Obsessive-compulsive Symptoms In Youth Research Articles

The OCI-CV-R: A Revision of the Obsessive-Compulsive Inventory - Child Version.

The Obsessive-Compulsive Inventory-Children's Version (OCI-CV) was developed to assess obsessive-compulsive symptoms in youth. Recent changes in the Diagnostic and Statistical Manual (DSM-5) exclude hoarding from inclusion in the diagnosis of obsessive-compulsive disorder (OCD). Accordingly, the present study examined the reliability, validity, factorial structure, and diagnostic sensitivity of a revised version of the scale - the OCI-CV-R- that excludes items assessing hoarding. Participant were 1047 youth, including 489 meeting DSM criteria for primary OCD, 298 clinical controls, and 260 nonclinical controls, who completed the OCI-CV and measures of obsessive-compulsive symptom severity, depression, and anxiety at various treatment and research centers. Findings support a five-factor structure (doubting/checking, obsessing, washing, ordering, and neutralizing), with a higher order factor. Factorial invariance was found for older (12-17 years) and younger (7-11 years) children. Internal consistency of the OCI-CV-R was acceptable, and discriminant and convergent validity were adequate and akin to that of its progenitor. Diagnostic sensitivity and specificity were found for a total score of 8 and higher. It is recommended that the OCI-CV-R replace the former version, and that this measure serve as part of a comprehensive clinical assessment of youth with OCD. Recommendations for further research with ethnically and racially diverse samples, as well as the need to establish benchmark scores are discussed.

Altered Network-Based Functional Connectivity Associated With Obsessive-Compulsive Symptoms in Youth

Little is known about the neurobiology underlying obsessive-compulsive symptoms (OCS). Given evidence that OCS may increase risk for subsequent psychiatric conditions that have been associated with functional dysconnectivity, we hypothesized OCS-related alterations in brain functional connectivity in the Philadelphia Neurodevelopment Cohort.

Correlation of Error-Related Brain Activity and Obsessive-Compulsive Symptoms in Youth

Patients diagnosed with Obsessive-Compulsive Disorder (OCD) demonstrate altered patterns of functional brain activity during error processing, specifically in frontal-striatal-thalamic circuitry incorporating the dorsal anterior cingulate cortex (dACC). Obsessive compulsive symptoms (OCS), however, exist along a dimension in patients with and without diagnoses of OCD. The relationship between brain activity during error processing and continuous, dimensionally-measured OCS is still unknown.

Relationship of affect intolerance with anxiety, depressive, and obsessive-compulsive symptoms in youth

BackgroundStructural research on the construct of affect intolerance (an overarching latent construct indicated by distress tolerance and anxiety sensitivity) has only been conducted in adults. Given that a self-report measure of distress tolerance was recently validated for youth and affect intolerance may be a core mechanism of transdiagnostic interventions for internalizing disorders, we examined how affect intolerance relates to internalizing symptoms in youth. We predicted that a latent affect intolerance factor (indicated by distress tolerance and anxiety sensitivity) would be associated with self and parent-reports of youth anxiety, depressive, and obsessive-compulsive symptoms, controlling for age and gender. MethodsAt a pre-treatment evaluation, youth with a primary depressive, anxiety, or obsessive-compulsive spectrum disorder (N=277) aged 8-17, and their parent, completed questionnaires. ResultsGreater levels of the affect intolerance factor predicted greater youth- and parent-reported youth anxiety, depression, and obsessive-compulsive symptoms, controlling for age. LimitationsFuture research should replicate findings in a sample with a greater proportion of depressed youth and utilize experimental or longitudinal methods. ConclusionsImportantly, distress tolerance and anxiety sensitivity are core transdiagnostic processes that can be targeted in cognitive-behavioral interventions. Future research should examine how transdiagnostic interventions for youth with internalizing disorders can target these cross-cutting emotional vulnerabilities.

The effect of transdiagnostic emotion-focused treatment on obsessive-compulsive symptoms in children and adolescents

Obsessive-compulsive disorder (OCD) commonly onsets in childhood. Given OCD's high comorbidity with other emotional disorders (e.g., depression, anxiety), transdiagnostic treatment that aims to enhance youth's tolerance and regulation of various negative emotions before starting exposure may facilitate simultaneous treatment of multiple comorbid symptoms. The current study examined the effects of transdiagnostic treatment in an open trial of clinical youth. Children and adolescents (N = 170) with any primary emotional disorder (e.g., an anxiety, depressive, or obsessive-compulsive spectrum disorder) started Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents (UP–C/A) treatment. Youth (M age = 12; 50% female) were primarily white and Hispanic/Latinx. Youth and their parent(s) completed an intake and follow-up assessments (8, 16, and 24 weeks). The outcome measures were self- and parent-reported obsessive-compulsive symptoms (OCS), treatment engagement, and client satisfaction. Over the course of the UP-C/A, youths' OCS decreased significantly, across reporters, regardless of child age or gender. These findings provide preliminary support for utilizing the UP-C/A to treat OCS in youth. While these results do not imply equivalence with existent, exposure and response prevention treatments for pediatric OCD, it is possible that the flexible structure of the UP-C/A may be applied successfully to OCS.

Reciprocal links between anxiety sensitivity and obsessive-compulsive symptoms in youth: a longitudinal twin study.

BackgroundAnxiety sensitivity, the tendency to fear the symptoms of anxiety, is a key risk factor for the development anxiety disorders. Although obsessive–compulsive disorder was previously classified as an anxiety disorder, the prospective relationship between anxiety sensitivity and obsessive–compulsive symptoms (OCS) has been largely overlooked. Furthermore, a lack of genetically informative studies means the aetiology of the link between anxiety sensitivity and OCS remains unclear.MethodsAdolescent twins and siblings (N = 1,579) from the G1219 study completed self‐report questionnaires two years apart assessing anxiety sensitivity, OCS, anxiety and depression. Linear regression models tested prospective associations between anxiety sensitivity and OCS, with and without adjustment for anxiety and depressive symptoms. A phenotypic cross‐lagged model assessed bidirectional influences between anxiety sensitivity and OCS over time, and a genetic version of this model examined the aetiology of these associations.ResultsAnxiety sensitivity was prospectively associated with changes in OCS, even after controlling for comorbid anxiety and depressive symptoms. The longitudinal relationship between anxiety sensitivity and OCS was bidirectional, and these associations were predominantly accounted for by nonshared environmental influences.ConclusionsOur findings are consistent with the notion that anxiety sensitivity is a risk factor for OCS during adolescence, but also suggest that experiencing OCS confers risk for heightened anxiety sensitivity. The reciprocal links between OCS and anxiety sensitivity over time are likely to be largely mediated by nonshared environmental experiences, as opposed to common genes. Our findings raise the possibility that interventions aimed at ameliorating anxiety sensitivity could reduce risk for OCS, and vice versa.

Are punitive parenting and stressful life events environmental risk factors for obsessive-compulsive symptoms in youth? A longitudinal twin study

BackgroundPunitive parenting and stressful life events are associated with obsessive-compulsive symptoms (OCS). However, the lack of longitudinal, genetically-informative studies means it remains unclear whether these factors represent environmentally-mediated risks for the development of OCS. MethodsTwins and siblings from the Genesis1219 study completed self-report questionnaires two years apart (Time 1: N = 2616, mean age = 15.0; Time 2: N = 1579, mean age = 17.0 years) assessing OCS, maternal and paternal punitive parenting, and dependent stressful life events. Multiple regression models tested cross-sectional and longitudinal associations between the putative environmental risk factors and obsessive-compulsive symptoms using: (a) individual scores; and (b) monozygotic twin difference scores. The aetiologies of significant phenotypic associations between putative risk factors and OCS were further examined using multivariate genetic models. ResultsAt a phenotypic level, maternal and paternal punitive parenting and stressful life events were all associated with OCS both cross-sectionally and longitudinally. However, only stressful life events predicted the subsequent development of OCS, after controlling for earlier symptoms. Genetic models indicated that the association between life events and change in OCS symptoms was due to both genetic (48%) and environmental (52%) influences. Overall, life events associated with change in OCS accounted for 1.2% of variation in OCS at Time 2. ConclusionsStressful life events, but not punitive parenting, predict OCS change during adolescence at a phenotypic level. This association exists above and beyond genetic confounding, consistent with the hypothesis that stressful life events play a causal role in the development of obsessive-compulsive symptoms.

Development and Psychometric Evaluation of the Children’s Yale-Brown Obsessive-Compulsive Scale Second Edition

To develop and examine the psychometric properties of the Children's Yale-Brown Obsessive-Compulsive Scale Second Edition (CY-BOCS-II) in children and adolescents with obsessive-compulsive disorder (OCD). Youth with OCD (N= 102; age range 7-17 years), who were seeking treatment from 1 of 2 specialty OCD treatment centers,participated in the study. The CY-BOCS-II was administered at an initial assessment, and measures of OCD symptom severity,anxiety and depressive symptoms, behavioral and emotional problems, and global functioning were administered. Inter-rater and test-retest reliabilities were assessed on a subsample of participants (n= 50 and n= 31, respectively) approximately 1 week after intial assessment. The CY-BOCS-II demonstrated moderate-to-strong internal consistency (α= 0.75-0.88) and excellent inter-rater (intraclass correlation coefficient= 0.86-0.92) and test-retest (intraclass correlation coefficient= 0.95-0.98) reliabilities across all scales. Construct validity was supported by strong correlations with clinician-rated measures of OCD symptom severity and moderate correlations with measures of anxiety symptoms. Exploratory factor analysis showed a 2-factor structure, which was generally inconsistent with its adult counterpart, the Yale-Brown Obsessive-Compulsive Scale Second Edition. Initial findings support the CY-BOCS-II as a reliable and valid measure of obsessive-compulsive symptoms in youth.

My Child's thoughts frighten me: Maladaptive effects associated with parents' interpretation and management of children's intrusive thoughts

Background and objectivesEnvironmental factors explain substantial variance in youth's obsessive-compulsive symptoms (OCS) and much of this research has focused upon overt parenting behaviors (e.g., accommodation). No work, however, has examined how parents' internal processes (e.g., perception of children's intrusions) influence youth's OCS. Based upon the cognitive theory of obsessions, we propose that parents' misappraisal of children's intrusions as threatening will be positively associated with (a) the number of maladaptive intrusion management strategies recommended by the parent, as well as (b) children's obsessive beliefs, (c) interpretation biases, and (d) OCS severity. MethodsTwenty-seven children (M = 12.81; SD = 3.43) and the parent most involved in childcare completed diagnostic interviews and self-report questionnaires. In the laboratory, we induced obsessional anxiety in youth through a standardized in vivo paradigm (e.g., think about a personalized harm-related negative event occurring). Parents rated how they interpreted their children's unwanted thought and the intrusion management strategies they would recommend. ResultsParents who interpreted their children's intrusions as threatening recommended more maladaptive intrusion management strategies and their misappraisal positively and significantly correlated with the severity of children's obsessive beliefs, interpretation biases, and OCS, even after controlling for co-occurring internalizing symptoms. LimitationsSmall sample and cross-sectional design precludes causal conclusions. ConclusionsParents' misinterpretation of children's intrusions may operate as a mechanism by which OCS are generationally transmitted. Results can inform OC prevention programs that target parents' cognitive biases in their own psychotherapy.

The Relative Contribution of a Typological versus a Dimensional Approach for Understanding Obsessive-Compulsive Symptoms in Adolescents

In order to better understand the heterogeneous nature of Obsessive-Compulsive (OC) symptoms, a typological or a dimensional approach can be used to structure the variety of symptoms into a set of core components. However, there is still no consensus on which approach is the most robust to predict several OC-related criterion measures, especially in adolescents. From this perspective, the current study empirically identified OC classes (i.e., types), and explored whether types or dimensions are the strongest predictors of adolescent OC-related criterion variables. To identify OC classes, we conducted latent class analysis on the Youth Obsessive-Compulsive Symptoms Scale (YOCSS; De Caluwe and De Clercq 2014) that was completed by 682 community and referred adolescents (71.4 % girls, 12–18 years old, mean age = 15.67, SD = 1.53), and we also computed OC dimension scores as outlined in De Caluwe and De Clercq (2014). We subsequently used hierarchical regression analysis to examine the incremental validity of the OC classes beyond the OC domains, and vice versa, in predicting several OC-related criterion variables that were completed by the adolescents or their mothers (N = 325). The results indicated that the two identified OC classes only differed quantitatively but not qualitatively, hence reflecting severity classes, and also showed that OC domains have significant effects beyond the effects of the OC classes, whereas the reverse did not hold. The dimensional approach appears to have the strongest predictive value for OC symptomatology in adolescents, leading to clinical implications for conceptualization and assessment of obsessive and compulsive problems in younger age groups.

A General and Maladaptive Personality Perspective on Youth Obsessive–Compulsive Symptoms

Based on Krueger's (2005) conceptual model of the personality-psychopathology relationship, this study examines how personality predicts different youth obsessive–compulsive symptoms, comparing the relative contribution of general and maladaptive personality traits. Three-hundred forty-four adolescents provided self-reports on an obsessive–compulsive scale, and their mothers rated their child's general and maladaptive personality. Hierarchical regression analyses revealed that personality differentially predicts obsessive–compulsive symptomatology, and that the relative significance of general versus maladaptive personality predictors differs across various forms of obsessive–compulsive pathology. The results are discussed in terms of the value of including both general and maladaptive personality measures in the assessment of early obsessive–compulsive difficulties.

Psychometric Properties of the Children’s Yale-Brown Obsessive Compulsive Scale in Youth with Autism Spectrum Disorders and Obsessive–Compulsive Symptoms

The psychometric properties of the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS) were investigated in 46 treatment-seeking youth, 7-15 years of age, who were diagnosed with an autism spectrum disorder (ASD) and exhibited obsessive-compulsive symptoms. The CY-BOCS Total score exhibited good internal consistency, with differing internal consistencies observed on the Obsession Severity scale (α = 0.86) and Compulsion Severity scale (α = 0.59). Good to excellent inter-rater reliability was observed for the CY-BOCS Total score and both Severity scales. Convergent and divergent validity of the CY-BOCS Total score and both Severity scales were satisfactory. Insight into obsessive-compulsive symptoms was moderately associated with the CY-BOCS Total score. The CY-BOCS demonstrated treatment sensitivity, demonstrating significant changes in obsessive-compulsive symptoms within a subsample of youth receiving cognitive-behavioral treatment. Overall, the CY-BOCS demonstrated adequate psychometric properties and utility in assessing obsessive-compulsive symptoms in youth with ASD and clinically significant obsessive-compulsive symptoms.

Preliminary investigation of web-camera delivered cognitive-behavioral therapy for youth with obsessive-compulsive disorder

This study reports a waitlist controlled randomized trial of family-based cognitive-behavioral therapy delivered via web-camera (W-CBT) in children and adolescents with obsessive-compulsive disorder (OCD). Thirty-one primarily Caucasian youth with OCD (range = 7–16 years; 19 male) were randomly assigned to W-CBT or a Waitlist control. Assessments were conducted immediately before and after treatment, and at 3-month follow-up (for W-CBT arm only). Primary outcomes included the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS), clinical global improvement rates, and remission status. When controlling for baseline group differences, W-CBT was superior to the Waitlist control on all primary outcome measures with large effect sizes (Cohen's d ≥ 1.36). Thirteen of 16 youth (81%) in the W-CBT arm were treatment responders, versus only 2/15 (13%) youth in the Waitlist arm. Similarly, 9/16 (56%) individuals in the W-CBT group met remission criteria, versus 2/15 (13%) individuals in the Waitlist control. Gains were generally maintained in a naturalistic 3-month follow-up for those randomized to W-CBT. This preliminary study suggests that W-CBT may be helpful in reducing obsessive-compulsive symptoms in youth with OCD. Given considerable access issues, such findings hold considerable promise for treatment dissemination.

Case Series of Behavioral Psychotherapy for Obsessive-Compulsive Symptoms in Youth with Prader-Willi Syndrome

Obsessive-compulsive symptoms among youth with Prader-Willi Syndrome (PWS) are frequently present and associated with considerable problems in the daily functioning of the child and his/her family. Although pharmacological and psychosocial treatments exist that target obsessive-compulsive symptoms among typically developing youth, these treatments have not been systematically adapted and/or evaluated for this population. Furthermore, although psychotropic medications have shown promising support in addressing obsessive-compulsive symptoms in several case reports involving youth with PWS, associated efficacy is modest and potential for side effects is a realistic concern. Given efficacy and tolerability of cognitive-behavioral treatment for obsessive-compulsive symptoms in typically developing youth, an adapted version of this approach may hold promise in treating clinically problematic obsessive-compulsive symptoms in youth with PWS. Thus, we report on a case series of behavioral treatment for obsessive-compulsive symptoms in three youth with PWS. Diagnostic and symptom severity assessments were conducted at screening, pre-treatment, and post-treatment by a trained independent evaluator. All youth were considered treatment responders and exhibited meaningful reductions in compulsion severity, overall obsessive-compulsive severity, and obsessive-compulsive related impairment. These data provide preliminary evidence for the utility of behavioral therapy in treating obsessive-compulsive symptoms in youth with PWS.

P03-01 - Behavioral treatment of obsessive-compulsive symptoms in youth with Prader-Willi Syndrome: results from a pilot study

ObjectivesObsessive-compulsive (OC) symptoms are common in both children and adults with Prader-Willi Syndrome (PWS), to the degree that they are considered central to the syndrome's behavioral phenotype and constitute diagnostic criteria for the disorder. Although efficacious behavioral treatments (e.g., exposure and response prevention) exist for OC symptoms in typically developing youth, these treatments are not tailored to meet the specific needs of youth with PWS and their families. The purpose of the current study is to report on a modified CBT protocol that addresses obsessive-compulsive symptoms in youth with PWS.MethodsThree children received a modified version of cognitive-behavioral therapy targeting obsessive-compulsive symptoms in PWS. Measures were administered at screening, baseline, and post-treatment and included the Schedule for Affective Disorders and Schizophrenia for School-Aged Children, Children's Yale-Brown Obsessive Compulsive Scale (CYBOCS), Family Accommodation Scale, Clinical Global Impression - Severity (CGI-S), Clinical Global Improvement (CGI), and measures of impairment and adaptive functioning. Treatment consisted for 12 family-based CBT sessions that included exposure and response prevention; cognitive restructuring; and other operant treatment elements.ResultsParticipants experienced reduced CYBOCS scores at baseline to post-treatment, 25 to 15.3. All three youth were considered treatment responders on the CGI-Improvement scale. Similar reductions on secondary variables such as OCD impairment were reported.ConclusionsAlthough these results are preliminary, initial results suggest that behavioral treatment of OC symptoms may be effective in the PWS population. This treatment holds promise for being a safe and tolerable method for reducing compulsive symptoms in youth with PWS.