Pediatric OCD Research Articles

Obsessive-compulsive disorder in children and adolescents: Parental understanding, accommodation, coping and distress

Parental accommodation of pediatric OCD is common and is associated with negative affect in parents. Qualitative accounts of caring for a child with OCD are limited and no studies have assessed differences between mothers and fathers in accommodation, coping and distress. The current study used a mixed methods approach to understand parental accommodation, negative affect and coping. Forty-one mothers and 29 fathers of 43 children with OCD were asked to write narratives about their understanding and management of OCD and to complete measures of accommodation, coping, and distress. Symptom accommodation was high with almost half of the parents watching the child complete rituals or waiting for the child on a daily basis. Analysis of parental narratives indicated a distressing struggle between engaging in and resisting accommodation in order to manage their own and their child's anger and distress. T-tests and correlation analysis indicated that accommodation did not differ significantly between mothers and fathers but was more strongly associated with negative affect in mothers. Analyses indicated that mothers reported using all types of coping strategy more often than fathers, particularly escape-avoidance, taking responsibility and using social support. Escape-avoidance coping was positively correlated with accommodation and negative affect in both mothers and fathers. Interventions that target parental constructions of OCD and their behavioural and emotional responses to it may assist in reducing the occurrence of accommodation, avoidant coping and parental distress.

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AbstractNew AACAP Practice Parameter for Pediatric OCDLack of Funding Mechanism Seen as Barrier for TeenScreen ProgramChild Behavior Checklist Differentiates Between ADHD DeficitsExpert Recommendations on Treating Aggressive YouthCognitive Function in Adolescent Schizophrenia following ECTAutism Diagnosis Changing Over Time and Linked to Other DisordersStudy Identifies Early Risk Factors for ADHDPresence of Disruptive Behaviors With Bipolar Predicts Drug ResponseDieting and ADHD: The Saga Continues

CBT specific process in exposure-based treatments: Initial examination in a pediatric OCD sample

Cognitive-behavioral theory and empirical support suggest that optimal activation of fear is a critical component for successful exposure treatment. Using this theory, we developed coding methodology for measuring CBT-specific process during exposure. We piloted this methodology in a sample of young children (N=18) who previously received CBT as part of a randomized controlled trial. Results supported the preliminary reliability and predictive validity of coding variables with 12 weeks and 3 months treatment outcome data, generally showing results consistent with CBT theory. However, given our limited and restricted sample, additional testing is warranted. Measurement of CBT-specific process using this methodology may have implications for understanding mechanism of change in exposure-based treatments and for improving dissemination efforts through identification of therapist behaviors associated with improved outcome.

Maternal and Child Expressed Emotion as Predictors of Treatment Response in Pediatric Obsessive–Compulsive Disorder

Expressed emotion (EE) is associated with symptoms and treatment outcome in various disorders. Few studies have examined EE in pediatric OCD and none of these has assessed the child's perspective. This study examined the relationship among maternal and child EE, child OCD severity, and OCD-related functioning pre- and post-treatment. At pre-treatment, mothers completed speech samples about the child with OCD and an unaffected sibling. Children with OCD completed speech samples about parents. There were low rates of high maternal EE (child with OCD: 16.1%; sibling: 2.6%) and high child EE about parents (mothers: 11.9%; fathers: 10.2%). High EE was primarily characterized by high criticism, not high overinvolvement. High maternal EE and child EE regarding fathers were associated with pre-treatment child OCD severity but not post-treatment severity. High child and maternal EE were predictive of post-treatment OCD-related functioning. EE may be an important child and maternal trait associated with pre-treatment OCD severity and generalization of treatment gains.

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AbstractTreating Individuals Who Have Autism: DSM‐V, ABA, and BeyondThe Science of Infant Mental Health: Implications for Prevention of MaltreatmentBipolar‐I Disorder from Childhood into Adolescent YearsBrief CBT for Pediatric Obsessive‐Compulsive DisorderFacebook Postings Show Beliefs/Stereotypes About ADHDParental Accommodation in Pediatric OCD: Findings from the POTS TrialAntidepressant Use During Pregnancy May Have Link to AutismSleep and its Impact on AdolescentsPrevention of Psychiatric Disorders

P01-358 - Pediatric obsessive-compulsive disorder: A case report

IntroductionObsessive compulsive disorder (OCD) in childhood was first described by Legrand du Saulle in late XIX century, however, a systematic study in pediatric population was not made until 1986, by Rapoport. It is has been documented in scientific literature that younger patients usually hide their symptoms because of shame or that they do not find their obsessions and compulsions excessive, so that they feel them in an egosyntonic way, delaying diagnosis until several years after their first symptoms.Aims and methodologyTo highlight the specific symptoms in Pediatric OCD and review its treatment and approach through the study of a case report.ResultsA 11-year-old boy was referred by his paediatrician to a child mental outpatient service for behavioural disturbances in the last few months. For the last three years, he had been performing rituals of cleaning, order and checking, increasingly complex and with a significant impact on his life, to the point of not being able to go to school and have other members of his family involved. He also had religious and catastrophic obsessions that generated him important distress. He was treated with high doses of sertraline and low doses of risperidone, and cognitive-behavioral psychotherapy with exposure response prevention and training in relaxation techniques were associated to the treatment. The patient improved partially.ConclusionsThis case illustrates the delay in the diagnosis of Pediatric OCD itself as well as the complexity when treating this disorder.

Obsessive Beliefs in Youth With OCD and Their Mothers

The current study builds from mounting support for a role of OCD-related beliefs in pediatric OCD and evidence suggesting a role of both genetic and environmental factors in conferring risk for obsessive-compulsive behaviors. Specifically, data are presented examining the correspondence in OCD-related beliefs in 28 youth with OCD and their mothers. Findings showed a significant, moderate, positive correlation between youth and their mothers’ beliefs regarding inflated perceptions of personal responsibility and the likelihood of threat. However, perfectionism and certainty beliefs were not significantly correlated across generations, and beliefs regarding the importance and control of thoughts were negatively correlated in youth with OCD and their mothers. These initial findings are consistent with previous studies from unselected adolescents and adults with OCD and their relatives in suggesting that familial loading may be particularly strong for responsibility and threat beliefs.

Long-term outcomes of obsessive–compulsive disorder: follow-up of 142 children and adolescents

Obsessive-compulsive disorder (OCD) often starts in childhood and adolescence and can be a chronic disorder with high persistence rates. There are few prospective long-term follow-up studies. To follow up young people with OCD to clarify persistence rates and relevant predictors, presence of other psychiatric disorders, functional impairment, service utilisation and perceived treatment needs. All young people with OCD assessed over 9 years at the National and Specialist Paediatric OCD clinic, Maudsley Hospital, London, were included. Sixty-one per cent (142 of 222) of all contactable young people and parents completed computerised diagnostic interviews and questionnaires. We found a persistence rate of OCD of 41%; 40% of participants had a psychiatric diagnosis other than OCD at follow-up. The main predictor for persistent OCD was duration of illness at assessment. High levels of baseline psychopathology predicted other psychiatric disorders at follow-up. Functional impairment and quality of life were mildly to moderately affected. Approximately 50% of participants were still receiving treatment and about 50% felt a need for further treatment. This study confirms that paediatric OCD can be a chronic condition that persists into adulthood. Early recognition and treatment might prevent chronicity. Important challenges for services are ensuring adequate treatment and a smooth transition from child to adult services.

Glutamate and the Treatment of Obsessive-Compulsive Disorder

public health problem. Patients suffering from OCD have distressing obsessions and compulsions that impair their daily functioning. This severe and chronically debilitating disorder affects more than 3 million people in the United States. Estimates of the lifetime prevalence of OCD in pediatric and adult populations range from 1% to 3%. According to the World Health Organization, OCD is among the 10 most disabling medical conditions worldwide. Among anxiety disorders, the National Comorbidity Survey Replication states that OCD has the highest percentage (50.6%) of serious cases. The clinical phenomenology and nosology of pediatric OCD are well described. This makes OCD a leading candidate for innovative developmental neurobiological study. In contrast to major depression and bipolar disorder, the clinical presentation in childhood and adulthood is similar, making findings more applicable across the age span. The two reasons to focus our study and attention on pediatric OCD are:

Glutamate and the Treatment of Obsessive-Compulsive Disorder

public health problem. Patients suffering from OCD have distressing obsessions and compulsions that impair their daily functioning. This severe and chronically debilitating disorder affects more than 3 million people in the United States. Estimates of the lifetime prevalence of OCD in pediatric and adult populations range from 1% to 3%. According to the World Health Organization, OCD is among the 10 most disabling medical conditions worldwide. Among anxiety disorders, the National Comorbidity Survey Replication states that OCD has the highest percentage (50.6%) of serious cases. The clinical phenomenology and nosology of pediatric OCD are well described. This makes OCD a leading candidate for innovative developmental neurobiological study. In contrast to major depression and bipolar disorder, the clinical presentation in childhood and adulthood is similar, making findings more applicable across the age span. The two reasons to focus our study and attention on pediatric OCD are:

The Rationale and Some Features of the Nordic Long-Term OCD Treatment Study (NordLOTS) in Childhood and Adolescence

OCD is a more prevalent disorder than was once thought at a point prevalence from 0.6–1.5% in older children and young adolescents (Heyman et al. 2001) often running a chronic course as found in a meta-analysis of available outcome studies (Stewart et al. 2004). While a third of those who still were ill did fairly well, the other 2/3 had significant impairment and suffering. However, the patients had received very different therapies ranging from those known to be ineffective, such as psychodynamic psychotherapy, ‘‘classical’’ family therapy or drugs as benzodiazepines to therapies that had included CBT and/or serotonine active drugs at some point. The range of outcome did not differ as much as one would have hoped, given the range of treatments (see also Nissen and Thomsen 2008). Those who had had an inadequate first treatment tended to do worse. More than 50% of adults with OCD report onset in childhood/adolescence (Rasmussen and Eisen 1992), and we really do not know to what extent adults with OCD had been in treatment as children, nor if they had, to what extent it helped. The question of chronic pediatric OCD is not a trivial one, children with OCD grow up and many adults with OCD had childhood onset (Rasmussen and Eisen 1992). Adult OCD is the 10:th most common cause of disability from illness, including somatic illness (Lopez 1996, cited in Haynes et al. 2006).

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AbstractStrategies for Treatment‐Resistant OCD in Pediatric PatientsStudy: Use of Antipsychotics Climbs in Privately Insured PreschoolersCommentary: Treatment‐Resistant Pediatric OCDLisdexamfetamine‐Associated Reductions in GrowthOmega‐3 Fish Oils May Reduce Psychotic Risk in Teens and AdultsMethylphenidate Effects on Sleep in ChildrenIloperidone (Fanapt) Now Available in U.S.Tourette's Syndrome in a Boy With Bipolar DisorderOlanzapine (Zyprexa) Warnings for Adolescent UseDrug Safety Labeling Changes

Memantine as an Augmenting Agent for Severe Pediatric OCD

Memantine as an Augmenting Agent for Severe Pediatric OCD

The Pediatric Obsessive-Compulsive Disorder Treatment Study II: rationale, design and methods.

This paper presents the rationale, design, and methods of the Pediatric Obsessive-Compulsive Disorder Treatment Study II (POTS II), which investigates two different cognitive-behavior therapy (CBT) augmentation approaches in children and adolescents who have experienced a partial response to pharmacotherapy with a serotonin reuptake inhibitor for OCD. The two CBT approaches test a "single doctor" versus "dual doctor" model of service delivery. A specific goal was to develop and test an easily disseminated protocol whereby child psychiatrists would provide instructions in core CBT procedures recommended for pediatric OCD (e.g., hierarchy development, in vivo exposure homework) during routine medical management of OCD (I-CBT). The conventional "dual doctor" CBT protocol consists of 14 visits over 12 weeks involving: (1) psychoeducation, (2), cognitive training, (3) mapping OCD, and (4) exposure with response prevention (EX/RP). I-CBT is a 7-session version of CBT that does not include imaginal exposure or therapist-assisted EX/RP. In this study, we compared 12 weeks of medication management (MM) provided by a study psychiatrist (MM only) with two types of CBT augmentation: (1) the dual doctor model (MM+CBT); and (2) the single doctor model (MM+I-CBT). The design balanced elements of an efficacy study (e.g., random assignment, independent ratings) with effectiveness research aims (e.g., differences in specific SRI medications, dosages, treatment providers). The study is wrapping up recruitment of 140 youth ages 7–17 with a primary diagnosis of OCD. Independent evaluators (IEs) rated participants at weeks 0,4,8, and 12 during acute treatment and at 3,6, and 12 month follow-up visits.NCT00074815

S34-04 Antineuronal antibodies in pediatric OCD and Tourette Syndrome

The objective of our study was to test the autoimmune hypothesis of OCD and TS as disorders related with PANDAS, and find clinical features or specific immunological markers related with them. Child onset OCD in adults has been associated with higher mean ASLO titers, higher frequencies of history of tic disorders, tonsillitis in childhood and compulsive symptoms. Also, two proteins, with molecular weights of 86kDa and 55kDa, have shown antibody binding in sera from 7 patients.The fact that some clinical and biological features related with PANDAS are found in adults and that antineuronal antibodies exist in patients with OCD or TS diagnosis that don't meet PANDAS criteria, lends further evidence that autoimmunity related with OCD is wider than PANDAS.

S34-03 The relationship between streptococcal antibodies and the course of OCD and tics in a pediatric population

The clinical phenotype of pediatric OCD and tic disorders in relation to streptococcal antibody patterns will be discussed. Also, cellular and other immune findings will be presented on a group of children with OCD and tic disorders taking into account clinical phenotype data.

Case Series: Sensory Intolerance as a Primary Symptom of Pediatric OCD

Marked intolerance or intrusive re-experiencing of ordinary sensory stimuli that in turn drive functionally impairing compulsive behaviors are occasionally seen in young children with OCD. We describe a number of children with DSM-IV OCD ascertained from a family genetic study of pediatric OCD, whose intolerance of ordinary sensory stimuli created significant subjective distress and time-consuming ritualistic behavior that was clinically impairing. In each case, these sensory symptoms were the primary presenting symptoms and were experienced in the absence of intrusive thoughts, images, or ideas associated with "conventional" OCD symptoms. These symptoms suggest abnormalities in sensory processing and integration in at least a subset of OCD patients. Recognition of these sensory symptoms and sensory-driven behaviors as part of the broad phenotypic variation in children with OCD could help clinicians more easily identify OCD patients and facilitate treatment.

Brain activation in paediatric obsessive-compulsive disorder during tasks of inhibitory control

Obsessive-compulsive disorder (OCD) may be related to a dysfunction in frontostriatal pathways mediating inhibitory control. However, no functional magnetic resonance imaging (fMRI) study has tested this in children. To test whether adolescents with OCD in partial remission would show abnormal frontostriatal brain activation during tasks of inhibition. Event-related fMRI was used to compare brain activation in 10 adolescent boys with OCD with that of 9 matched controls during three different tasks of inhibitory control. During a 'stop' task, participants with OCD showed reduced activation in right orbitofrontal cortex, thalamus and basal ganglia; inhibition failure elicited mesial frontal underactivation. Task switching and interference inhibition were associated with attenuated activation in frontal, temporoparietal and cerebellar regions. These preliminary findings support the hypothesis that paediatric OCD is characterised by a dysregulation of frontostriatothalamic brain regions necessary for motor inhibition, and also demonstrate dysfunction of temporoparietal and frontocerebellar attention networks during more cognitive forms of inhibition.

Research on Children Yielding Valuable Clinical Information

Research on Children Yielding Valuable Clinical Information

Specificities of Treatment in Pediatric Obsessive-Compulsive Disorder

AbstractObsessive-compulsive disorder (OCD) experienced in childhood or adolescence is often a chronic disorder with high subjective distress and impairment of family and social functioning. An early comprehensive intervention schedule can have a profound effect on outcome in later years. The clinical manifestations of OCD among children and adolescents do not seem to be inherently different from those of adult patients. In younger subjects, the clinical picture tends to be dominated by compulsions, and insight can be poor, with little recognition of the symptoms as a problem.There is often a shift in symptoms over time, with some symptoms being replaced by others, while in adults, the core obsessions and compulsions tend to be more stable. In addition to depression and anxiety disorders, the spectrum of comorbid psychopathology seen in pediatric OCD patients includes tic, disruptive behavior, and specific developmental disorders. The treatment of childhood and adolescent OCD relies on cognitive-behavioral techniques of psychotherapy and pharmacotherapeutic interventions similar to those recommended in adults. The efficacy of exposure and response prevention in pediatric OCD has been shown in numerous open studies, and four controlled trials. Pharmacotherapy relies on serotonergic medication, and all have been demonstrated to be significantly superior to placebo, as reported in a recently published meta-analysis. Current concerns with the use of SSRIs in children and adolescents were explored as regards OCD and anxiety disorders, and there is no evidence for an increase in suicide or related behaviors.