The goal of this study was to discriminate subtypes of pediatric obsessive-compulsive disorder (OCD) among youth with and without a comorbid tic disorder. Seventy-four youth (M(age)=9.7+/-2.3 years) with a principal diagnosis of OCD, with (n=46) or without (n=28) a comorbid tic disorder, were assessed with a semi-structured diagnostic interview and the Children's Yale Brown Obsessive-Compulsive Scale (CY-BOCS). The CY-BOCS Symptom Checklist was used to categorize obsessions and compulsions. Group differences were analyzed by t tests, chi(2), and discriminant function analyses. Results suggested that subjects without tics had significantly more contamination obsessions, sexual obsessions, and counting compulsions than youth with comorbid tics. Generally speaking, however, youth with and without tics had similar symptom presentations. These data suggest that pediatric OCD patients with and without comorbid tics may have some aspects of symptom presentation that differ, but generally have more OCD symptoms in common than different. Implications of these findings on clinical presentation and treatment efficacy are highlighted.
"Comorbidity may complicate the presentation of OCD and has been shown to impact OCD severity, impairment, adaptive functioning and treatment response (Huppert et al. 2009; March et al. 2007; Storch et al. 2008). For example, the presence of oppositional behavior may require contingency management strategies and/or augmented parent-training to enhance on-task behavior (Lewin in press); severe depression may necessitate prerequisite therapy and/or psychopharmacology (e.g., to bolster energy, motivation and reduce irritability ); comorbid PDD NOS symptoms might suggest a reduction of cognitive and abstract therapeutic components, instead emphasizing concrete, behavioral strategies. "
[Show abstract][Hide abstract] ABSTRACT: Obsessive-compulsive disorder (OCD) presents heterogeneously and can be difficult to assess in youth. This review focuses on research-supported assessment approaches for OCD in childhood. Content areas include pre-visit screening, diagnostic establishment, differential diagnosis, assessment of comorbid psychiatric conditions, tracking symptom severity, determining psychosocial functioning, and evaluating clinical improvement. Throughout this review, similarities and differences between assessment approaches geared towards clinical and research settings are discussed.
Child and Youth Care Forum 04/2010; 39(2):73-89. DOI:10.1007/s10566-009-9092-8 · 1.25 Impact Factor
"Despite the intuitive nature of many of our findings, the existing literature lacks sufficient documentation of the impact of co-occurring anxiety and externalizing disorders on childhood OCD. Overall, and unlike comorbid tic disorders [14, 47], the presence of comorbid anxiety and externalizing psychopathology (among the most common co-occurring conditions in youngsters with OCD) is associated with greater symptom severity and functional and family impairment. Recent documentation of the negative impact comorbid symptomatology can have on response of OCD to both medication and cognitive-behavioral treatment [27, 46] further underscores the importance of a better understanding of the relationship of OCD characteristics and associated disorders. "
[Show abstract][Hide abstract] ABSTRACT: The present study examines the influence of diagnostic comorbidity on the demographic, psychiatric, and functional status of youth with a primary diagnosis of obsessive compulsive disorder (OCD). Two hundred and fifteen children (ages 5-17) referred to a university-based OCD specialty clinic were compared based on DSM-IV diagnostic profile: OCD without comorbid anxiety or externalizing disorder, OCD plus anxiety disorder, and OCD plus externalizing disorder. No age or gender differences were found across groups. Higher OCD severity was found for the OCD + ANX group, while the OCD + EXT group reported greater functional impairment than the other two groups. Lower family cohesion was reported by the OCD + EXT group compared to the OCD group and the OCD + ANX group reported higher family conflict compared to the OCD + EXT group. The OCD + ANX group had significantly lower rates of tic disorders while rates of depressive disorders did not differ among the three groups. The presence of comorbid anxiety and externalizing psychopathology are associated with greater symptom severity and functional and family impairment and underscores the importance of a better understanding of the relationship of OCD characteristics and associated disorders. Results and clinical implications are further discussed.
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