Pediatric OCD Research Articles

6.118 PREDICTING THE LONG-TERM OUTCOME IN PEDIATRIC OBSESSIVE-COMPULSIVE DISORDER: A NATURALISTIC PROSPECTIVE COHORT STUDY

OCD causes suffering and reduces the psychosocial functioning for a substantial number of youngsters. Clinical guidelines recommend CBT as the first line of treatment for pediatric OCD, although a combination of CBT and selective SSRIs may be necessary in severe OCD. Although these treatments are established based on numerous randomized- controlled trails (RCT) there is little known about the generalizability to treatment in ordinary CAP and the durability and predictors of long-term outcome of treatment. This prospective naturalistic study reports results of identified predictors of the long-term outcome (3-year).

51.5 GROUP AND FAMILY COGNITIVE BEHAVIORAL THERAPY FOR PEDIATRIC OBSESSIVE-COMPULSIVE DISORDER: EXAMINING TRADITIONAL AND NOVEL OUTCOMES

This study aims to examine broad outcomes following group family CBT (GF-CBT) for pediatric OCD. Youth and parent data are examined between baseline, endpoint, and one-month follow-up. Traditional outcome measures of severity, impairment, and family accommodation are captured in addition to novel outcomes, including OCD-related disruptive behaviors, family impairment, and parental tolerance of the child’s OCD-related distress.

Disrupted latent decision processes in medication-free pediatric OCD patients

BackgroundDecision-making in Obsessive Compulsive Disorder has typically been investigated in the adult population. Computational approaches have recently started to get integrated into these studies. However, decision-making research in pediatric OCD populations is scarce. MethodsWe investigated latent decision processes in 21 medication-free pediatric OCD patients and 23 healthy control participants. We hypothesized that OCD patients would be more cautious and less efficient in evidence accumulation than controls in a two alternative forced choice (2AFC) task. ResultsPediatric OCD patients were less efficient than controls in accumulating perceptual evidence and showed a tendency to be more cautious. In comparison to post-correct decisions, OCD patients increased decision thresholds after erroneous decisions, whereas healthy controls decreased decision thresholds. These changes were coupled with weaker evidence accumulation after errors in both groups. LimitationsThe small sample size limited the power of the study. ConclusionsOur results demonstrate poorer decision-making performance in pediatric OCD patients at the level of latent processes, specifically in terms of evidence accumulation.

Integration of EMDR, TCC and Pharmacological Therapy in a case of obsessive-compulsive disorder in the pediatric age

Objectives: Integrated treatment between psychotherapy and drug therapy in a pediatric OCD case. Methodology: Reprocessing through EMDR of past traumatic events. Restructuring of the main distortions of thought and process of exposure and prevention of response by means of cognitive and behavioral therapies. Pharmacological support with gradual dosage reduction until discontinuation. Results : Patient was able to reduce and then extinguish anxiety related to obsessive thoughts. To date (30 months after diagnosis) he no longer feels the need to implement compulsive rituals, effectively manages the sporadic residual obsessive thoughts and has recovered a satisfactory level of functioning. Conclusions: Efficacy of the integration between EMDR, TCC and pharmacological support.

D‐cycloserine found ineffective in CBT augmentation for pediatric OCD

Even after intervention with cognitive behavior therapy (CBT) for obsessive‐compulsive disorder (OCD), some patients still have symptoms. An antibiotic, D‐cycloserine, has been shown to enhance CBT outcomes for adults with OCD, but according to a new study, it is ineffective in youth.

Brief intensive CBT for pediatric OCD with E-therapy maintenance

Cognitive behaviour therapy (CBT), incorporating exposure and response prevention (ERP), has received strong empirical support for the treatment of paediatric OCD, and moreover, is considered the first line treatment of choice (Geller & March, 2012). However, despite the availability of effective treatments for this chronic and debilitating disorder, only a small proportion of youth receive these evidence-based approaches. The present study aimed to examine the effectiveness of an intensive ERP-based treatment for youth OCD, using a multiple baseline controlled design. Children and youth (N=10; aged 11–16 years) with a primary diagnosis of OCD were randomly assigned to a 1- or 2-week baseline monitoring condition followed by the intervention. The efficacy of the intensive treatment, involving 1 session psychoeducation, 2-sessions ERP plus e-therapy maintenance was examined across parent- child- and clinician-rated measures at post-treatment and 6-month follow-up. Overall, there were significant reductions across time on almost all measures (except self-report anxiety), and moreover, the majority of the sample (80%) were considered reliably improved, and meeting clinically significant change. At post-treatment, 60% were in remission of symptoms, and at 6-month follow-up this increased to 70%. These findings provide strong support for intensive, time-limited approaches to ERP-based CBT for children and youth with OCD.

Distinguishing Fear Versus Distress Symptomatology in Pediatric OCD.

Prior research has identified OCD subtypes or "clusters" of symptoms that differentially relate to clinical features of the disorder. Given the high comorbidity between OCD and anxiety, OCD symptom clusters may more broadly associate with fear and/or distress internalizing constructs. This study examines fear and distress dimensions, including physical concerns (fear), separation anxiety (fear), perfectionism (distress), and anxious coping (distress), as predictors of previously empirically-derived OCD symptom clusters in a sample of 215 youth diagnosed with primary OCD (ages 7-17, mean age=12.25). Self-reported separation fears predicted membership in Cluster 1 (aggressive, sexual, religious, somatic obsessions, and checking compulsions) while somatic/autonomic fears predicted membership in Cluster 2 (symmetry obsessions and ordering, counting, repeating compulsions). Results highlight the diversity of pediatric OCD symptoms and their differential association with fear, suggesting the need to carefully assess both OCD and global fear constructs that might be directly targeted in treatment.

A study of phenomenology, psychiatric co-morbidities, social and adaptive functioning in children and adolescents with OCD.

To study the phenomenology, social, adaptive and global functioning of children and adolescents with OCD. Studies have shown varying prevalence of paediatric OCD ranging from 1% to 4%. Childhood-onset OCD have some important differences in sex distribution, presentation, co-morbidities and insight. 25 subjects (6 to ≤18 years) with a DSM-IV-TR diagnosis of OCD were included in this study. Subjects were evaluated using K-SADS-PL, Children's Y-BOCS, HoNOSCA, C-GAS and VABS-II. The mean age of the sample was 14.9±2.2 years. Obsession of contamination was commonest (68%) followed by aggressive obsession (60%); commonest compulsions were washing and cleaning (72%) followed by checking (56%). Most distressing obsessions were obsession of doubt about their decision (28%), having horrible thoughts about their family being hurt (20%) and thought that something terrible is going to happen and it will be their fault (16%). Most subjects rate spending far too much time in washing hands (60%) as most distressing compulsion, followed by rewriting and checking compulsions (both 12%). 76% subjects have co-morbid psychiatric diagnosis. Anxiety disorders (24%), depression (16%), and dissociative disorder (16%) were common co-morbidities. Mean C-GAS score of the sample was 53.2±9.9. 44% of subjects had below average adaptive functioning. The study shows that, most frequent obsessions and compulsions may be different from most distressing ones and this finding might have clinical implication. Most of the children and adolescent with OCD have co-morbidities. Children also had problems in adaptive functioning.

Graph-theoretical analysis of resting-state fMRI in pediatric obsessive–compulsive disorder

BackgroundfMRI graph theory reveals resting-state brain networks, but has never been used in pediatric OCD. MethodsWhole-brain resting-state fMRI was acquired at 3T from 21 children with OCD and 20 age-matched healthy controls. BOLD connectivity was analyzed yielding global and local graph-theory metrics across 100 child-based functional nodes. We also compared local metrics between groups in frontopolar, supplementary motor, and sensorimotor cortices, regions implicated in recent neuroimaging and/or brain stimulation treatment studies in OCD. ResultsAs in adults, the global metric small-worldness was significantly (P<0.05) lower in patients than controls, by 13.5% (%mean difference=100%X(OCD mean – control mean)/control mean). This suggests less efficient information transfer in patients. In addition, modularity was lower in OCD (15.1%, P<0.01), suggesting less granular – or differently organized – functional brain parcellation. Higher clustering coefficients (23.9–32.4%, P<0.05) were observed in patients in frontopolar, supplementary motor, sensorimotor, and cortices with lower betweenness centrality (−63.6%, P<0.01) at one frontopolar site. These findings are consistent with more locally intensive connectivity or less interaction with other brain regions at these sites. LimitationsRelatively large node size; relatively small sample size, comorbidities in some patients. ConclusionsPediatric OCD patients demonstrate aberrant global and local resting-state network connectivity topologies compared to healthy children. Local results accord with recent views of OCD as a disorder with sensorimotor component.

Side-effects of SSRIs disrupt multimodal treatment for pediatric OCD in a randomized-controlled trial

ObjectiveActivation Syndrome (AS) is a side-effect of antidepressants consisting of irritability, mania, self-harm, akathisia, and disinhibition. The current study was conducted to analyze how AS may hinder treatment outcome for multimodal treatment for children and adolescents with Obsessive-Compulsive Disorder. MethodsFifty-six children or adolescents were recruited at two treatment sites in a double-blind randomized-controlled trial where participants received Cognitive-Behavioral Therapy and were randomized to slow titration of sertraline, regular titration of sertraline or placebo. ResultsUsing a recently developed measure of AS, results suggested that higher average levels of irritability, akathisia, and disinhibition significantly interfered with treatment response and explained 18% of the variance in obsessive-compulsive symptoms during treatment. Interestingly, only session-to-session increases in irritability resulted in a session-to-session increase in obsessive-compulsive symptoms. The observed results were unchanged with the addition of SSRI dosage as a covariate. ConclusionsResults provide empirical support for the proposed hypothesis that AS may hinder multimodal treatment outcome for pediatric OCD. These findings suggest that dosage changes due to AS do not explain why those with higher AS had worse multimodal outcome. Other possible mechanisms explaining this observed disruption are proposed, including how AS may interfere with Cognitive-Behavioral Therapy.

Child-focused treatment of pediatric OCD affects parental behavior and family environment

This study aimed to investigate the impact of child-focused pediatric OCD treatment on parental anxiety, family accommodation and family environment. Forty-three parents (72.1% female, mean age±SD=43.1±5.6 years) were evaluated at baseline and after their children's (n=33, 54.5% female, mean age±SD=12.9±2.7 years) randomized treatment with Group Cognitive-Behavioral Therapy or fluoxetine for 14 weeks. Validated instruments were administered by trained clinicians. Parents were assessed with the State-Trait Anxiety Inventory (STAI), the Family Accommodation Scale (FAS) and the Family Environment Scale (FES). The Yale-Brown Obsessive–Compulsive Scale was administered to children. Significant findings after the children's treatment include decreased family accommodation levels (participation, modification and distress/consequences domains); increased cohesion and active-recreational components of the family environment. In addition, changes in the FAS distress/consequences and the FES cohesion subscores were correlated with the children's clinical improvement. These results suggest that child-focused OCD treatment may have a positive impact on family accommodation and family environment. Future studies should further clarify the reciprocal influences of pediatric OCD treatment and family factors.

DIFFICULT-TO-TREAT PEDIATRIC OBSESSIVE-COMPULSIVE DISORDER: FEASIBILITY AND PRELIMINARY RESULTS OF A RANDOMIZED PILOT TRIAL OFd-CYCLOSERINE-AUGMENTED BEHAVIOR THERAPY

This study examined the feasibility and preliminary effectiveness of d-cycloserine (DCS)-augmented cognitive behavioral therapy (CBT) for children and adolescents with difficult-to-treat Obsessive Compulsive Disorder, in a double-blind randomized controlled pilot trial (RCT). Seventeen children and adolescents (aged 8-18 years) with a primary diagnosis of OCD, which was deemed difficult-to-treat, were randomly assigned to either nine sessions of CBT including five sessions of DCS-augmented exposure and response prevention (ERP) [ERP + DCS] or nine sessions of CBT including five sessions of placebo-augmented ERP [ERP + PBO]. Weight-dependent DCS or placebo doses (25 or 50 mg) were taken 1 hour before ERP sessions. At posttreatment, both groups showed significant improvements with 94% of the entire sample classified as responders. However, a greater improvement in the ERP + DCS relative to the ERP + PBO condition was observed at 1-month follow-up on clinician-rated obsessional severity and diagnostic severity, and parent ratings of OCD severity. There were no changes across time or condition from 1- to 3-month follow-up. In this preliminary study, DCS-augmented ERP produced significant improvements in OCD severity from posttreatment to 1-month follow-up, relative to a placebo control condition, in severe and difficult-to-treat pediatric OCD. The significant effect on obsessional severity suggests that DCS augmentation might be associated with enhanced modification of obsessional thoughts during ERP, and warrants further investigation.

Table of Contents

AbstractFamily support and childhood sexual abuse: A powerful force in recoveryBest treatments for young people with heroin addiction: No rule bookAutism risk spotted at birth in abnormal placentasDysregulation in pediatric OCDEnhanced motion perception found in autismParents' attitudes and rise in ADHD medicine abuseNational briefing highlights federal collaborations for children's MHTelepsychiatry: Technology Improves Access

Preliminary Predictors of Within-Session Adherence to Exposure and Response Prevention in Pediatric Obsessive–Compulsive Disorder

Background Cognitive-behavioral therapy with exposure and response prevention (ERP) is an effective treatment for pediatric OCD; however, up to 30 % of children are treatment non-responders and as many as 40 % are partial responders. Although poor treatment adherence has been linked to attenuated response in adults with OCD, little research has examined treatment adherence in pediatric OCD.

The Nordic long-term OCD treatment study (NordLOTS): rationale, design, and methods

BackgroundThis paper describes and discusses the methodology of the Nordic long-term OCD-treatment study (NordLOTS). The purpose of this effectiveness study was to study treatment outcome of CBT, to identify CBT non- or partial responders and to investigate whether an increased number of CBT-sessions or sertraline treatment gives the best outcome; to identify treatment refractory patients and to investigate the outcome of aripiprazole augmentation; to study the outcome over a three year period for each responder including the risk of relapse, and finally to study predictors, moderators and mediators of treatment response.MethodsStep 1 was an open and uncontrolled clinical trial with CBT, step 2 was a controlled, randomised non-blinded study of CBT non-responders from step 1. Patients were randomized to receive either sertraline plus CBT-support or continued and modified CBT. In step 3 patients who did not respond to either CBT or sertraline were treated with aripiprazole augmentation to sertraline.ConclusionsThis multicenter trial covering three Scandinavian countries is going to be the largest CBT-study for paediatric OCD to date. It is not funded by industry and tries in the short and long-term to answer the question whether further CBT or SSRI is better in CBT non-responders.

Cognitive Behavior Therapy Augmentation of Pharmacotherapy in Pediatric Obsessive-Compulsive Disorder: The Pediatric OCD Treatment Study II (POTS II) Randomized Controlled Trial

Cognitive Behavior Therapy Augmentation of Pharmacotherapy in Pediatric Obsessive-Compulsive Disorder: The Pediatric OCD Treatment Study II (POTS II) Randomized Controlled Trial

Gender specific short stature in male adolescents with obsessive-compulsive disorder

BackgroundObsessive-compulsive disorder (OCD) is a neuropsychiatric illness with frequent childhood onset and notable gender differences. Anecdotally, male OCD-affected youth frequently report concerns about short stature, resulting in endocrinology consultation. Initial reports have described this phenomenon, yet none have systematically analyzed potential confounders for this observation or examined for this in adults. Determining whether short stature is truly associated with OCD among adolescent males is important given its emotional impacts and costs of potentially unnecessary medical evaluations. This may also inform future studies of the potential complex etiologic overlaps between OCD, neuroendocrine pathophysiology and genetic risk variants. MethodsA total of 42 adolescents (9–20 years old) were recruited from a tertiary Pediatric OCD clinic between 2008 and 2010. Subjects with a DSM-IV OCD diagnosis who provided voluntary informed consent/assent were included; those with comorbid eating disorders were excluded. Height and weight were measured and transformed into percentiles using the US CDC growth census database (NHANES 2000). Clinical variables were compared by gender via the Fisher's exact test using a significance threshold of p<0.05. A multiple regression model predicting short stature was built to control for potential confounders. For secondary analyses, height and weight were collected from a random sample of OCD-affected adults (20–33 years old) at an OCD treatment program to examine for short stature among OCD-affected men. ResultsThe mean height percentile was 33.9% (SD 29.6) for male and 51.5% (SD 31.1) for female adolescents, with significantly more cases of short stature (<20%ile for age) among males (p=0.004). Comparative analyses demonstrated no significant confounding gender differences accounting for observed height differences (p>0.05). After adjusting for important clinical covariates, including serotonin reuptake inhibitor (SRI) use, psychostimulant use, and Tourette history, short stature remained strongly associated with male gender (OR=7.4; 95% CI: 1.5–36.6; p=0.01). This gender difference was not found in a comparable adult sample (p=0.45), which had no elevated incidence of short stature. ConclusionsShort stature is common among adolescent OCD-affected males but not females, and appears to normalize by adulthood. This feature does not appear to be attributable to confounding clinical factors such as medication use.

Increased orbital frontal gray matter volume after cognitive behavioural therapy in paediatric obsessive compulsive disorder

Objectives. Identify differences in regional brain volume between medication-free pediatric OCD patients and controls and examine changes after cognitive behavioural therapy. Methods. We assessed 29 medication-free paediatric OCD patients (Age: M = 13.78 years; SD = 2.58; range 8.2–19.0) and 29 controls, matched on age and gender, with T1-weighted MR scans in a repeated measures, pre-post treatment design. Voxel based morphometry (VBM) following diffeomorphic anatomical registration through exponential lie algebra (DARTEL) was used to test voxel-wise for the effects of diagnosis and treatment on regional gray matter (GM) and white matter (WM) volumes. Results. After cognitive behavioural therapy, orbitofrontal GM and capsula externa WM increased in paediatric OCD relative to controls. In patients, changes in symptom severity (delta CY-BOCS) correlated positively with GM volume in the orbitofrontal cortex after treatment. Furthermore, before treatment, paediatric OCD patients, compared to the controls, showed larger GM volume in left frontal pole and left parietal cortex and larger WM volume in cingulum and corpus callosum. Conclusions. Our findings underscore the involvement of the ventral frontal-striatal circuit in paediatric OCD and the plasticity of this circuit in response to the modulatory effects of CBT. The possible relation to brain development is discussed.

Prevalence and significance of verbal-performance IQ discrepancies in pediatric OCD

Prevalence and significance of verbal-performance IQ discrepancies in pediatric OCD

Error in Financial Disclosure in: Cognitive Behavior Therapy Augmentation of Pharmacotherapy in Pediatric Obsessive-Compulsive Disorder: The Pediatric OCD Treatment Study II (POTS II) Randomized Controlled Trial

Error in Financial Disclosure in: Cognitive Behavior Therapy Augmentation of Pharmacotherapy in Pediatric Obsessive-Compulsive Disorder: The Pediatric OCD Treatment Study II (POTS II) Randomized Controlled Trial