Abbe M Garcia

• Brown University

Response Inhibition (RI) is the ability to suppress behaviors that are inappropriate for a given context. Obsessive-compulsive disorder (OCD) has been associated with impaired RI in adults as measured by the Stop Signal Task (SST). Conflicting results have been found in terms of the relationship between OCD severity and SST performance, and no stud...

Exposure and response prevention is the front-line treatment for OCD, but many patients do not achieve symptom remission. Most theories of exposure mechanism suggest that eliciting and/or tolerating distress is necessary for exposure effectiveness. Moreover, research suggests that the type of distress may relate to treatment response, such that pat...

Family-based cognitive behavioral therapy (CBT) is an effective treatment for obsessive compulsive disorder (OCD), but not all children respond. Children with early-onset OCD may exhibit poorer outcomes, possibly due to developmental factors that affect treatment engagement and distress tolerance, which may ultimately affect treatment dose. Homewor...

In an effort to improve patient conceptualization and targeted treatment, researchers have sought to accurately classify OCD subtypes. To date, the most common form of OCD classification has used the content of symptom topography as opposed to functional links between symptoms to categorize OCD. The aim of the current study was to explore the assoc...

Family accommodation (FA) has been shown to relate to poorer treatment outcomes in pediatric obsessive compulsive disorder (OCD), yet few studies have examined the trajectory of change in FA throughout treatment and its relation to treatment outcomes. This study examined change in FA in relation to change in symptom severity and impairment in 63 yo...

This study tested whether a new training tool, the Exposure Guide (EG), improved in-session therapist behaviors that have been associated with youth outcomes in prior clinical trials of exposure therapy. Sixteen therapists in practice settings treated 46 youth with an anxiety disorder or Obsessive-Compulsive Disorder (OCD). Therapists were randomly...

This study tested whether a new training tool, the Exposure Guide (EG), improved in-session therapist behaviors (i.e. indicators of quality) that have been associated with youth outcomes in prior clinical trials of exposure therapy. Six therapists at a Community Mental Health Agency (CMHA) provided exposure therapy for eight youth with Obsessive Co...

“Nadine,” a 10‐year‐old female, was referred by her outpatient psychiatrist to the Bradley Hospital Partial Hospital Program for OCD and Related Disorders (OCD PHP) for intensive treatment of her unusual, dangerous, and obsession‐like interests, combined with frequent, severe, and developmentally inappropriate tantrum outbursts. These symptoms cont...

The role of disgust in anxiety and related disorders has been extensively studied in adults, however its role in childhood psychopathology is in need of further investigation. The adult literature has suggested that two distinct sub-constructs within “disgust proneness” may differentially predict anxiety-related disorders. Namely, disgust propensit...

This study measured therapist behaviors in relation to subsequent habituation within exposure tasks, and also tested their direct and indirect relationships (via habituation) with clinical outcomes of exposure therapy. We observed 459 videotaped exposure tasks with 111 participants in three clinical trials for pediatric obsessive–compulsive disorde...

This study examined the feasibility, acceptability, and preliminary efficacy of a decision rule driven treatment for youth with comorbid conduct problems and depression. A randomized, controlled, repeated measures design was used to compare two treatment approaches: Decision-Rule Based Treatment (DR) and Sequential Treatment (SEQ). Participants inc...

Obsessive-compulsive disorder (OCD) and trichotillomania (hair pulling disorder, HPD) are both considered obsessive-compulsive and related disorders due to some indications of shared etiological and phenomenological characteristics. However, a lack of direct comparisons between these disorders, especially in pediatric samples, limits our understand...

The aim of the present study is to examine the influence of parent anxiety on supportive and nonsupportive parental responses to children’s negative emotions in anxious and non anxious youth. Parental anxiety was positively correlated with a nonsupportive response ( Distress) and negatively correlated with a supportive response (Problem Focused) in...

1 Background Despite gains made in the study of childhood anxiety, differential diagnosis remains challenging because of indistinct boundaries between disorders and high comorbidity. This is certainly true for generalized anxiety disorder (GAD) and obsessive–compulsive disorder (OCD) as they share multiple cognitive processes (e.g., rumination, int...

Obsessive–compulsive disorder (OCD) in children under 8 years of age, referred to as early-onset OCD, has similar features to OCD in older children, including moderate to severe symptoms, impairment, and significant comorbidity. Family-based cognitive behavioral therapy (FB-CBT) has been found efficacious in reducing OCD symptoms and functional imp...

Pediatric obsessive-compulsive disorder is a chronic and impairing condition that often persists into adulthood. This review refreshes the state of support for psychosocial treatments and the predictors or moderators that relate to their efficacy and evaluates how the literature has improved since the last update in 2014. A secondary goal is to pro...

Objective: This study measured a variety of within-exposure fear changes and tested the relationship of each with treatment outcomes in exposure therapy. Method: We coded 459 videotaped exposure tasks from 111 participants in 3 clinical trials for pediatric obsessive-compulsive disorder (OCD; POTS trials). Within exposures, fear level was observ...

The present study explored the concept of tolerance for child distress in 46 children (ages 5–8), along with their mothers and fathers, who received family-based CBT for OCD. The study sought to describe baseline tolerance, changes in tolerance with treatment, and the predictive impact of tolerance on symptom improvement. Tolerance was rated by cli...

Background: Past research has found that patients with obsessive-compulsive disorder (OCD) exhibit deficits in executive functioning (EF) (Greisberg & McKay, 2003). Though the category of EF is very broad, deficits in EF are theorized to play a role in maintaining the perseverative thought processes and behaviors characteristic of OCD. Although def...

This chapter covers the growing literature on the phenomenology, assessment, and recent advances in treatment of obsessive-compulsive problems in very young children, and concludes with a discussion of future directions and areas in need of focused empirical attention. Obsessive-compulsive (OC) symptoms in early childhood tend to onset gradually. C...

Background: There is growing literature to suggest parent accommodation (PA) affects the severity and contributes to the maintenance of pediatric OCD symptoms. Little research has examined the relationship between PA and change in symptoms following treatment in a partial hospitalization setting. Those who are referred to a partial program often ex...

The Pediatric Obsessive-Compulsive Disorder Treatment Study II (POTS II) investigated the benefit of serotonin reuptake inhibitor (SRI) augmentation with cognitive behavioral therapy (CBT). Primary outcomes focused on OCD symptom change and indicated benefit associated with a full course of CBT. Given that the majority of youth with OCD suffer from...

Studies have shown a high prevalence of autistic spectrum traits in both children and adults with psychiatric disorders; however the prevalence rate has not yet been investigated in young children with OCD. The aim of the current study was to (1) determine whether ASD traits indicated by the Social Communication Questionnaire (SCQ) and the Social R...

Objective: Despite advances in supported treatments for early onset obsessive–compulsive disorder (OCD), progress has been constrained by regionally limited expertise in pediatric OCD. Videoteleconferencing (VTC) methods have proved useful for extending the reach of services for older individuals, but no randomized clinical trials (RCTs) have evalu...

Cognitive-behavioral therapy (CBT) using exposure with response prevention (ERP) is the treatment of choice for obsessive-compulsive disorder (OCD); however, developmental modifications should be considered when treating young children. This article presents a case study illustrating family-based CBT using ERP with a 7-year-old boy. The delivery of...

Contamination is the most common concern in obsessive-compulsive disorder (OCD), with 50–55 % of those with OCD exhibiting contamination fear. Similarly, cleaning compulsions, the compulsions most linked to contamination OCD, are the second most common OCD symptom, second to compulsive checking. Various maladaptive cognitions, disgust sensitivity,...

The Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS) is the most commonly used instrument to assess the symptoms and severity of pediatric obsessive compulsive disorder (OCD). However, only one prior study has evaluated the psychometric properties of the CY-BOCS for assessing young children, ages 5 to 8 years. The limited available eviden...

Objective Prior research has shown that youth with co-occurring tic disorders and obsessive-compulsive disorder (OCD) may differ from those with non-tic-related OCD in terms of clinical characteristics and treatment responsiveness. A broad definition of “tic-related” was used to examine whether children with tics in the Pediatric OCD Treatment Stud...

Importance: Cognitive behavior therapy (CBT) has been established as efficacious for obsessive-compulsive disorder (OCD) among older children and adolescents, yet its effect on young children has not been evaluated sufficiently. Objective: To examine the relative efficacy of family-based CBT (FB-CBT) involving exposure plus response prevention v...

Stress is the contextual variable most commonly implicated in tic exacerbations. However, research examining associations between tics, stressors, and the biological stress response has yielded mixed results. This study examined whether tics occur at a greater frequency during discrete periods of heightened physiological arousal. Children with co-o...

A virtual reality environment (VRE) was designed to expose participants to substance use and sexual risk-taking cues to examine the utility of VR in eliciting adolescent physiological arousal. 42 adolescents (55% male), with a mean age of 14.54 years (SD = 1.13) participated. Physiological arousal was examined through heart rate (HR), respiratory s...

Given the burdens of early-onset obsessive-compulsive disorder (OCD), limitations in the broad availability and accessibility of evidence-based care for affected youth present serious public health concerns. The growing potential for technological innovations to transform care for the most traditionally remote and underserved families holds enormou...

Pediatric obsessive-compulsive disorder (OCD) is associated with substantial morbidity, comorbidity, family difficulties, and functional impairment. Fortunately, OCD in youth has also been found responsive to cognitive behavioral therapy (CBT) both alone and in combination with medication. This paper highlights key areas a treatment provider must b...

Pediatric obsessive-compulsive disorder (OCD) is a chronic and impairing condition that often persists into adulthood. Barrett, Farrell, Pina, Peris, and Piacentini (2008), in this journal, provided a detailed review of evidence-based psychosocial treatments for youth with OCD. The current review provides an evidence-base update of the pediatric OC...

Important developmental differences in obsessive-compulsive disorder (OCD) in very young children (ages 4–8) may be observed when compared to older children and adolescents. Although findings are preliminary, the chapter discusses the nature, contributing factors, and treatment of OCD in young children. Treatment modifications and considerations ar...

Previous research has shown that among the various subtypes of obsessive–compulsive disorder (OCD), adults (e.g. Frost, Krause, and Steketee (1996). Behavior Modification, 20(1), 116–132.) and older children and adolescents (Bloch et al. (2009). Pediatrics, 124(4), 1085–1093; Storch et al. (2007). Compr Psychiatry, 48(4), 313–318.) with problematic...

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-treatme...

The extant literature on the treatment of pediatric obsessive-compulsive disorder (OCD) indicates that partial response to serotonin reuptake inhibitors (SRIs) is the norm and that augmentation with short-term OCD-specific cognitive behavior therapy (CBT) may provide additional benefit. To examine the effects of augmenting SRIs with CBT or a brief...

Few studies have examined predictors of parental accommodation (assessed with the Family Accommodation Scale-Parent Report) among families of children with obsessive-compulsive disorder (OCD). No studies have examined this phenomenon using empirically derived subscales of the Family Accommodation Scale-Parent Report (i.e., Caregiver Involvement, Av...

Parent-child interaction paradigms are often used to observe dysfunctional family processes; however, the influence of such tasks on a participant's level of activation remain unclear. The aim of this pilot project is to explore the stimulus value of interaction paradigms that have been commonly used in child anxiety research. Twenty-nine parent-ch...

The Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS) is the instrument of choice for assessing symptom severity in older children (i.e., 8-18 years) diagnosed with obsessive-compulsive disorder (OCD). The reliability and validity of this measure for use among younger children (i.e., 5-8 years of age), however, has never been examined. The...

Pediatric psychologists are often interested in interactions among individuals (e.g., doctors and patients, parents and children). Most research examining the nature of these interactions has used correlational analyses. Sequential analysis provides greater detail on contingencies during interactions and the way that interactions play out over time...

To identify predictors and moderators of outcome in the first Pediatric OCD Treatment Study (POTS I) among youth (N = 112) randomly assigned to sertraline, cognitive behavioral therapy (CBT), both sertraline and CBT (COMB), or a pill placebo. Potential baseline predictors and moderators were identified by literature review. The outcome measure was...

Scant research has examined the effect of neuropsychological (NP) functioning on treatment outcome in pediatric obsessive-compulsive disorder (OCD). This study sought to address this gap in existing research. A total of 63 youths were included in this study and asked to complete the Rey-Osterrieth Complex Figure (ROCF) and specific subtests of the...

Researchers and practitioners have long debated the meaning and measurement of clinical significance. Shearer-Underhill and Marker (2010) offer a valuable contribution to this discussion by drawing the psychotherapy research community's attention to an additional statistical method for measuring clinical significance—the number needed to treat. Aft...

This paper describes the phenomenological features of early childhood onset obsessive compulsive disorder (OCD; defined as children meeting DSM-IV criteria for OCD with age of onset <8 years). Fifty-eight children (ages 4-8) were included in the sample. OCD and comorbid diagnoses were determined by structured interview, and OCD severity was measure...

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)...

Growing research has examined parental accommodation among the families of children with obsessive-compulsive disorder (OCD). However, these studies have utilized a parent-report (PR) version of a measure, the Family Accommodation Scale (FAS) that has never received proper psychometric validation. In turn, previously derived subscales have been dev...

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 O...

To examine clinical correlates of juvenile-onset OCD across the lifespan. Data collected at the intake interview from 257 consecutive participants with juvenile-onset OCD (20 children, 44 adolescents and 193 adults) in a naturalistic study of the clinical course of OCD were examined. Participants and parents of juvenile participants completed a str...

Chapter 2 covers all the parent tools that will be learned throughout the sessions to help the child cope with their OCD. These include differential attention (tangible rewards and positive reinforcement, praise and encouragement, removal of attention), a reward plan (components of successful reward programs, situations in which to reward the child...

This therapist guide presents a family-based treatment for OCD specifically designed for children ages 5-8. Using a cognitive-behavioral approach, it provides psycho-education for the family and a set of parent strategies involving differential attention, modeling, and scaffolding techniques, and child strategies that include cognitive tools such a...

Young children with obsessive-compulsive disorder (OCD) often require professional help to overcome their symptoms. This workbook corresponds to a treatment program specifically designed for children ages 5-8 and their families. Therapists can tailor the program to each child's developmental level and family situation, and the importance of parents...

Research on the effectiveness of cognitive-behavioral therapy, and in particular, exposure with response prevention for Obsessive-Compulsive Disorder (OCD), has only been systematically evaluated in children and adolescents ages 7–17. These treatments do not address the unique characteristics of young children with OCD. This paper discusses clinica...

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 con...

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 significan...

The presence of a comorbid tic disorder may predict a poorer outcome in the acute treatment of pediatric obsessive-compulsive disorder (OCD). Using data from the National Institute of Mental Health (NIMH)-funded Pediatric OCD Treatment Study (POTS) that compared cognitive-behavior therapy (CBT), medical management with sertraline (SER), and the com...

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 di...

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 rev...

Childhood onset of obsessive-compulsive disorder is not uncommon, so pediatricians should be familiar with its presentation and comorbidity. The authors discuss the evaluation and treatment of children and adolescents with this disorder.

Normative comparisons are a procedure for evaluating the clinical significance of therapeutic interventions. This procedure, consisting of comparing data on treated individuals with that of normative individuals, is described, and a step-by-step statistical methodology for conducting normative comparisons in the context of treatment-outcome researc...

Normative comparisons are a procedure for evaluating the clinical significance of therapeutic interventions. This procedure, consisting of comparing data on treated individuals with that of normative individuals, is described, and a step-by-step statistical methodology for conducting normative comparisons in the context of treatment–outcome researc...