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ABSTRACT: This study sought to examine possible differences in phenomenological features and/or symptom severity of children diagnosed with obsessive-compulsive disorder (OCD) and a comorbid grooming condition (i.e., skin picking and trichotillomania). A total of 202 children receiving a primary diagnosis of OCD were classified into two distinct groups: (1) OCD alone (n=154) and (2) OCD plus a comorbid grooming condition (OCD+grooming; n=48). Analyses revealed that those children presenting with a comorbid grooming condition demonstrated different symptom profiles than those with OCD alone. In addition, parents of these children were more likely to report the presence of tactile/sensory sensitivity than those in the OCD alone group. However, no differences were found with respect to symptom severity via self-report (e.g., OCI) or semi-structured interview (e.g., CY-BOCS). Possible clinical and treatment implications, future areas of research, and limitations to the present study are discussed.
Journal of anxiety disorders 04/2009; 23(6):753-9. · 2.68 Impact Factor
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ABSTRACT: To examine the relative efficacy of family-based cognitive-behavioral therapy (CBT) versus family-based relaxation treatment (RT) for young children ages 5 to 8 years with obsessive-compulsive disorder (OCD).
Forty-two young children with primary OCD were randomized to receive 12 sessions of family-based CBT or family-based RT. Assessments were conducted before and after treatment by independent raters blind to treatment assignment. Primary outcomes included scores on the Children's Yale-Brown Obsessive Compulsive Scale and Clinical Global Impressions-Improvement.
For the intent-to-treat sample, CBT was associated with a moderate treatment effect (d = 0.53), although there was not a significant difference between the groups at conventional levels. For the completer sample, CBT had a large effect (d = 0.85), and there was a significant group difference favoring CBT. In the intent-to-treat sample, 50% of children in the CBT group achieved remission as compared to 20% in the RT group. In the completer sample, 69% of children in the CBT group achieved a clinical remission compared to 20% in the RT group.
Results indicate that children with early-onset OCD benefit from a treatment approach tailored to their developmental needs and family context. CBT was effective in reducing OCD symptoms and in helping a large number of children achieve a clinical remission.
Journal of the American Academy of Child and Adolescent Psychiatry 06/2008; 47(5):593-602. · 4.98 Impact Factor
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Thomas J Spencer,
F Randy Sallee,
Donald L Gilbert,
David W Dunn,
James T McCracken,
Barbara J Coffey,
Cathy L Budman,
Randall K Ricardi, Henrietta L Leonard,
Albert J Allen,
Denai R Milton,
Peter D Feldman,
Douglas K Kelsey,
Daniel A Geller,
Steven L Linder,
Donald W Lewis,
Paul K Winner,
Roger M Kurlan,
Mark Mintz
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ABSTRACT: This study examines changes in severity of tics and ADHD during atomoxetine treatment in ADHD patients with Tourette syndrome (TS).
Subjects (7-17 years old) with ADHD (Diagnostic and Statistical Manual of Mental Disorders, DSM-IV) and TS were randomly assigned to double-blind treatment with placebo (n = 56) or atomoxetine (0.5-1.5 mg/kg/day, n = 61) for approximately 18 weeks.
Atomoxetine subjects showed significantly greater improvement on ADHD symptom measures. Treatment was also associated with significantly greater reduction of tic severity on two of three measures. Significant increases were seen in mean pulse rate and rates of treatment-emergent nausea, decreased appetite, and decreased body weight. No other clinically relevant treatment differences were observed in any other vital sign, adverse event, laboratory parameter, or electrocardiographic measure.
Atomoxetine is efficacious for treatment of ADHD and its use appears well tolerated in ADHD patients with comorbid TS.
Journal of Attention Disorders 02/2008; 11(4):470-81. · 2.45 Impact Factor
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ABSTRACT: Obsessive-compulsive disorder (OCD) is a distressing and functionally impairing disorder that can emerge as early as age 4. Cognitive behavior therapy (CBT) for OCD in youth shows great promise for amelioration of symptoms and associated functional impairment. However, the empirical evidence base for the efficacy of CBT in youth has some significant limitations, particularly as related to treating the very young child with OCD. This report includes a quantitative review of existing child CBT studies to evaluate evidence for the efficacy of CBT for OCD. It identifies gaps in the literature that, when addressed, would enhance the understanding of effective treatment in pediatric OCD. Finally, it presents a proposed research agenda for addressing the unique concerns of the young child with OCD.
Biological Psychiatry 03/2007; 61(3):337-43. · 8.28 Impact Factor
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ABSTRACT: Compulsions are meant to relieve anxiety or to prevent a dreaded event. An adolescent or adult may recognize that the ritual is unreasonable or excessive, but that is not necessarily true for the young child. Children and adolescents will attempt to hide their rituals, although with more severe symptoms, this is not usually possible. To meet the diagnostic criteria for the disorder, the person must experience distress, spend more than 1 hour a day in either obsessions or compulsions, or experience significant interference in his/her life. This article reviews the phenomenology, causes, treatment, and outcome of children and adolescents with obsessive-compulsive disorder.
Child and Adolescent Psychiatric Clinics of North America 11/2005; 14(4):727-43, viii. · 2.60 Impact Factor
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PEDIATRICS 05/2004; 113(4):907-11. · 4.47 Impact Factor
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ABSTRACT: The goal of this pilot study was to investigate the prevalence of obsessive-compulsive disorder (OCD) in a group of patients with systemic lupus erythematosus (SLE).
Fifty adult patients enrolled in out-patient SLE studies at the National Institute of Arthritis and Musculoskeletal and Skin Diseases (February 1995-October 1996) completed a self-report questionnaire adapted from the Yale-Brown Obsessive Compulsive Scale and an in-person psychiatric clinical interview with a psychiatrist or psychiatric clinical nurse specialist. DSM-IV lifetime diagnosis of OCD was determined by clinical interview.
Sixteen subjects (32%) met DSM-IV lifetime diagnostic criteria for OCD and an additional 5 (10%) met criteria for subclinical OCD. Mean +/- SD number of symptoms reported on the self-report questionnaire was significantly higher among subjects diagnosed with OCD on clinical interview (40.7 +/- 23.2) compared with those without OCD (8.9 +/- 11.7; t = 5.8, df = 27, p <.001).
Obsessive-compulsive disorder was 10 to 15 times more common in this cohort of patients with SLE compared with those in community-based studies of OCD. The use of an OCD self-report rating scale proved helpful in the identification of OCD symptoms among patients with SLE. Results suggest that further studies of OCD in patients with SLE are needed and may provide new insight into the pathophysiology of both disorders.
The Journal of Clinical Psychiatry 03/2004; 65(3):301-6. · 5.80 Impact Factor
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ABSTRACT: Despite a meaningful common core of symptoms observed across the life span, there are particularly unique features of early-onset (prepubertal) obsessive-compulsive disorder (OCD) that make consideration of early presentation different from adolescent or adult onset and that may have important implications for treatment. This article will first review the unique features of early-onset OCD, focusing particular attention to the developmental and familial context of these children's symptoms. The literature on behavioral family interventions for other childhood disorders, specifically anxiety, as well as that on family processes (e.g., parent-child interactions) in families of children with OCD will be reviewed. The pediatric OCD cognitive-behavioral therapy (CBT) literature (CBT alone and CBT plus medication) will also be reviewed, focusing on current evidence-based treatment guidelines. Finally, a model of family-based treatment for young children with OCD and some preliminary pilot data will be presented.
Journal of Child and Adolescent Psychopharmacology 02/2003; 13 Suppl 1:S71-80. · 2.88 Impact Factor
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ABSTRACT: Electrodermal activity and heart rate were recorded during rest, simple tones, and a reaction time task in 43 male and female adolescents and children with obsessive compulsive disorder and 30 male adolescents and children with disruptive behavior disorders who had lumbar cerebrospinal fluid drawn during the same week. Partial correlations controlling for age and sex showed that in the obsessive group metabolites of serotonin and dopamine, but not of norepinephrine, were positively correlated with electrodermal responsivity, most consistently in the reaction time task. This result was not replicated in disruptive boys. Adrenocorticotropic hormone was positively related to electrodermal activity and heart rate throughout the session. The results for the obsessive adolescents suggest that nigrostriatal dopamine turnover and central serotonin turnover affect electrodermal activity, generally confirming and extending conclusions from pharmacological studies. Diagnosis may affect these relationships.
Psychophysiology 10/1996; 33(6):731 - 739. · 3.29 Impact Factor
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ABSTRACT: review the diagnosis and treatment of OCD [obsessive- compulsive disorder] in [children and adolescents]
epidemiology and diagnosis / phenomenology [symptoms, age and gender effects, developmental factors, comorbidity, neuropsychological factors] / natural history and prognosis / OCD as a neurobehavioral disorder [genetic studies, neuroanatomy, neurophysiology, OCD as an antibody-mediated neuropsychiatric disorder] / clinical assessment and treatment [cognitive-behavioral therapy, pharmacotherapy] (PsycINFO Database Record (c) 2012 APA, all rights reserved)
10/1995;
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ABSTRACT: Obsessive-compulsive disorder (OCD) is a common, often chronic psychiatric disorder in children and adolescents. Aspects of OCD's phenomenology, patterns of comorbidity, diverse neurobiologic evidence, and response to pharmacotherapy with serotonin reuptake inhibitors all support designating OCD as a neurobehavioral condition. The authors provide a rationale for pharmacotherapy in OCD, review the empirical literature on treatment of OCD with medications, and discuss the use of pharmacotherapy in the context of multimodal treatment and commonly complicating comorbidities. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Child and Adolescent Psychiatric Clinics of North America 12/1994; · 2.60 Impact Factor
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ABSTRACT: historically, tics have been reported in obsessive-compulsive patients, as well as obsessive-compulsive symptomatology in Tourette syndrome (TS) patients / review the literature on the relationships between the 2 disorders / present recent findings [on incidence of tics and TS] from a large cohort of [6–18 yr olds] with obsessive-compulsive disorder (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Advances in neurology 10/1992; 58.
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ABSTRACT: Children and adolescents (N = 45) had skin conductance and heart rate recorded continuously during a rest period, presentation of tones, and a simple reaction time test and were assessed for extraversion and behavioral impulsivity. The major aims were: (1) to generalize previous findings of smaller electrodermal responsivity to moderate stimuli and faster reaction time in extraverts, which had been reported for adult samples, to normal children; (2) to test the hypothesis that increasing arousal and stimulus significance by means of task performance would alter the negative correlation between extraversion and responsivity as had been shown in previous studies using different methods; and (3) to determine if extraversion and impulsivity interacted in their effects on these variables. Results showed that extraversion (independent of age and sex) was consistently negatively correlated with skin conductance response magnitudes to all stimuli—somewhat more strongly for reaction-time stimuli—and was negatively correlated with reaction time. This generalizes previous results to children and to significant stimuli. Behavioral impulsivity, which was independent of extraversion, was positively correlated with responsivity. The two variables together accounted for up to 33% of the variance of the responsivity measures. The results suggest that the positive relationship between extraversion and speed of reaction may be partially mediated by electrodermal responsivity. They are also consistent with a model of higher dopaminergic activity in extraverts.
Personality and Individual Differences.
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ABSTRACT: Two neuropsychological tests, the Money Road Map test and the Stylus Maze, which had previously distinguished obsessive-compulsive patients from normal controls, were administered to 21 female patients with severe trichotillomania (an irresistible compulsion to pull out one's hair), and the results were compared with those of age- and sex-matched groups with obsessive-compulsive disorder (OCD) (n =12), other anxiety disorders (n=17), and normal controls (n=16). The trichotillo-mania group had significantly more errors than normal controls on the Stylus Maze, but not on the Road Map test. The OCD group differed significantly from normal controls in the number of rule breaks on the Stylus Maze. Within the trichotillomania group, errors on the two tasks correlated with symptom severity and predicted clinical response to clomipramine. Results are examined in terms of possible links between trichotillomania and OCD, and a neurobiological perspective of trichotillomania is discussed.
Journal of Anxiety Disorders.
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Education and Treatment of Children 31(3):395-416.
