before and after the 8-week observation period, participants wore the biosensor under controlled conditions of rest and stress in the clinic. Features are extracted from 4 different physiological signals within sliding windows to predict the distress event logged by participants during data collection. We will test the prediction models within participants across time and multiple participants. Model selection and estimation using 2-layer cross-validation are outlined for both scenarios. Participants were included between December 2021 and December 2022. Participants included 10 female and 8 male participants with an even sex distribution between groups. Patients were aged between 10 and 16 years, and adolescents without a psychiatric diagnosis were between the ages of 8 and 16 years. Most patients had moderate to moderate to severe OCD, except for 1 patient with mild OCD. The strength of the planned study is the investigation of predictions of OCD events in the wild. Major challenges of the study are the inherent noise of in-the-wild data and the lack of contextual knowledge associated with the recorded signals. This preregistered analysis plan discusses in detail how we plan to address these challenges and may help reduce interpretation bias of the upcoming results. If the obtained results from this study are promising, we will be closer to automated detection of OCD events outside of clinical experiments. This is an important tool for the assessment and treatment of OCD in youth. ClinicalTrials.gov NCT05064527; https://clinicaltrials.gov/study/NCT05064527. DERR1-10.2196/48571.

Obsessive-compulsive disorder in youth and young adults with depression: Clinical characteristics of comorbid presentations

Obsessive-compulsive disorder (OCD), anxiety disorders, and depressive disorders are highly comorbid, and each contribute to significant functional impairment for affected youth. Comorbid anxiety disorders in depressed youth have been associated with greater depressive symptom severity and impairment, but the impact of comorbid OCD in this population remains unclear. Accordingly, the present study examined the differential clinical characteristics of youth with depression and comorbid OCD relative to age/gender matched depressed youth with no such comorbidity and to those with depression and a comorbid (non-OCD) anxiety disorder. A sample of 797 youth and young adults ages 8–20 years who met diagnostic criteria for depression alone, depression with co-occurring OCD or any anxiety disorder were included in the present study. Rates of comorbid anxiety and OCD were very high (60.5% and 15.5%, respectively). Relative to youth with only depression, depressed youth with comorbid OCD or anxiety had greater severity of depression, suicidality, and overall impairment in social, physical, and emotional functioning. These results highlight the contribution of OCD or anxiety comorbidity in more complex clinical presentations for depressed youth.

Feasibility of internet-delivered cognitive-behavior therapy for obsessive-compulsive disorder in youth with autism spectrum disorder: A clinical benchmark study

Obsessive-compulsive disorder (OCD) is a treatable condition that often requires specialist care, particularly when comorbid with autism spectrum disorder (ASD). However, specialist clinics are few and typically located in large medical centers. To increase availability of evidence-based treatment for OCD in individuals with ASD, we adapted an internet-delivered cognitive behavior therapy (ICBT) protocol to suit the needs of these individuals and conducted a feasibility study (N = 22). The primary outcome was the clinician-rated Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS), administered at pre- and post-treatment as well as 3 months after treatment. ICBT was deemed acceptable and was associated with clinically significant improvements in CY-BOCS scores, corresponding to a large within-group effect size (Cohen's d = 1.33). Similarly, significant improvements were observed in most of the secondary parent- and self-rated measures. Approximately 60% of the participants were classed as treatment responders and 50% were in remission from their OCD at the 3-month follow-up. To provide a meaningful benchmark, we also analyzed data from a specialist clinic that regularly treats individuals with comorbid OCD and ASD (N = 52). These analyses indicated that specialized in-person CBT produced significantly larger effects (d = 2.69) while being markedly more resource demanding, compared to ICBT. To conclude, ICBT can be successfully adapted to treat OCD in youth with ASD and may be a viable alternative for those who do not have direct access to highly specialized treatment. Further improvements of the treatment protocol based on participant and therapist feedback are warranted, as is a formal test of its efficacy and cost-effectiveness in a randomized controlled trial.

Cognitive behavior therapy for obsessive compulsive disorder in youth: a narrative review

This narrative review is organized around the primary symptoms of obsessive compulsive disorder (OCD) including physical and cognitive symptoms and the effectiveness of cognitive behavior therapy (CBT) in reducing these symptoms in youth with an OCD diagnosis. These are followed by sections on the comorbidities of OCD including anxiety and depression, the effective delivery of CBT via both internet and in-person, the greater effectiveness of CBT versus pharmacotherapy, the use of alternative therapies and the negative effects of COVID-19 on both OCD and CBT. The review concludes with limitations of the literature and suggested future directions

Boosting exposure and response prevention with imagery-based techniques: a case study tackling sexual obsessions in an adolescent

Abstract Sexual obsessions are common in adolescents with obsessive compulsive disorder (OCD), but how to address these obsessions in a developmentally sensitive manner remains under-explored. This report presents the case of an adolescent who experienced unwanted sexual imagery, undergoing conventional exposure and response prevention, which was subsequently augmented with imagery-based techniques. This approach was associated with remission in symptoms of OCD and marked improvements in symptoms of anxiety and depression. The imagery-based approach was well received and valued as key to treatment success by the adolescent. This raises the tantalising possibility that working directly with images can fuel treatment innovation in tackling sexual (and non-sexual) obsessions in youth OCD. Key learning aims (1) Sexual obsessions are common in adolescent obsessive compulsive disorder (OCD). (2) Little guidance is available on how to conduct exposure and response prevention sensitively for sexual obsessions in adolescent OCD. (3) Imagery-based techniques can be used effectively for reducing sexual obsessions. (4) Imagery-based techniques delivered by videoconferencing can be acceptable for young people.

Intensive outpatient acceptance and commitment therapy with exposure and response prevention for adolescents

Intensive treatments for youth obsessive-compulsive disorder (OCD) are important and underresearched. This study used three adolescent cases to assess the preliminary efficacy of an intensive treatment combining acceptance and commitment therapy (ACT) with exposure and response prevention (ERP) for OCD. Participants received intensive treatment for 15 h per week for three weeks. Assessments were collected at pre-treatment, weekly during treatment, and at posttreatment. All participants ended treatment in the mild range of OCD severity with 32–60% reductions in symptoms.Participants also reported notable improvements in psychological flexibility and ended treatment in the non-clinical range of depression, anxiety, and stress. These results indicate promise and preliminary support for the use of ACT+ERP in intensive settings for adolescents with OCD. This paper focuses on the clinical application of these techniques.

Effectiveness of an online interpretation training as a pre-treatment for cognitive behavioral therapy for obsessive-compulsive disorder in youth: A randomized controlled trial

BackgroundCognitive behavioral therapy (CBT) is the treatment of choice for pediatric obsessive-compulsive disorder (OCD), but not all patients profit sufficiently. Long waitlists and wide variations in improvement rates ask for new interventions. We examined the effectiveness of a Cognitive Bias Modification–Interpretation (CBM-I) training that was offered during the waiting period for CBT. We tested 1) whether the CBM-I training is an effective intervention during a waitlist period for CBT, and 2) whether augmenting CBT with CBM-I improves treatment effect. MethodsParticipants (74 children with OCD, 8–18 years) were randomly assigned to either a CBM-I training or a waitlist, both followed by CBT. Resultsindicated that compared to the waitlist, the CBM-I training was effective in reducing OCD severity, with a medium effect size. Patients in the CBM-I training condition started subsequent CBT with less severe OCD, and this advantage was maintained during CBT. However, the CBM-I training did not result in a faster decline of symptoms during subsequent CBT. ConclusionThese findings indicate that CBM-I training could be an easy to implement, helpful intervention during a waitlist period. However, replications in larger samples and comparisons to active control conditions are needed.

Age moderated–anxiety mediation for multimodal treatment outcome among children with obsessive-compulsive disorder: An evaluation with correspondence analysis

IntroductionAnxiety expression varies by age in youth, and evaluation of putative mechanisms in treatment must consider both conjointly. Accordingly, age would moderate the mediation effect of anxiety in a youth obsessive-compulsive disorder (OCD) treatment trial. MethodsFifty-six children ages 7 – 17 participated in an RCT comparing three treatments: CBT with standard dosing of sertraline, CBT with slow dosing of sertraline, and CBT with placebo. To examine the moderated–mediation effects for OCD symptom improvement, we discretized the continuous anxiety and OCD measures into three symptom outcome categories, “improved”, “unchanged”, and “deteriorated”. To evaluate the moderating effect of age, we further examined the association of age and anxiety with the “improved” OCD category. For analysis, the age groups used as rows were cross tabulated with discretized anxiety and OCD measures. To estimate category associations with correlations, we adopted correspondence analysis. ResultsThe correlational results indicate that for all treatment conditions, age was a moderator of the mediation effect of physical anxiety symptoms for the improved OCD measures (outcomes). Specifically, age suppressed correlations with OCD outcomes, with Physical Symptoms as a mediator for the outcome measures. This moderated mediation effect was most evident for ages 8–10 in the CBT with placebo group. LimitationsThe moderated mediation effect manifest in this single RCT-based study should be validated in other studies. DiscussionFuture research investigating a wider range of ages as a potential moderator of other symptom and emotion mediators of outcome is warranted, particularly in relation to individual symptom profiles of OCD.

Felt but not seen: Observed restricted repetitive behaviors are associated with self-report-but not parent-report-obsessive-compulsive disorder symptoms in youth with autism spectrum disorder.

Youth with autism spectrum disorder often exhibit symptoms of obsessive-compulsive disorder; however, it can be difficult for parents and clinicians to tell the difference between the restricted and repetitive behaviors often seen in autism spectrum disorder and symptoms of obsessive-compulsive disorder. This difficulty in distinguishing symptoms may arise from the fact that these symptoms appear the same to observers but are typically differentiated based on whether the motivation for the behavior is to reduce stress (restricted and repetitive behaviors) or whether the behavior itself is stressful (obsessive-compulsive disorder). It is important to know the difference between these two symptoms as it may impact the treatment prescribed. The goal of this study was to better determine the difference between restricted and repetitive behaviors and symptoms of obsessive-compulsive disorder in youth with autism spectrum disorder. It was found that although parents and clinicians had trouble differentiating between the two, the children were able to provide insight as to their own motivations for behavior, and thus whether they were restricted and repetitive behaviors or symptoms of obsessive-compulsive disorder. It was also found that children may actually have subjective negative experiences when engaging in restricted and repetitive behaviors, which complicates their classification. These results provide guidance for better understanding, distinguishing, and ultimately treating obsessive-compulsive disorder behavior in youth with autism spectrum disorder.

Examining parent-report of Children's emotion regulation in paediatric OCD: Associations with symptom severity, externalising behaviour and family accommodation

Paediatric Obsessive-Compulsive Disorder (OCD) is associated with significant family accommodation (FA), which frequently results in heightened parental distress, increased OCD severity and impairment. Examining factors which might drive FA is an important focus for the field. This study aimed to examine parents' report of children's emotion regulation (ER) and associations with OCD severity, externalising symptoms, and FA. Participants were 76 youth (7 to 17 years) with a primary diagnosis of OCD and one of their parents. Following child diagnostic and OCD symptom interviews, parents completed study questionnaires. Results indicated that parent-report of children's emotional Lability/Negativity was significantly and positively correlated with child externalising symptoms and FA, whereas children's adaptive ER was significantly and negatively correlated with externalising symptoms only. Furthermore, children's emotional Lability/Negativity predicted externalising symptoms, even when accounting for OCD severity. Lability/Negativity did not predict FA after controlling for OCD severity and externalising symptoms, however it was a significant moderator of the relationship between OCD severity and FA. These findings extend the growing body of literature on ER and OCD in youth and highlight the importance for clinicians to specifically address such deficits in ER as a part of OCD treatment.

Sub-graph entropy based network approaches for classifying adolescent obsessive-compulsive disorder from resting-state functional MRI.

This paper presents a novel approach for classifying obsessive-compulsive disorder (OCD) in adolescents from resting-state fMRI data. Currently, the state-of-the-art for diagnosing OCD in youth involves interviews with adolescent patients and their parents by an experienced clinician, symptom rating scales based on Diagnostic and Statistical Manual of Mental Disorders (DSM), and behavioral observation. Discovering signal processing and network-based biomarkers from functional magnetic resonance imaging (fMRI) scans of patients has the potential to assist clinicians in their diagnostic assessments of adolescents suffering from OCD. This paper investigates the clinical diagnostic utility of a set of univariate, bivariate and multivariate features extracted from resting-state fMRI using an information-theoretic approach in 15 adolescents with OCD and 13 matched healthy controls. Results indicate that an information-theoretic approach based on sub-graph entropy is capable of classifying OCD vs. healthy subjects with high accuracy. Mean time-series were extracted from 85 brain regions and were used to calculate Shannon wavelet entropy, Pearson correlation matrix, network features and sub-graph entropy. In addition, two special cases of sub-graph entropy, namely node and edge entropy, were investigated to identify important brain regions and edges from OCD patients. A leave-one-out cross-validation method was used for the final predictor performance. The proposed methodology using differential sub-graph (edge) entropy achieved an accuracy of 0.89 with specificity 1 and sensitivity 0.80 using leave-one-out cross-validation with in-fold feature ranking and selection. The high classification accuracy indicates the predictive power of the sub-network as well as edge entropy metric.

Adapting an Exposure and Response Prevention Manual To Treat Youth Obsessive-Compulsive Disorder and Comorbid Anxiety Disorder: The Case of "Daniel"

Exposure and Response Prevention (E/RP) is an evidenced-based, short-term (12-20 sessions) treatment for Obsessive-Compulsive Disorder (OCD). This treatment has been shown to be effective in randomized control trials (RCTs), including pediatric samples (Franklin et al., 2011). Despite the strong evidence supporting the effectiveness of E/RP, the current E/RP literature remains wanting in terms of clinical process research to support novice clinicians in the adaptation of the principles, techniques, and interventions with such a complex and heterogeneous disorder, as well as with youth suffering from comorbid disorders. Thus, the present study aims to provide a detailed account of the course of a 25-session E/RP treatment and its outcomes with a 14-year-old called by the pseudonym "Daniel," to protect his identity. Guided by the Pragmatic Case Study Method (Fishman, 1999, 2005, 2013), as the therapist I examined this case in systematic qualitative detail and also gathered and analyzed data from standardized quantitative assessment measures. The study concludes with an analysis of the process used in meeting Daniel’s positive treatment goals as well as a discussion of the importance of adaptations made to the E/RP manualized protocol to address the entire range of Daniels’s symptoms.

Content overlap between youth OCD scales: Heterogeneity among symptoms probed and implications

Assessing obsessive compulsive disorder (OCD) in paediatric populations is complex, and a number of scales have been developed or validated for this purpose. As is the case with instruments measuring other mental health disorders, it is often assumed that youth OCD scales assess the same construct and can be used interchangeably. However, the extent to which this is true is unknown. One way to assess this – beyond calculating convergent validity – is to measure the extent of content overlap between scales. In the current paper, we apply a recently-developed method of content overlap analysis to a set of freely-available, self-report instruments for OCD measurement that were developed for or validated in paediatric populations. We found a high level of heterogeneity among scales purportedly assessing the same construct. Implications for clinical practice and research are discussed, as well as what further research is required.

Accommodation in Youths’ Mental Health: Evidence and Issues

Accommodation refers to the ways in which parents or other family members modify routines or expectations to alleviate a child’s symptoms and emotional distress. In the context of youth obsessive-compulsive disorder (OCD) and anxiety, accommodation contributes to both the development and the maintenance of the disorder. We review the literature on accommodation in youths, including evidence for the central role that accommodation plays in the maintenance of OCD and anxiety. We then highlight several issues requiring further research, including the role of accommodation in other disorders and settings.

Clinical and Research Insights Into the Assessment and Treatment of Anxiety and Obsessive-Compulsive Disorder in Youth With Autism Spectrum Disorder

Anxiety disorders and OCD are among the most common and impairing psychiatric comorbidities seen in children and adolescents with autism spectrum disorder (ASD). Unfortunately, these internalizing disorders often go unrecognized or misdiagnosed and, therefore, untreated in the context of ASD. Although a fair amount of ASD research has informed evidence-based assessment and treatment, this knowledge has not been well disseminated to clinicians. The objective of this Clinical Perspectives is to discuss practical, evidence-based recommendations for the assessment and treatment of anxiety and OCD in children and adolescents with ASD.

37.2 The Assessment and Cognitive-Behavioral Treatment of Obsessive-Compulsive Disorder in Youth With Autism Spectrum Disorder

The goal of this session is to provide guidelines on the differential diagnosis of OCD and autism spectrum disorder (ASD) and the cognitive-behavioral treatment of OCD within ASD.

Accommodation in youth with OCD and anxiety.

Accommodation refers to the ways in which family members act to alleviate a child's symptoms and distress. In the context of youth obsessive-compulsive disorder (OCD) and anxiety, accommodation may contribute to the development and maintenance of the disorder. We review the theory and research literature on accommodation, including measures of accommodation. Findings support the idea that accommodation is not a preferred parenting strategy; the sequelae of accommodation are negative and are often associated with both parent and sibling distress. Accommodation should be assessed and targeted in treatment for youth OCD and anxiety. We conclude by identifying several areas for future research, including the development of interventions that specifically target accommodation, the evaluation of potential family factors implicated in accommodation, and the exploration of the construct of accommodation in other childhood disorders.

Error-related brain activity in youth and young adults before and after treatment for generalized or social anxiety disorder

Increased error monitoring, as measured by the error-related negativity (ERN), has been shown to persist after treatment for obsessive-compulsive disorder in youth and adults; however, no previous studies have examined the ERN following treatment for related anxiety disorders. We used a flanker task to elicit the ERN in 28 youth and young adults (8–26years old) with primary diagnoses of generalized anxiety disorder (GAD) or social anxiety disorder (SAD) and 35 healthy controls. Patients were assessed before and after treatment with cognitive-behavioral therapy (CBT) or selective serotonin reuptake inhibitors (SSRI), and healthy controls were assessed at a comparable interval. The ERN increased across assessments in the combined sample. Patients with SAD exhibited an enhanced ERN relative to healthy controls prior to and following treatment, even when analyses were limited to SAD patients who responded to treatment. Patients with GAD did not significantly differ from healthy controls at either assessment. Results provide preliminary evidence that enhanced error monitoring persists following treatment for SAD in youth and young adults, and support conceptualizations of increased error monitoring as a trait-like vulnerability that may contribute to risk for recurrence and impaired functioning later in life. Future work is needed to further evaluate the ERN in GAD across development, including whether an enhanced ERN develops in adulthood or is most apparent when worries focus on internal sources of threat.

Mediators of Exposure Therapy for Youth Obsessive-Compulsive Disorder: Specificity and Temporal Sequence of Client and Treatment Factors

ObjectiveBehavioral engagement and cognitive coping have been hypothesized to mediate effectiveness of exposure-based therapies. Identifying which specific child factors mediate successful therapy and which therapist factors facilitate change can help make our evidence-based treatments more efficient and robust. The current study examines the specificity and temporal sequence of relations among hypothesized client and therapist mediators in exposure therapy for pediatric Obsessive Compulsive Disorder (OCD). MethodYouth coping (cognitive, behavioral), youth safety behaviors (avoidance, escape, compulsive behaviors), therapist interventions (cognitive, exposure extensiveness), and youth anxiety were rated via observational ratings of therapy sessions of OCD youth (N=43; ages=8 – 17; 62.8% male) who had received Exposure and Response Prevention (ERP). Regression analysis using Generalized Estimation Equations and cross-lagged panel analysis (CLPA) were conducted to model anxiety change within and across sessions, to determine formal mediators of anxiety change, and to establish sequence of effects. ResultsAnxiety ratings decreased linearly across exposures within sessions. Youth coping and therapist interventions significantly mediated anxiety change across exposures, and youth-interfering behavior mediated anxiety change at the trend level. In CLPA, youth-interfering behaviors predicted, and were predicted by, changes in anxiety. Youth coping was predicted by prior anxiety change. ConclusionsThe study provides a preliminary examination of specificity and temporal sequence among child and therapist behaviors in predicting youth anxiety. Results suggest that therapists should educate clients in the natural rebound effects of anxiety between sessions and should be aware of the negatively reinforcing properties of avoidance during exposure.