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Differential efficacy of cognitive-behavioral therapy and pharmacological treatments for pediatric obsessive–compulsive disorder: A meta-analysis

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... A meta-analysis suggested clomipramine to be more effective compared with SSRI for the treatment of OCD in children (11). That said, direct comparisons of clomipramine and SSRI have not shown any superiority for any of the two drugs for treating OCD in adults (12)(13)(14)(15)). ...
... To be familiar with the ground of research on OCD treatment, the reader is humbly referred to the previously conducted systematic reviews and meta-analyses concerning the abovementioned issues (7,11,(19)(20)(21)(22)(23). ...
... First, being superior over placebo does not yet advocate for the intervention's clinical implications, especially when an even more effective treatment option clearly exists. Such an option, exemplified herein by CBT, has been fairly validated, and its efficacy in children and adolescents has been confirmed multiple times by various studies (11,20,21,(40)(41)(42). Second, leaving the "placebo" arms of children untreated for the study duration would be somewhat unethical. ...
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Background: Obsessive-compulsive disorder (OCD) is a common behavioral disorder among adolescents and children. The selective serotonin reuptake inhibitors (SSRIs) are the first pharmacological choice for this condition due to mild adverse effect profile. Objective: This systematic review was performed to evaluate the efficacy of SSRI for OCD in adolescents and children. Methods: Search terms were entered into PubMed, PsycINFO, Scopus, CINAHL, and Google Scholar. The included studies were randomized, placebo-controlled trials of SSRIs conducted in populations of children and adolescents younger than 18 years. Change from baseline Children’s Yale-Brown Obsessive-Compulsive Scale (CY-BOCS), end-treatment CY-BOCS with respective SD, and response and remission rates were collected for continuous and dichotomous outcome assessment, respectively. Cochrane Rev Man software was used for meta-analyses, providing Forest plots where applicable. Results: SSRIs were superior to placebo with a small effect size. There was no additional benefit of combination treatment over cognitive behavioral therapy (CBT) alone, but CBT added substantial benefit to SSRI monotherapy. Fluoxetine and sertraline appear to be superior to fluvoxamine. Conclusion: The results of current systematic review and meta-analysis support the existing National Institute for Health and Care Excellence (NICE) guidelines for choosing CBT as first line of treatment and substituting it with SSRI, depending on patient preference. Adding CBT to current SSRI treatment is effective for non-responders and partial responders, but adding SSRI to ongoing CBT does not prove beneficial. The SSRIs have different effectiveness, and their relative efficacy remains to be investigated.
... Similarly, meta-analyses provide ample support for the treatment of pediatric OCD with CBT. Specifically, the effect sizes from several meta-analytic studies yield mean effect sizes ranging from 1.21 to 1.74 with passive comparison groups (McGuire et al., 2015;Sánchez-Meca et al., 2014;Öst et al., 2016;Watson and Rees, 2008). Although both CBT and pharmacological interventions such as serotonin reuptake inhibitors (SRIs) have been identified as first-line, evidence-based treatments for youth with OCD, research suggests that CBT outperforms SRIs, and outcomes for youth receiving the combination of the two are not statistically different from outcomes for youth receiving CBT alone (Sánchez-Meca et al., 2014;Öst et al., 2016). ...
... Specifically, the effect sizes from several meta-analytic studies yield mean effect sizes ranging from 1.21 to 1.74 with passive comparison groups (McGuire et al., 2015;Sánchez-Meca et al., 2014;Öst et al., 2016;Watson and Rees, 2008). Although both CBT and pharmacological interventions such as serotonin reuptake inhibitors (SRIs) have been identified as first-line, evidence-based treatments for youth with OCD, research suggests that CBT outperforms SRIs, and outcomes for youth receiving the combination of the two are not statistically different from outcomes for youth receiving CBT alone (Sánchez-Meca et al., 2014;Öst et al., 2016). Cognitive-behavioral approaches to OCD in youth typically include a combination of psychoeducation and cognitive restructuring in addition to the central component of exposure and response prevention (ERP), in which youth are exposed to the feared stimulus (obsessions) and prevented from engaging in a compulsive response that intends to reduce the distress of the obsession (Sánchez-Meca et al., 2014). ...
... Although both CBT and pharmacological interventions such as serotonin reuptake inhibitors (SRIs) have been identified as first-line, evidence-based treatments for youth with OCD, research suggests that CBT outperforms SRIs, and outcomes for youth receiving the combination of the two are not statistically different from outcomes for youth receiving CBT alone (Sánchez-Meca et al., 2014;Öst et al., 2016). Cognitive-behavioral approaches to OCD in youth typically include a combination of psychoeducation and cognitive restructuring in addition to the central component of exposure and response prevention (ERP), in which youth are exposed to the feared stimulus (obsessions) and prevented from engaging in a compulsive response that intends to reduce the distress of the obsession (Sánchez-Meca et al., 2014). ERP has long been lauded as a key component of CBT for OCD; however, several recent meta-analyses were unable to detect a statistically significant advantage for ERP over cognitively-focused treatment approaches without ERP, all noting that this finding is to be interpreted with caution given methodological limitations and calling for more focused research dismantling components of CBT for OCD to determine their relative effectiveness (McGuire et al., 2015;Sánchez-Meca et al., 2014;Öst et al., 2016). ...
Chapter
Cognitive-behavioral therapy is an empirically supported treatment for youth with a range of disorders (e.g., anxiety, depression, trauma, chronic pain) and is widely practiced and taught in training programs. Cognitive-behavioral therapy is an integration of multiple theoretical approaches, including behavioral, cognitive, and developmental, that targets potential areas of vulnerability in each domain. Existing research has established its efficacy and supports its effectiveness, yet future research must further these gains through treatment personalization and implementation research.
... Available evidence of level-A, i.e., evidence in the form of RCTs, systematic reviews and meta-analysis is available for all these treatments in children and adolescents. [27][28][29][30][31][32][33][34] In general, available studies suggest that these treatments are better than placebo and combined treatment with CBT plus pharmacotherapy is better than pharmacotherapy alone. In short term, i.e., 12 weeks, response rate with CBT alone (70%), combined CBT and SRIs (COMBO) (66%) and SRIs (49%) is more than the placebo (29%) and waitlist (13%). ...
... Monitoring should be done on CYBOCS and CGI-I. [27][28][29][30][31][32][33][34] Recommendation: The treatment modality used should be guided by moderators and predictors of response derived empirical research evidence but taking into account the individual patient concerned This is more relevant in cases where the long duration of illness is there, family history of OCD and/or related disorders in first degree, high family accommodation, presence comorbid (Tic/Tourette's, ADHD, OC spectrum, depression) Level an evidence (RCTs, systematic reviews and meta-analysis) is available for pharmacotherapy (SRIs), CBT and combination of SRIs and CBT All these treatments are better than placebo and combined treatment with CBT plus pharmacotherapy is better than pharmacotherapy alone In short term response and remission rates of SRIs, CBT, and COMBO (SRIs + CBT) is significantly better than placebo and/or waitlist In short term effect size of SRIs versus placebo and CBT versus waitlist is significantly more But in short term, but effect size for CBT versus SRI and COMBO (CBT + SRI) versus CBT are not significant There is evidence for long term (9 months-1 year) efficacy of CBT but there is minimal data for long-term efficacy of SRIs (only one study) Initially, evidence emerged for COMBO better than CBT for moderate to severe OCD but now contradictory findings also coming Data for effectiveness of CBT from Scandinavian countries also present Median age of children and adolescents is 13, preadolescent population still underrepresented in studies ...
... Symptom severity does not predict poor outcome. [27][28][29][30][31][32][33][34] Comorbidities should be addressed depending on their severity and dysfunction hand in hand with OCD with their respective evidence-based treatments Maintenance treatment Those who achieve remission (CYBOCS score <11) should be on maintenance CBT with booster sessions for a minimum of 12 months if they were on CBT alone. Those who were on SSRI then they should be maintenance SSRI at an optimal dose for a minimum of 12 months. ...
... Die Kombination von KVT und Psychopharmakotherapie zeigte sich in der bisher größten kontrollierten Untersuchung (POTS 2004) am effektivsten [43]. In einer aktuellen Metaanalyse von 18 kontrollierten Studien zeigte sich für eine alleinige KVT eine Effektstärke von d = 1,203, für eine alleinige pharmakologische Behandlung eine Effektstärke von d = 0,745 und für eine kombinierte Behandlung von d = 1,704 [44]. ...
... Neben SSRI wurde vor allem bei Erwachsenen das trizyklische Antidepressivum Clomipramin eingesetzt. In 2 Metaanalysen von randomisierten, kontrollierten Studien zu SSRI und Clomipramin bei pädiatrischen Patienten war Clomipramin noch wirksamer als die SSRI [44,46]. Es traten jedoch gerade im Kindes-und Jugendalter unter Clomipramin mehr unerwünschte Arzneimittelwirkungen und Studienabbrüche auf als unter den SSRI [47], daher wird es in der Regel nicht als "erstes" Zweite-Wahl-Medikament eingesetzt. ...
... 5 The meta-analyses found that clomipramine, an older tricyclic SRI, had a greater treatment effect than the SSRIs. 7,8,10 However, clomipramine is associated with more frequent side effects including cardiac and seizure events; 3,7 thus, it is not recommended for use as a first-line medication among affected youth. Greater treatment effects were associated with lower methodological quality of SRI studies in two meta-analyses, 6,7 and with higher baseline OCD symptom severity in one meta-analysis. ...
... CBT and SSRIs are efficacious and appropriate choices for treating pediatric OCD; however, CBT has superior efficacy to SSRIs. [5][6][7][8] There is no conclusive evidence that combined treatment is more effective than CBT monotherapy for moderate to severe OCD, or that the efficacy of CBT is lower in those with severe OCD. 4-6 Current evidence supports the first-line use of CBT in the treatment of pediatric OCD, with SSRIs added according to clinical judgment of individual need. ...
Article
This article provides an update on the evidence base for the treatment of pediatric obsessive-compulsive disorder (OCD). Recent meta-analyses have found that cognitive-behavioral therapy (CBT) is the most efficacious monotherapy for pediatric OCD, and that serotonin reuptake inhibitors demonstrate a moderate treatment effect. There is little evidence to indicate when CBT should be combined with pharmacology, despite it being recommended for all severe cases. Although access to high-quality CBT is often limited, there is promising evidence supporting the use of intensive CBT and therapist-guided e-therapy. There is insufficient information about the efficacy and safety of second-line pharmacological interventions in pediatric populations even though they are widely used. Although existing treatments can be highly efficacious for pediatric OCD, there is a clear need to increase access to evidence-based treatments, improve response and remission rates in available treatments, and evaluate second-line interventions for treatment nonresponders.
... The following keywords were combined, in English and Spanish, in the electronic searches: ((obsessive-compulsive) or (OCD)) and ((treatment) or (cognitive behavioral therapy) or (CBT) or (exposure response prevention) or (ERP)) and ((family) or (parents)), which should be in the title or the abstract. Second, the references of three meta-analyses cited above and five systematic reviews were consulted (Barrett, Farrell, Pina, Peris, & Piacentini, 2008;Himle, 2003;March, Franklin, Nelson, & Foa, 2001;Rosa-Alcázar et al., 2012;Rosa-Alcázar et al., 2015;Sánchez-Meca et al., 2014;Thompson-Hollands et al., 2014;Turner, 2006). Third, the references of the located studies were also reviewed. ...
... The main purpose of this research was to investigate the efficacy of CBFT in reducing the obsessive-compulsive symptoms and family accommodation in pediatric OCD. Global adjusted effect size for the CY-BOCS presented a large magnitude, d adj = 1.45, similar to the effect sizes reported for CBFTs (ds ranging from 1.68 to 2.03) in previous meta-analyses (Rosa-Alcázar et al., 2015;Sánchez-Meca et al., 2014;Thompson-Holland et al., 2014). In the same direction as results in previous meta-analysis (Rosa-Alcázar et al., 2015), the mean effect size obtained in the follow-ups indicated that reductions in obsessivecompulsive symptoms were not only maintained but were also in- In the follow-ups the mean effect size for family accommodation obtained from six studies was greater, exhibiting a large magnitude (d + = 1.06), although this effect size was not adjusted due to there being no control groups at follow-ups. ...
Article
A meta-analysis on the efficacy of cognitive-behavior-family treatment (CBFT) on children and adolescents with obsessive-compulsive disorder (OCD) was accomplished. The purposes of the study were: (a) to estimate the effect magnitude of CBFT in ameliorating obsessive-compulsive symptoms and reducing family accommodation on pediatric OCD and (b) to identify potential moderator variables of the effect sizes. A literature search enabled us to identify 27 studies that fulfilled our selection criteria. The effect size index was the standardized pretest-postest mean change index. For obsessive-compulsive symptoms, the adjusted mean effect size for CBFT was clinically relevant and statistically significant in the posttest (dadj=1.464). For family accommodation the adjusted mean effect size was also positive and statistically significant, but in a lesser extent than for obsessive-compulsive symptoms (dadj=0.511). Publication bias was discarded as a threat against the validity of the meta-analytic results. Large heterogeneity among effect sizes was found. Better results were found when CBFT was individually applied than in group (d+=2.429 and 1.409, respectively). CBFT is effective to reduce obsessive-compulsive symptoms, but offers a limited effect for family accommodation. Additional modules must be included in CBFT to improve its effectiveness on family accommodation.
... 3 Meta analiz çalışmasına göre ise BDT'nin tek başına veya SSGİ ile kombine uygulanması SSGİ'nin tek başına uygulanmasından üstündür. 4 BDT sonrası ilk seçenek SSGİ olup, OKB tedavisinde etkili olduğu yapılan çalış-malarla gösterilmiştir. 4 Çocuklarda kullanımı için Food and Drug Administration (FDA) onayı olan ilaçlar; klomipramin, fluoksetin, sertralin ve fluvoksamin olarak bilinir. ...
... 4 BDT sonrası ilk seçenek SSGİ olup, OKB tedavisinde etkili olduğu yapılan çalış-malarla gösterilmiştir. 4 Çocuklarda kullanımı için Food and Drug Administration (FDA) onayı olan ilaçlar; klomipramin, fluoksetin, sertralin ve fluvoksamin olarak bilinir. FDA çocuk ve ergenlerde OKB tedavisinde maksimum doza 3-4 hafta içinde ...
Article
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ÖZET Obsesif kompulsif bozukluk (OKB); yineleyen obsesyon ve kompulsiyonların görüldüğü, dönemsel alevlenmelerle giden, psikososyal işlevsellik düzeyinde belirgin bir bozulmaya yol açabilen nörobiyolojik temeli olan ruhsal bir hastalıktır. Obsesyon; tekrarlayıcı, istenmeyen, mantık dışı kabul edilen intruzif (girici) düşünce ya da dürtüler; kompulsiyon ise obsesyonlara tepki olarak ortaya çıkan, anksiyeteyi geçici olarak azaltmaya yardımcı, kişinin yapmak zorunda hissettiği, tekrarlayan davranış ya da zihinsel eylemlerdir. Çocukluk çağı OKB’si, komorbidite, başlangıç yaşı ve cinsiyet gibi değişkenlerin çeşitliliğine bağlı oldukça heterojen bir klinik görünümdedir. Bu sunumda çocuk ve ergenlerde OKB’de ilaç tedavisi, tedavi yanıtı ve ilgili değişkenleri araştıran klinik çalışmaların gözden geçirilmesi ve güncel yaklaşımların özetlenerek klinisyenlere sunulması amaçlanmıştır.
... For children and young people, CBT should always be the first-line approach (Sánchez-Meca et al., 2014;Skapinakis et al., 2016a), with ERP as core elements . ERP is both highly effective and also an acceptable intervention for youth ages 3-8 years with OCD . ...
... Key adaptations for younger children include extensive parental involvement targeting family accommodation and frequent family meetings while delivering a full course of ERP. According to the study of Sánchez-Meca et al. (2014), effect sizes were large for CBT (d+ = 1.742) and combined (medication plus CBT) interventions (d+ = 1.710) and moderate for pharmacological only treatments (d+ = 0.746). Familybased CBT (Piacentini et al., 2011;Freeman et al., 2014) is also effective for children and adolescents with OCD, especially when there is a high degree of accommodation. ...
Article
In this position statement, developed by The International College of Obsessive-Compulsive Spectrum Disorders, a group of international experts responds to recent developments in the evidence-based management of obsessive-compulsive disorder (OCD). The article presents those selected therapeutic advances judged to be of utmost relevance to the treatment of OCD, based on new and emerging evidence from clinical and translational science. Areas covered include refinement in the methods of clinical assessment, the importance of early intervention based on new staging models and the need to provide sustained well-being involving effective relapse prevention. The relative benefits of psychological, pharmacological and somatic treatments are reviewed and novel treatment strategies for difficult to treat OCD, including neurostimulation, as well as new areas for research such as problematic internet use, novel digital interventions, immunological therapies, pharmacogenetics and novel forms of psychotherapy are discussed.
... In addition, findings showed symptom severity decreased more in the condition with full CBT, and that the child-rated depressive symptoms showed no change across conditions. Further, in a meta analysis of 18 studies [27] looking at the differential effects of treatment, CBT (n = 11; CBT and CBT with EX/RP); medication management (n = 10); and combined CBT and medication management (n = 3) vs. a control condition, on juvenile-onset OCD, ages 7-17, each treatment was found to be efficacious in reducing OCD symptoms and severity as well as secondary outcomes. In this meta analysis, secondary outcomes were identified as the analysis of moderating variables across studies and showed improvements on depression and anxiety, particularly within CBT interventions. ...
... This study has identified downstream effects of FB-CBT on secondary acute treatment outcomes (non-OCD symptoms) among children with early-onset OCD, particularly for internalizing comorbidity. This finding is similar to what Lewin et al. [22] found in their treatment study of children with early-onset OCD and secondary outcomes of anxiety symptoms, as well as studies on secondary outcomes among samples of juvenile-onset OCD [26,27]. It is possible that the underlying processes and mechanisms of CBT EX/RP treatment in particular, and, in early-onset OCD, FB-CBT specifically, extend beyond the primary target of OCD to secondary acute outcomes, particularly when the comorbid symptoms are internalizing symptoms. ...
Article
Full-text available
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 impairment in children ages 5–8 years with OCD; however, its effectiveness on reducing comorbid psychiatric symptoms in this same population has yet to be demonstrated. This study examined the acute effects of FB-CBT vs. family-based relaxation treatment over 14 weeks on measures of secondary treatment outcomes (non-OCD) in children with early-onset OCD. Children in the FB-CBT condition showed significant improvements from pre- to post-treatment on secondary outcomes, with a decrease in overall behavioral and emotional problems, internalizing symptoms, as well as overall anxiety symptom severity. Neither condition yielded significant change in externalizing symptoms. Clinical implications of these findings are considered.
... The remaining 14 meta-analyses included patients with treatment-respondent OCD. Of these 14 studies, 6 were about double-blind, randomized, placebo-controlled trials on pediatric patients with OCD that showed superiority of SRIs for the treatment of OCD with a moderate effect size and a non-significant risk of suicidality, as well as that combined therapy was no more effective irrespective of the initial severity of the samples [14,[45][46][47][48][49]. All meta-analyses found that high doses of SSRIs were more effective as first-line therapy for patients with OCD; however, combined therapy was more effective than monotherapy. ...
Article
Full-text available
Obsessive-compulsive disorder (OCD) is a common mental health disorder that occurs at all ages, but more commonly in younger people. It affects 1-1.5% of the general population. Many pharmacological therapies have been reported to diminish OCD symptoms, as well as increase the patient's quality of life. So far, several meta-analyses have directly compared such treatment approaches in treatment-responsive and treatmentresistant OCD. This review evaluated all treatment options for OCD in both children and adolescents, and aimed to establish whether existing pharmacological therapies work similarly well, taking into account medical comorbidities such as substance use, anxiety, metabolic disorders, and finally, an overview of issues related to safety and monitoring. Our review included data from 16 meta-analyses and 8 practical guidelines focusing on OCD patients. In adults with OCD, we found that combined therapy shows favorable outcomes versus SRI alone and produced better results. In children with OCD the greatest incremental treatment gains occur early in treatment with selective serotonin reuptake inhibitors (SSRIs). Finally, in treatment-resistant OCD augmentation of SRIs can be regarded as an evidence-based measure in pharmacological therapy. The results of this review mostly support the previous reviews on the pharmacological management of OCD. However, we noted that combination/augmentation of SSRIs significantly improved symptoms in treatment-resistant OCD compared with monotherapy. From a clinical perspective, antipsychotics combination/augmentation of SSRIs should be used in comorbid psychosis, a frequent comorbidity in OCD, especially as the presence of comorbidities is highly associated with treatment resistance in OCD.
... The effectiveness of cognitive behavioral therapy (CBT) for childhood obsessive compulsive disorder (OCD) has been well established [1][2][3][4][5]. However, average symptom reduction is limited and almost half of the patients still have considerable complaints after standard treatment [6][7][8]. ...
Article
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Reframing cognitions is assumed to play an important role in treatment for obsessive-compulsive disorder (OCD). However, there hardly is any empirical support for this assumption, especially for children. The aim of this study was to examine if changing dysfunctional beliefs is a mediating mechanism of cognitive behavioral therapy (CBT) for childhood OCD. Fifty-eight children (8-18 years) with OCD received CBT. Dysfunctional beliefs (OBQ-CV) and OCD severity (CY-BOCS) were measured pre-treatment, mid-treatment, post-treatment, and at 16-week follow-up. Results showed that OCD severity and dysfunctional beliefs decreased during CBT. Changes in severity predicted changes in beliefs within the same time interval. Our results did not support the hypothesis that changing dysfunctional beliefs mediates treatment effect. Future studies are needed to replicate these findings and shed more light on the role of explicit and implicit cognitions in treatment for childhood OCD.
... L'enfant réalise alors que les conséquences aversives anticipées dans l'obsession ne se produisent pas [31]. Les résultats d'une méta-analyse comparant l'efficacité de la thérapie et de la pharmacothérapie chez le TOC à l'enfance montrent une taille d'effet supérieure de la TCC avec EPR combinée avec la médication avec les tailles d'effet de la TCC avec EPR sans médication (d = 1,203) et avec la prise d'inhibiteur de la recapture de la sérotonine (d = 1,704) [38,39]. Dans l'une des seules études cliniques à répartition aléatoire (n = 112), The Pediatric OCD Treatment Study Team [3], indique que 61 % des enfants ayant suivi une TCC avec EPR et 47 % des enfants ayant reçu une TCC avec EPR combinée à une médication étaient toujours aux prises avec des symptômes OC après 14 semaines de traitement. ...
Article
Résumé Le trouble obsessionnel-compulsif (TOC) se caractérise par la présence d’obsessions et/ou de compulsions, altérant le fonctionnement et causant une détresse significative. Selon the Expert Consensus Guidelines, la thérapie cognitive-comportementale (TCC) combinée à la prise de médicaments est considérée comme le traitement le plus efficace (March, Frances & Carpenter, 1997). Toutefois, selon the Pediatric OCD Treatment Study (2004), 47 % des enfants ayant un TOC sont réfractaires à la TCC combinée à la prise de médicaments après 14 semaines de suivi. Fontaine, Berthiaume et O’Connor (2018), ont mis sur pied un manuel de traitement inspiré du modèle adulte de la thérapie basée sur les inférences (TBI). La TBI cible les composantes imaginaires des obsessions et des compulsions dans le récit de l’enfant et identifie le doute obsessionnel pour diminuer les symptômes du TOC plutôt que d’utiliser des techniques d’expositions avec prévention de la réponse (O’Connor & Aardema, 2011). L’objectif de cette étude est d’évaluer la faisabilité et l’effet de la TBI auprès d’un enfant. Cette étude présente l’étude de cas d’une enfant de 12 ans atteinte du TOC. Les résultats montrent une réduction complète des obsessions et des compulsions à la fin du traitement, alors que ces dernières étaient considérées comme sévère à l’évaluation prétraitement. L’amélioration clinique des symptômes du TOC s’est maintenue à l’évaluation de suivi huit mois. La présente étude de cas évalue la faisabilité et évalue l’effet de la TBI chez l’enfant montrant des résultats prometteurs. Ainsi, une étude de validation de l’efficacité de la TBI devra être conduite ultérieurement en tenant compte des limites méthodologiques et des pistes de réflexion suggérées.
... Whereas the adult Y-BOCS relies on interview data from the client, the CY-BOCS culls ratings from both the child and the parent or guardian. Further, the instructions specify that "sometimes, however, it may also be useful to interview the child or parent alone" [7]. Other instruments designed to assess pediatric OCD symptoms, namely the Leyton Obsessional Inventory-Child Version survey (LOI-CV), the Children's Obsessional Compulsive Inventory (CHOCI), the Obsessive-Compulsive Inventory-Child Version (OCI-CV), the Child Saving Inventory, and the Obsessive Beliefs Questionnaire-Children's Version are promising assessments for assessing symptoms and the severity of OCD, but they do not assess the obsessive-compulsive dimensionality [8]. ...
Article
Background: Obsessive Compulsive Disorder (OCD) is one of the common psychiatric disorders among children and adolescent. Prevalence of child and adolescent OCD is 2% in Bangladesh. Gold standard Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) is a clinician-rated and most widely used scale in measurement of OCD symptom severity and thereby treatment response in children and adolescent age group. A validated scale for children and adolescent patient with OCD is needed for measuring symptom severity as well as treatment outcome in Bangladesh. Aim of the study: The aim of this study was to develop a culturally adapted and psychometrically validated Bangla version Children's Yale Brown Obsessive Compulsive Scale for use in Bangla speaking child and adolescent patients with obsessive compulsive disorder in Bangladesh. Methods: This validation study was conducted in the period of July 2016 to September 2017 in the department of Psychiatry, Bangabandhu Sheikh Mujib Medical University, Dhaka. In this study researcher applied Bangla version of Children's Yale Brown Obsessive- Compulsive Scale in 47 child and adolescent with OCD and assessed the validity (Content validity, Face validity, Convergent validity and Factor analysis) and reliability (Internal consistency, Inter-rater reliability, Test-retest reliability). Results: Age of the respondents were ranging from 8-17 years. Content validity and face validity was maintained by following standard procedures. Good convergent validity was found with culturally adapted Developmental and Well Being Assessment (DWABA) Bangla by using spearman's rho. Factor analysis revealed 2 components in the construct. Communalities were above accepted level. In assessing internal consistency, Cronbach's Alpha (a) value was 0.91, which reflects good reliability. Inter rater reliability was excellent for CY-BOCS total and each individual 10 items as the range of intraclass correlation was 0.96 to 0.98 which represented very .........
... Recent research has found that CBT has the potential to reduce and control symptomology of OCD in a way that far exceeds the pharmacological methods such as serotonergic antidepressants [9]. Several studies found that CBT garnered a greater effect size and provided more substantial improvements of clinical symptoms [10][11][12][13]. A meta-analysis carried out by Olatunji et al [14] examined the efficacy of CBT for OCD and found that the therapy was highly effective for the reduction of symptomology. ...
Article
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Background Cognitive behavioral therapy (CBT) in its basic principle has developed itself as a stand-alone, substantial method of therapy. With effective application in therapy for a range of mental health issues, the spread of CBT methods to Web-based therapy sources is evident. The development of mobile phone apps using CBT principles is increasing within the research area. Despite the move to Web-based methods of therapy, it is argued that these methods lack the same efficacy of face-to-face therapy sessions. Objective The aim of this review was to assess extent research findings with regard to the effectiveness of CBT-related mobile health (mHealth) apps. By assessing only studies employing a randomized controlled trial design, the review aimed to determine app efficacy within the highly regarded method of investigation. Methods A comprehensive literature search was conducted across several databases. Search results were filtered, and results were subject to strict inclusion and exclusion criteria because of the nature of the review. Where possible, analysis of effect size was calculated and results reported. Results A total of 8 studies investigating the effectiveness of mHealth CBT-related apps across a range of mental health issues were reviewed. Three studies used the app against a control group, and 5 studies used the app intervention against another form of treatment or intervention. A range of effect sizes were seen across all included studies (d=−0.13 to 1.83; 0.03-1.44), with the largest effects often being seen when comparing the data from pre- to posttest for the app engaged group. Conclusions The studies reviewed support the use of mHealth apps containing CBT principles for a range of mental health issues. However, the effectiveness over longer time periods should be assessed. Researchers and professionals should seek to collaborate effectively when creating new apps to enhance their effectiveness as a treatment for the general public.
... is preferable in moderate-severe OCD was stated in the US OCD practise parameter (D. Geller et al., 2012), based on the findings of the POTS-study (2004), and endorsed in two recent meta-analyses, one based on child only studies (Sanchez-Meca et al., 2014) and one based on both adult and child studies (Romanelli, Wu, Gamba, Mojtabai, & Segal, 2014). However, the conclusion is not unproblematic due to the heterogeneous outcome in the COMBO group, with the superiority of COMBO dependent on one site, while another site had equally high efficacy in CBT only as in COMBO. ...
Chapter
This chapter first considers what is known about the phenomenology of obsessive compulsive disorder (OCD), its course, and what model or understanding of OCD pathogenesis is most appropriate. Then, it discusses what implications this understanding has for the way care for patients should be organized. The chapter argues that pediatric OCD should be seen as a developmental disorder in the development of goal-directed behaviors. The arguments for this view will be based on the following considerations: neurobiological findings, including some neuropsychological findings; cognitive neuroscience findings; clinical aspects like comorbidity; inferences from treatment; and the natural course of pediatric OCD. Treatment of OCD in children with Autism Spectrum Disorders (ASD) needs to be adjusted to the deficits in executive functioning, social development and their perception of the environment.
... If untreated, OCD symptoms often persist into adulthood [14], and lead to substantial impairments in family, academic and social functioning, and to a reduced quality of life [15][16][17]. Cognitive behavioral therapy (CBT) is the first-line treatment for pediatric OCD [18], and its effectiveness has been extensively demonstrated [19][20][21]. However, treatment for OCD is hampered by several problems [9,22]. ...
Article
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Many children with mental health disorders do not receive adequate treatment due to the uneven dissemination of resources, and other barriers to treatment. In the case of pediatric obsessive compulsive disorder treatment progress is also hindered by partial or non-response to treatment in addition to poor compliance. This debate paper focuses on new technologies as a potential vehicle to address the challenges faced by traditional treatment, with special reference to cognitive behavioral therapy for pediatric obsessive compulsive disorder. We discuss the achievements and challenges that previous studies have faced, debate ways to overcome them, and we offer specific suggestions for further research in the area.
... Research findings in psychological and pharmacological interventions have suggested that early detection and treatment can improve the prognosis in many cases (Leonard et al., 1993;Rosa-Alcázar, Iniesta-Sepúlveda, & Rosa-Alcázar, 2012;Rosa-Alcázar et al., 2015;Sánchez-Meca, Rosa-Alcázar, Iniesta-Sepúlveda, & Rosa-Alcázar, 2014). ...
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El objetivo de este estudio fueanalizar las propiedades psicométricas del ShortLOI-CVen unamuestra españolacomunitaria.Los participantes fueron 914 niñosyadolescentescon edad mediade13.01años (varones =51.3%).ElAFE mostróun modelo de tresfactores compuesto por los dominios Obsesiones, CompulsionesyLimpieza. Tanto lapuntuación total comolas subescalas mostraron una adecuadaconsistenciainterna.Laversión española mostróbuena fiabilidad test-retestymoderada validezconvergenteydiscriminante.Los participantes más jóvenes (8a10 años) obtuvieron medias más altasquela escala Totalydistintas subescalas quelos mayores (grupo de11-13yde 14-18años). Se encontraron también diferencias significativas respecto al sexo, siendo losvarones los que mayoresmedias mostraron en laescala de compulsiones.Pese aqueesnecesariamás investigación, estos resultados sugirieron que la versión en español del ShortLOI-CV mostróun buen rendimiento psicométricos para evaluar los síntomas obsesivo-compulsivosen niñosyadolescentesen población comunitaria The aim of the current study was to analyze psychometric properties of the Short LOI-CV in Spanish community sample. Participants were 914 children and adolescents with mean age of 13.01 years (51.3% males). An EFA yielded a three-factor model representing Obsessions, Compulsions, and Cleanliness dimensions. Both, total score and subscales showed an adequate internal consistency. The Spanish version also exhibited good test-retest reliability and moderate convergent and discriminant validity. The younger participants (from 8 to 10 years) obtained higher means for total score and subscales than older participants (groups 11-13 and 14-18 years). Significant differences related to gender were also observed since males obtained higher means in Compulsions subscale. Despite more research is required, the Spanish version of the Short LOI-CV exhibited promising psychometric results to assess obsessive-compulsive symptoms in community population.
... Research findings in psychological and pharmacological interventions have suggested that early detection and treatment can improve the prognosis in many cases (Leonard et al., 1993;Rosa-Alcázar, Iniesta-Sepúlveda, & Rosa-Alcázar, 2012;Rosa-Alcázar et al., 2015;Sánchez-Meca, Rosa-Alcázar, Iniesta-Sepúlveda, & Rosa-Alcázar, 2014). ...
Article
The aim of the current study was to analyze psychometric properties of the Short LOI-CV in Spanish community sample. Participants were 914 children and adolescents with mean age of 13.01 years (51.3% males). An EFA yielded a three-factor model representing Obsessions, Compulsions, and Cleanliness dimensions. Both, total score and subscales showed an adequate internal consistency. The Spanish version also exhibited good test-retest reliability and moderate convergent and discriminant validity. The younger participants (from 8 to 10 years) obtained higher means for total score and subscales than older participants (groups 11-13 and 14-18 years). Significant differences related to gender were also observed since males obtained higher means in Compulsions subscale. Despite more research is required, the Spanish version of the Short LOI-CV exhibited promising psychometric results to assess obsessive-compulsive symptoms in community population.
... Seven of nine participants (78%) were treatment responders, and large treatment effects (d = 1.35-2.58) were obtained on primary outcomes (e.g., obsessive-compulsive 1 3 youth with OCD, demonstrating superiority to pharmacological treatment [10,11]. When OCD is present with comorbid psychiatric disorders, treatment and prognosis are complicated, with research suggesting diminished treatment response [12,13]. ...
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Obsessive-compulsive disorder (OCD) is prevalent among youth with autism spectrum disorder (ASD). Cognitive-behavioral therapy (CBT) with ASD-specific modifications has support for treating OCD in this population; however, use of intensive CBT in youth with ASD and severe OCD has not been tested. The current study examined the preliminary effectiveness of an individualized intensive CBT protocol for OCD in adolescents with ASD. Nine adolescents (aged 11-17 years) completed a regimen of intensive CBT (range 24-80 daily sessions) incorporating exposure with response prevention (ERP). Treatment materials, language and techniques were modified in accordance with evidence-based findings for this population. Seven of nine participants (78%) were treatment responders, and large treatment effects (d = 1.35-2.58) were obtained on primary outcomes (e.g., obsessive-compulsive symptom severity). Preliminary findings suggest that an intensive CBT approach for OCD is effective among adolescents with ASD.
... The best established psychological treatment for pediatric and adult OCD is cognitive-behavioral therapy (CBT) with exposure response prevention (ERP) as the core component (Rosa-Alcázar et al., 2008;. The effectiveness of ERP has been demonstrated in children with OCD (McGuire et al., 2015), showing superiority to (Sánchez-Meca et al., 2014) and active psychotherapy control conditions (e.g., relaxation therapy; Freeman et al., 2014;Piacentini et al., 2011). ...
... Several randomized clinical trials showed that cognitive behavioural therapy (CBT), including exposure with response prevention (ERP) and/or cognitive restructuring techniques, is the most effective psychological intervention for OCD (e.g., Gava et al., 2009;Olatunji, Williams, Powers, and Smits, 2013;Sánchez-Meca, Rosa-Alcázar, Iniesta-Sepúlveda, and Rosa-Alcázar, 2014). ERP entails confrontation with obsessional stimuli (exposure) and refraining from compulsions to demonstrate that feared consequences will not occur (response prevention) (Gava et al., 2009). ...
... Other authors have also demonstrated a high prevalence of anxiety disorders, with panic disorder and simple phobia (44,66). It is evident that anxiety disorders, depression, and neurological development disorders such as attention deficit hyperactivity are, among other clinical manifestations, associated with JH (43,44). ...
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Objectives To identify psychosocial and motor aspects related to joint hypermobility (JH) in a sample from almost all Brazilian states by age range and sex; to characterize JH by the Beighton total score ≥4, ≥5, and ≥6 according to sex and age and atypicality in the sitting position and in the hands; identify, in the total sample, manifestations of “growing pain” and its location, fatigue, attention deficit, anxiety, insomnia, drowsiness, apathy, depression, delay in walking, not crawling or crawling differently, school performance, spatial orientation and/or temporally impaired, social isolation, and being stigmatized as “lazy/clumsy/apathetic”. Methods This retrospective, observational, quantitative, and cross-sectional study used data obtained through analyses of descriptive and inferential crossings between 2012 and 2020 of 482 medical records of individuals between 1 and 76 years of age, from most Brazilian states. All patients previously diagnosed with “joint hypermobility syndrome” (JHS) and “Ehlers-Danlos syndrome hypermobility type” (EDS-HT) had their medical records reassessed, following the guidelines established in 2017. The analysis of GJH was performed using the updated method by Beighton method; atypical characteristics were investigated in the hands and the ability to sit in the “W” and the “concave” positions. The characteristics and manifestations of “growing pain” and its location were analyzed in the total sample, fatigue, insomnia, drowsiness, apathy, depression, social isolation, attention deficit, anxiety, stigmatization as “lazy,” clumsy/restless, impaired school performance, and spatial and/or temporal orientation. Descriptive and inferential statistical methods were used, such as Mean, Median, Mode, Standard Deviation, Standard Error, Maximum Value, Minimum Value, Komolgorov-Smirnov , Significance, Relative Value, Absolute Value, Mann-Whitney U , and Correlation of Spearman . Results JH in the total sample predominated in the upper limbs, the majority were women, represented by 352 (73.02%), 15 years old or older with 322 (66.80%), 312 (64.73%) had a Beighton total score ≥6, which decreased as the age increased. Always sitting in the “concave” position was represented by 54.15% and the ability to sit in the “W” position by 39.21%; signs on the hands totaled between 27.59 and 44.19% with a significant correlation between the variables. Among the characteristics, fatigue predominated, followed by an awkward/clumsy/restless individual, attention deficit, anxiety and stigmatized as “lazy,” insomnia, drowsiness, apathy, depression, impaired spatial and/or temporal orientation, and social isolation. From the total sample, pain in the lower limbs was reported by 55.81% and having or having had “growing pain” was reported by 36.93%, delay in walking occurred in 19.92%, 15.35% did not crawl or crawled differently, and for 12.86%, school performance was impaired. Higher Beighton total scores showed a trend towards motor implications and correlation between variables. Ability to still sit in the “concave” position was possible for 54.15% and to sit in the “W” position for 39.21%. Conclusion In the total sample, the JH characteristic prevails in the upper limbs of female children, adolescents and adults, with a total Beighton score ≥6. Most sit in the “concave” position and less than half also sit in the “W” position and with atypical hand postures. The higher Beighton scores, which include the upper limbs, show a tendency to not crawl or crawl differently, delayed ambulation, and impaired school performance. The predominance of JH in the upper limbs is suggestive of a justification for not crawling or crawling differently. Characteristics of atypical motor performance in hands and sitting posture, in addition to fatigue, pain since childhood, anxiety, apathy, depression, sleep disorders, stigmatization, attention deficit, spatial and/or temporal orientation impairment, and social isolation are characteristics. suggestive of psychosocial implications at different ages. Future studies with motor and psychosocial aspects of people with JH will help to identify the phenotype of this population and consequent guidance for clinical management based on the motor and psychosocial aspects of people with JH.
... The recommended first-line psychological treatment for OCD is cognitive-behavioral therapy (CBT; American Psychiatric Association, 2013; National Institute for Health and Clinical Excellence, 2005). A large body of evidence has demonstrated the efficacy of CBT for OCD in youth (e.g., Öst, Riise, Wergeland, Hansen, & Kvale, 2016;Sánchez-Meca, J., Rosa-Alcázar, A. I., Iniesta-Sepúlveda, M., & Rosa-Alcázar, 2014). The majority of treatment trials have used CBT with an emphasis on the use of exposure with response prevention (ERP) as the key ingredient (e.g., Barrett, Healy-Farrell, & March, 2004;Freeman et al., 2014). ...
Article
Evidence for using cognitive-behavioral therapy (CBT) for the treatment of obsessive-compulsive disorder (OCD) in young people emphasizes the use of exposure with response prevention (ERP) as the key ingredient. CBT with a cognitive focus is used more often in adults, and comparatively there is less evidence for its use with young people. Although a significant proportion of young people with OCD respond well to CBT using ERP, a subset does not. Therefore, there is a need to consider alternative approaches. This case study describes the treatment of a 15-year-old girl with severe OCD using a cognitive approach. This case identifies the criteria used to make the decision to use a cognitive over an ERP approach and highlights the differences between the treatments. This case study demonstrates the merit of considering the cognitive approach to treatment of OCD for some young people.
... ). Por otra parte, existen estudios que re- lacionan el mayor número de horas (Sánchez-Meca,Rosa-Alcázar et al., 2014) y de sesiones de terapia con una mayor eficacia de la TCC(McGuire, Piacentini et al., 2015).3. Los factores moderadores o variables que pueden influir en la efi- cacia del tratamiento. ...
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El trastorno obsesivo-compulsivo (TOC) se inicia a menudo durante la infancia o la adolescencia y puede convertirse en un trastorno crónico y altamente incapacitante si no se trata de forma adecuada. Su impacto no solo se limita al paciente (interrupción del desarrollo psicosocial, alta comorbilidad psiquiátrica a largo plazo, etc.), sino que puede extenderse a la familia, lo cual genera un alto nivel de sufrimiento. Durante mucho tiempo, los tratamientos psicológicos y farmacológicos empleados en niños y adolescentes han sido los mismos que los utilizados en población adulta. Sin embargo, el TOC de inicio en la infancia presenta una serie de características distintivas que tienen implicaciones para el manejo clínico y la respuesta al tratamiento. En primer lugar, acostumbra a aparecer junto a otra patología comórbida que puede interferir en la terapia cognitivo-conductual (TCC), tratamiento de primera elección para este trastorno. Si el TOC cursa con un trastorno por tics, las compulsiones pueden estar más relacionadas con fenómenos sensoriales que con pensamientos obsesivos, por lo que la eficacia de las intervenciones centradas en el manejo de cogniciones puede ser menor; y si cursa con un trastorno depresivo, este podría reducir la capacidad del niño o adolescente para tolerar el malestar relacionado con la exposición con prevención de respuesta, uno de los componentes fundamentales de la TCC para el TOC. En segundo lugar, muchas de las técnicas psicológicas usadas con adultos presuponen, por una parte, una capacidad de introspección o unas habilidades metacognitivas que pueden no estar presentes en pacientes de menor edad, y por otra, hay una necesidad de incluir a las familias en toda intervención psicológica realizada en niños y adolescentes. Todos estos hechos justifican la necesidad de que la intervención psicológica se realice por profesionales debidamente entrenados. Con el objetivo de mejorar la calidad asistencial de los niños y adolescentes con TOC, profesionales de dos reconocidos hospitales de nuestro país (Servicio de Psiquiatría del Niño y el Adolescente del Hospital General Universitario Gregorio Marañón de Madrid y Servicio de Psiquiatría y Psicología Infantil y Juvenil del Hospital Clínic Universitari de Barcelona), se han propuesto realizar esta Guía Práctica Clínica sobre el TOC en niños y adolescentes. La guía se dirige a todos los profesionales de salud mental infanto-juvenil interesados en implementar tratamientos basados en datos empíricos.
... In adulthood, OCD has been ranked among the top 10 most disabling illnesses by the World Health Organization (Murray & Lopez, 1996). Over the last decade, substantial evidence has accumulated for the efficacy of cognitive behavioral therapy (CBT) in treating pediatric OCD ( Sánchez-Meca, et al., 2014;Watson & Rees, 2008). In line with the robust evidence base, there is international consensus that CBT is a first-line treatment for OCD in children and adolescents (Geller & March, 2012;NICE, 2005). ...
Chapter
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Innovations in CBT for Childhood Anxiety, OCD, and PTSD - edited by Lara J. Farrell April 2019
... The correlations of the OCD-CA subscales with other ratings were predominantly close to those of the OCD-CA Total scores, with the exception of the subscale Checking, which had mainly lower correlations. Correlations in the other samples (OCDS, COS) were similar (Additional file 5,6). ...
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Background: This study assesses the psychometric properties of the German version of the Padua Inventory-Washington State University Revision for measuring pediatric OCD. Methods: The parent-rating and self-rating inventory is assessed in a clinical sample (CLIN: n = 342, age range = 6-18 years) comprising an OCD subsample (OCDS: n = 181) and a non-OCD clinical subsample (non-OCD: n = 161), and in a community sample (COS: n = 367, age range = 11-18 years). Results: An exploratory factor analysis yielded a four-factor solution: (1) Contamination & Washing, (2) Catastrophes & Injuries, (3) Checking, and (4) Ordering & Repeating. Internal consistencies of the respective scales were acceptable to excellent across all samples, with the exception of the self-report subscale Ordering and Repeating in the community sample. The subscales correlated highly with the total score. Intercorrelations between the subscales were mainly r ≤ .70, indicating that the subscales were sufficiently independent of each other. Convergent and divergent validity was supported. Participants in the OCD subsample scored significantly higher than those in the non-OCD clinical subsample and the COS on all scales. In the COS, self-rating scores were significantly higher than parent-rating scores on all scales, while significant mean differences between informants were only found on two subscales in the OCD subsample. Conclusion: The German version of the Padua Inventory-Washington State University Revision for measuring pediatric OCD is a promising, valid and reliable instrument to assess self-rated and parent-rated pediatric OCD symptoms in clinical and non-clinical (community) populations.
... When we look at these different data, treatment of TTM appears to resemble that of TS treatment, with antipsychotics seemingly effective and selective serotonin reuptake inhibitors (SSRI) [196][197][198][199][200][201][202] ineffective (while SSRIs are a well-established treatment for OCD [203][204][205][206][207][208][209][210][211][212][213][214]. A metaanalysis found serotonin reuptake inhibitors (SRI) to be effective in TTM, 215 contradicting a previous metaanalysis. ...
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Objective: Trichotillomania (TTM) is characterized by the pulling out of one's hair. TTM was classified as an impulse control disorder in DSM-IV, but is now classified in the obsessive-compulsive related disorders section of DSM-5. Classification for TTM remains an open question, especially considering its impact on treatment of the disorder. In this review, we questioned the relation of TTM to tic disorder and obsessive-compulsive disorder (OCD). Method: We reviewed relevant MEDLINE-indexed articles on clinical, neuropsychological, neurobiological, and therapeutic aspects of trichotillomania, OCD, and tic disorders. Results: Our review found a closer relationship between TTM and tic disorder from neurobiological (especially imaging) and therapeutic standpoints. Conclusion: We sought to challenge the DSM-5 classification of TTM and to compare TTM with both OCD and tic disorder. Some discrepancies between TTM and tic disorders notwithstanding, several arguments are in favor of a closer relationship between these two disorders than between TTM and OCD, especially when considering implications for therapy. This consideration is essential for patients.
... ERP involves prolonged and repeated exposure to obsessional stimuli without acting out compulsions; this is thought to decrease distress and the perceived necessity to respond to triggering stimuli [29]. The effectiveness of ERP has been demonstrated in OCD children [30] and has been shown to be more effective than pharmacological monotherapy [49] and active psychotherapy (e.g., relaxation therapy) [15,42]. Currently, CBT with ERP as the core component is the most established and effective psychological treatment for pediatric OCD [14,15,37,44,59]. ...
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Obsessive-compulsive disorder (OCD) is a neuropsychiatric disorder that is frequently diagnosed in children and adolescents. In pediatric OCD, family plays an important role in the development and maintenance of the disease. In this relationship, both genetic and behavioral factors, such as parental modeling and family accommodation, are significant. Parental modeling concerns the daily enactment of dysfunctional behavioral patterns by a parent with OCD, which may influence children. Family accommodation, in contrast, describes the direct participation of parents in their child’s compulsive rituals, by modifying daily routines or by facilitating avoidance of OCD triggers, to decrease the child’s distress and time spent executing compulsions. Approximately 80–90% of the relatives of OCD patients actively participate in patients’ rituals. The literature demonstrates that a high level of family accommodation is associated with OCD symptom severity, reduced response to cognitive-behavioral treatment (CBT), and a higher risk of therapy dropout. Despite this, no studies have aimed at delineating practical guidance for psychotherapists to support parents in reducing family accommodation. The main aim of this paper is to propose a psychoeducation intervention focused on cognitive-behavioral strategies to help families to manage their child’s OCD behaviors without enacting dysfunctional family accommodation behaviors in order to support their child’s successful therapy.
... The characteristics extracted were: (1) year of the study; (2) geographical location; (3) sample size (total and by groups); (4) mean age (total and by groups); (5) sex distribution (total and by groups); (6) education level (primary, secondary or tertiary); (7) outcome; and (8) statistics reported to calculate the effect sizes. Finally, methodological quality was measured using an ad hoc 12-dichotomous item checklist (see Appendix 1) based on checklists previously used and in other methodological reviews (Lorz et al., 2013;Maher et al., 2003;Sánchez-Meca et al., 2014). ...
Article
Although some meta-analyses have investigated the effect of Entrepreneurship Education (EE), they mixed studies with high and low methodological quality. Thus, their results might overestimate the impact. This paper aims to examine the efficacy of the EE in student samples, attending to studies with a pre-posttest design and a control group. The results showed small effect sizes for EE in increasing Entrepreneurship Intention (EI) and Self-efficacy. Moreover, meta-regression confirmed that the duration of intervention programs predicted larger effect sizes for the EI. Finally, the practical implications of other potential moderator variables are discussed.
... Fortunately, both behavioral and pharmacological interventions have demonstrated efficacy for pediatric OCD. Cognitive-behavioral therapy (CBT) and the use of selective serotonin reuptake inhibitors (SSRIs) are two empirically supported treatments for pediatric OCD that have produced large treatment effects for symptom reduction and diagnostic remission (for reviews, see McGuire et al., 2015;Öst et al., 2016;Sánchez-Meca et al., 2014). CBT in the context of OCD encompasses principles of exposure plus response prevention (ERP), which involves systematic, graded exposure to an anxiety-provoking stimulus, thought, or situation (e.g., touching an unclean surface), and delaying or preventing the execution of a compulsion to alleviate the anxiety (e.g., handwashing). ...
Chapter
This chapter discusses biological models and treatments for obsessive-compulsive and related disorders (OCRDs) in light of recent findings in the genetics and neurobiology of pediatric obsessive-compulsive disorder (OCD). It then describes major biological models proposed for OCD based on the understanding of the neurotransmitters, neurocircuitry and genetic factors implicated in OCRDs with an emphasis on the pediatric population. Next, the chapter also discusses pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS)/pediatric acute-onset neuropsychiatric syndrome (PANS), a proposed subtype of acute onset pediatric OCD. Three main neurotransmitters – serotonin, dopamine and glutamate – have been implicated in OCD. The chapter provides an overview of the evidence supporting an association with each of these neurotransmitters, with further discussion in the imaging and genetic sections which follow. Finally, it reviews the different classes of medications used for pediatric OCD, and new and innovative non-pharmacological approaches.
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Þó að gagnreyndum meðferðarúrræðum fyrir börn og unglinga með geðraskanir hafi fjölgað mikið á síðustu 30-40 árum, þá vantar enn mikið upp á reynslugögn fyrir framhaldsmeðferð. Margar geðraskanir eru langvinnar þar sem þörf er á meðferð, í einu eða öðru formi, í langan tíma. Í þessari grein er fjallað um nauðsyn þrepaskiptrar einstaklingsbundinnar meðferðar (sequential individualized treatment) svo hægt sé að ná betri meðferðarárangri, auka lífsgæði og starfshæfni til lengri tíma hjá fólki með langvinnar geðraskanir. Þrepaskipt meðferð má einnig kalla meðferðaráætlun sem er einstaklingsbundin og byggir á sjúklingaupplýsingum í upphafi meðferðar og á meðan meðferð stendur yfir. Þrepaskipt meðferð samræmist betur raunverulegum gangi sumra geðraskana, heldur en bráðameðferð sem á að leysa allan vanda sjúklings fyrir fullt og allt. Klínískar leiðbeiningar fjalla um þrepaskipta meðferð en það er sjaldgæft að reynslugögn um þrepaskipta meðferð búi að baki leiðbeiningunum. Í greininni eru tekin dæmi af áráttu- og þráhyggjuröskun hjá börnum og unglingum og ólíkum tilraunasniðum lýst. Sérstaklega verður fjallað um fjölþrepaslembivalsrannsókn (sequential multiple assignment randomized trials) eða SMART sem er afar gagnleg leið til þess að þróa og meta árangur meðferðaráætlunar fyrir þrepaskipta meðferð. Gagnlegum dæmum um óvissuatriði í klínískum leiðbeiningum verður lýst og fjallað um hvernig SMART tilraunasnið geti dregið úr slíkri óvissu. Einnig verður fjallað um atriði er varða afköst (power) í SMART tilraunasniði. The status of evidence-based treatments for children with psychiatric disorders has improved significantly over the last 30-40 years. However, there is still a great need for evidence-based sequential treatments for patients with more chronic psychiatric disorders. In this paper, I discuss the necessity of sequential individualized treatments in order to obtain better treatment outcomes and increased quality of life over time for people with chronic psychiatric disorders. Sequential treatment is a form of treatment plan which is individualized and is based on patient characteristics at baseline and intermediate treatment outcomes. Sequential treatments may more accurately meet the needs of of more chronic psychatric disorders, compared to acute treatments that are supposed to cure the patient once and for all. Clinical guidelines discuss the need of sequential treatments but they are rarely evidence-based. The paper provides examples on how sequential treatments are needed for children and adolescents with obsessive-compulsive disorder. I present examples of appropriate research designs to evaluate sequential treatments for this group. Sequential multiple assignment randomized trials (SMART) will be discussed specifically. SMART is a very practical research design to develop and evaluate sequential treatments. I will describe specific examples of non-evidence-based sequential treatments recommended in clinical guidelines and present how a SMART design may be used to evaluate different treatment sequences. I will also discuss power issues when using the SMART design.
Article
Background Studies have shown that pharmacological and psychological treatments are effective for children and adolescents with obsessive-compulsive disorder (OCD). However, few network meta-analyses have examined whether pharmacological or psychological treatments on their own, or combined, are most effective. Methods We conducted a database search and selected randomized controlled trials of pharmacological or psychological treatments, alone or in combination, for children and adolescents with OCD. The primary outcome was change in symptom severity as a result of treatment, as assessed using the Yale-Brown Obsessive Compulsive Scale (YBOCS) or Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS). Results We included 18 studies with 1353 participants and 12 kinds of treatments. In terms of efficacy, all pharmacological and psychotherapy treatments were more effective than placebo. Among the 12 treatments, the efficacy of pharmacological treatment combined with cognitive behavioral therapy (CBT) was more effective than pharmacological treatment alone. When pharmacological treatment was used alone, escitalopram was significantly more effective than clomipramine (CY-BOCS average change 3.42; 95% CI 2.11, 4.65), fluvoxamine (CY-BOCS average change 3.59; 95% CI 1.09, 6.20), paroxetine (CY-BOCS average change 2.80; 95% CI 0.01, 5.64) and sertraline (CY-BOCS average change 3.49; 95% CI 1.53, 5.64). Conclusions The available evidence suggests that the combination of pharmacological and psychological treatment is likely to be most effective for children and adolescents with OCD.
Article
Purpose of review: This article describes the phenomenology and clinical presentation of obsessive-compulsive disorder (OCD), a common but underdiagnosed psychiatric disorder. Guidance for effectively identifying obsessive-compulsive symptoms is provided, and treatment options, including psychotherapy, pharmacologic management, and neuromodulation approaches for treatment-resistant OCD, are discussed. Recent findings: OCD affects 2% to 3% of adults worldwide and is associated with substantial individual disability and societal costs. Lack of recognition of common OCD symptom types, in addition to shame and fear of stigma on the part of patients, has created an average delay in diagnosis by almost 10 years and a delay in effective treatment (ie, a treatment gap) of nearly 2 years. Cognitive-behavioral therapy (CBT), specifically a form of CBT that includes a type of behavioral intervention called exposure and response prevention, remains the most effective form of treatment for OCD. If CBT is not effective or not available, pharmacologic treatment with selective serotonin reuptake inhibitors (SSRIs) or clomipramine, a nonselective serotonin reuptake inhibitor, can also be of benefit. Neuromodulation approaches such as deep brain stimulation and transcranial magnetic stimulation are rapidly emerging as effective treatments for OCD, particularly for patients who have not experienced an adequate response to psychotherapy or pharmacologic management. Summary: OCD affects more than one in every 50 adults in the United States but is recognized and adequately treated in fewer than half of those affected. Early intervention and appropriate treatment can substantially reduce OCD symptom severity, improve quality of life, and minimize the functional disability associated with this chronic and often debilitating illness.
Article
Zwangsstörungen gehören mit einer Langzeitprävalenz von 1-3% auch im Kindes- und Jugendalter zu den häufigsten psychischen Störungen. Es liegen zwei Erkrankungsgipfel im Altersbereich von 11-14 Jahren und im jungen Erwachsenenalter mit 20 Jahren vor. 20% der Zwangsstörungen beginnen vor dem Alter von 10 Jahren und 60% vor dem Alter von 25 Jahren. Die Erkrankung wird oftmals sehr spät erkannt. Es dauert im Durchschnitt über 10 Jahre bis die Patienten professionelle Hilfe aufsuchen. Es gibt einige behandlungsrelevante Unterschiede von Zwangsstörungen im Kindes- und Jugendalter im Vergleich zum Erwachsenenalter. In der Diagnostik und Behandlung müssen das Alter und der Entwicklungsstand der Betroffenen sowie die Bedingungen um familiären und sozialen Umfeld berücksichtigt werden. Die Fehl- und Unterdiagnosen sind im Kindes- und Jugendalter wie im Erwachsenenalter sehr hoch. Verlaufsstudien zeigen, dass die Erkrankung oft chronisch verläuft und zu einer erheblichen psychosozialen Beeinträchtigung führt. Auch ist das Risiko für die Entwicklung von weiteren psychischen, aber auch somatischen Störungen und Folgeerkrankungen hoch. Aus der Studienlage wird deutlich, dass der frühe Behandlungsbeginn einer der wichtigsten positiven prognostischen Faktoren ist (Walitza et al., 2020, Fineberg et al., 2019). Wegen der hohen Bedeutung der Früherkennung und frühen Interventionen wurde 2019 ein internationales Consensus-Statement verfasst (Fineberg et al., 2019) in welchem auch die Aspekte, die Kinder und Jugendliche betreffen, berücksichtigt werden. Zudem besteht eine Unterversorgung, diese kommt unter anderem zustande durch mangelnde Verfügbarkeit von einer anwendergerechten Zusammenfassung der Evidenz von Behandlungsansätzen im Rahmen einer Leitlinie für Diagnostik und Therapie im Kindes- und Jugendalter. Diese Gründe, aber auch das Ziel der breiten Disseminierung der Leitlinie zu allen Versorgern, die Kinder und Jugendliche sehen, ist Anlass und Grund für diese Leitlinie. Neben der Praxis und Anwendung selbst, ist eine Leitlinie auch relevant für die Aus- und Weiterbildung. Zum aktuellen Zeitpunkt werden die evidenzbasierten Therapien national und international nicht flächendeckend eingesetzt. Bislang gibt es für Zwangsstörungen im Kindes- und Jugendalter keine S3-Leitlinie. Ziel ist es die Diagnostik und Behandlung von Zwangsstörungen zu verbessern und den Therapeuten eine Leitlinie auf S3 Niveau an die Hand zu geben.
Article
The appraisal model of obsessive-compulsive disorder (OCD) suggests that six key appraisal domains contribute to the aetiology and maintenance of OCD symptoms. An accumulating body of evidence supports this notion and suggests that modifying cognitive appraisals may be beneficial in reducing obsessive-compulsive symptomatology. This literature review first summarises the nature of OCD and its treatment, followed by a summary of the existing correlational and experimental research on the role of cognitive appraisal processes in OCD across both adult and paediatric samples. While correlational data provide some support for the relationship between cognitive appraisal domains and OCD symptoms, results are inconclusive, and experimental methods are warranted to determine the precise causal relationship between specific cognitive appraisal domains and OCD symptoms.
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The interest in computational thinking development at pre-university education stage is increasing. In this study, a meta-analysis was conducted to address two main objectives: (a) to analyze the effectiveness of empirical interventions in K-12 education for the development of Computational Thinking (CT); and (b) to identify and evaluate the variables that influences the effectiveness of the interventions. The analysis was especially focused on the intra-group effect sizes. Interventions show large effect size in the development of CT in the comparison between pre- and post-tests (g = 1.044). Among the different types of interventions, programming is the most efficient learning tool.
Book
Dieses Buch ist geschrieben für Kinder- und Jugendlichenpsychotherapeuten, Kinder- und Jugendpsychiater, in der Beratung und klinisch tätige Psychologen, Schulpsychologen, Psychologische Psychotherapeuten, Ärztliche Psychotherapeuten, Psychiater sowie Kinder- und Jugendlichenpsychotherapeuten und Psychologische und ärztliche Psychotherapeuten in Aus- und Weiterbildung. Bewährt für den Einstieg, als Nachschlagewerk, für die Supervision und Qualitätssicherung in der Verhaltenstherapie. In diesem Buch finden sich mit Blick auf die Praxis (1) allgemeine Grundlagen verhaltenstherapeutischen Arbeitens, (2) eine konkrete Beschreibung von verhaltenstherapeutischen Techniken, Einzelverfahren und Methoden, (3) störungsspezifische Behandlungspläne. Praxisnäher geht es nicht! Aus dem Inhalt Psycho- und verhaltenstherapeutische Methoden – Einzel- und Gruppentherapieprogramme – Behandlungsanleitungen für psychische und psychosomatische Störungen – Mit einheitlichem Kapitelaufbau – Indikationsstellung, technisches Vorgehen, Nebenwirkungen und Kontraindikationen, weiterführende Literatur. Die Herausgeber Univ.-Prof. Dr. sc. hum. Dipl. Psych. Manfred Döpfner, Leitender Psychologe an der Kinder- und Jugendpsychiatrie, Uniklinik Köln. Prof. Martin Hautzinger, Ordinarius für Klinische Psychologie und Psychotherapie, Eberhard Karls Universität Tübingen. Prof. Michael Linden, Medizinische Klinik m.S. Psychosomatik der Charité Universitätsmedizin Berlin und Institut für Verhaltenstherapie Berlin.
Article
Pediatric obsessive-compulsive disorder (OCD) often produces significant and chronic impairment for patients and their families. A subset of youths with OCD experience rapid-onset, severe OCD symptoms with multiple co-occurring neuropsychiatric problems, motor/sensory impairments, and dietary restrictions temporally linked to infectious disease, termed pediatric acute-onset neuropsychiatric syndrome (PANS). Although medical treatment for youths in this clinical subgroup has gained attention in recent years, literature detailing the evidence-based psychological treatment of such cases remains sparse. We describe the application of exposure plus response prevention (ERP), a cognitive-behavioral approach with extensive research support for pediatric and adult OCD, for a pediatric patient who presented for treatment with a multidisciplinary team of infectious disease, psychiatry, and psychology. This case report details the flexible application of ERP, as guided by a social-ecological framework wherein the patient, family, and broader community were all integral to treatment. This case study emphasizes the importance of future research on PANS-suspected pediatric OCD cases, as well as the utility of flexible application of ERP, guided by an ecological framework.
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Innovations in CBT for Childhood Anxiety, OCD, and PTSD - edited by Lara J. Farrell April 2019
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Eine Zwangsstörung ist durch Zwangsgedanken und/oder Zwangshandlungen charakterisiert. In der Behandlung haben sich kognitiv-verhaltenstherapeutische Interventionen und Pharmakotherapie bewährt. Im Rahmen der kognitiv-verhaltenstherapeutischen Behandlung werden familienzentrierte Interventionen, die kognitiv-behaviorale Therapie des Kindes/Jugendlichen (insbesondere Exposition mit Reaktionsmanagement) sowie umfeldzentrierte Interventionen angewandt, die gegebenenfalls mit medikamentöser Behandlung (als multimodale Therapie) kombiniert werden können.
Article
This brief report examines the evidence for moderators of psychosocial treatment for youth with obsessive-compulsive disorder (OCD). Understanding treatment moderators can help clinicians select the most appropriate intervention for a particular patient and consequently increase the likelihood of initial response. A systematic search of the literature was conducted to identify randomized trials and meta-analyses reporting on moderators of psychosocial treatment for pediatric OCD. All studies included a comparison of cognitive-behavioral therapy (CBT) to active or control conditions. Few studies have evaluated moderators of psychosocial treatment for youth with OCD, and among those studies, few variables have demonstrated a differential effect on treatment response. Moderator analyses require large samples to garner the statistical power necessary to adequately evaluate differential responding in subgroups, and unfortunately, most reports of moderators in this review are post-hoc investigations of datasets from trials with relatively small sample sizes. Given the overwhelming number of CBT treatment variants and potential moderators, it would be impossible to conduct all the necessary head-to-head trials with sufficient sample sizes to develop helpful clinical guidelines. The best option for advancing the moderator literature is to utilize advanced statistical approaches for pooling existing data sets. Recommendations for leveraging emerging techniques in individual participant data meta-analysis (IPD-MA) are briefly discussed.
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Objective: To assess benefits and harms of cognitive behavioral therapy (CBT) versus no intervention or versus other interventions for pediatric obsessive-compulsive disorder (OCD). Method: We searched for randomized clinical trials of CBT for pediatric OCD. Primary outcomes were OCD severity, serious adverse events, and level of functioning. Secondary outcomes were quality of life and adverse events. Remission from OCD was included as an exploratory outcome. We assessed risk of bias and evaluated the certainty of the evidence with the Grading of Recommendations Assessment, Development and Evaluation. Results: We included nine trials (N=645) comparing CBT with no intervention and three trials (N=146) comparing CBT with selective serotonin reuptake inhibitors (SSRIs). Compared with no intervention, CBT decreased OCD severity (mean difference [MD]=-8.51, 95% CI -10.84 to -6.18, p<.00001, low certainty), improved level of functioning (patient-rated: standardized MD [SMD]=-0.90, 95% CI -1.19 to -0.62, p<.00001, very low certainty; parent-rated: SMD=-0.68, 95% CI -1.12 to -0.23, p=.003, very low certainty) had similar proportions of participants with adverse events (risk ratio=1.06, 95% CI 0.93 to 1.22, p=0.39, GRADE: low certainty), and was associated with reduced risk of still having OCD (risk ratio=0.50, 95% CI 0.37 to 0.67, p<.00001, very low certainty). We had insufficient data to assess the effect of CBT versus no intervention on serious adverse events and quality of life. Compared with SSRIs, CBT led to similar decreases in OCD severity (MD=-0.75, 95% CI -3.79 to 2.29, p=.63, GRADE: very low certainty) and was associated with similar risk of still having OCD (risk ratio=0.85, 95% CI 0.66 to 1.09, p=.20, very low certainty). We had insufficient data to assess the effect of CBT versus SSRIs on serious adverse events, level of functioning, quality of life, and adverse events. Conclusion: CBT may be more effective than no intervention and comparable to SSRIs for pediatric OCD, but we are very uncertain about the effect estimates.
Article
en This review updates previous similar papers published in JFT in 2000, 2009 and 2014. It presents evidence from meta‐analyses, systematic literature reviews, narrative literature reviews and controlled trials for the effectiveness of systemic interventions for families of children and adolescents with common mental health problems and other difficulties. In this context, systemic interventions include both family therapy and other family‐based approaches such as parent training, or parent implemented behavioural programmes. The evidence supports the effectiveness of systemic interventions either alone or as part of multimodal programmes for sleep, feeding and attachment problems in infancy; recovery from child abuse and neglect; conduct problems, emotional problems, eating disorders, somatic problems, and first episode psychosis. 抽象 zh 针对儿童问题的家庭治疗和系统干预:当前的实证基础 本文对2000年、2009年和2014年发表在JFT上的相似综述进行了更新。本文提供了统合分析、系统文献综述、叙事文献综述和对有常见心理健康问题以及其他障碍的青少年儿童进行系统干预有效性的对照试验的实证数据。在本文中,系统性干预包括家庭治疗和其他家庭为基础的方法,如家长培训或家长实施的行为计划。数据支持单独使用或作为多模式计划一部分的系统性干预措施对于婴儿期睡眠、喂养和依恋问题;儿童虐待和忽视的恢复;行为问题、情绪问题、饮食失调、躯体问题和首发精神病的有效性。 Abstracto es Terapia familiar e intervenciones sistémicas para problemas centrados en los niños: revisión actualizada de la evidencia de resultados Esta revisión actualiza artículos similares anteriores publicados en JFT en 2000, 2009 y 2014. Presenta evidencia de meta‐análisis, revisiones sistemáticas de literatura, revisiones de literatura narrativa y ensayos controlados para la efectividad de intervenciones sistémicas para familias de niños y adolescentes con problemas habituales de salud mental y otras dificultades. En este contexto, las intervenciones sistémicas incluyen tanto la terapia familiar como otros enfoques basados en la familia, como la capacitación de los padres o los programas conductuales implementados por los padres. La evidencia apoya la efectividad de las intervenciones sistémicas, ya sea de forma independiente o como parte de programas multimodales para el sueño, la alimentación y los problemas de apego en la infancia; recuperación del abuso y negligencia infantil; problemas de conducta, problemas emocionales, trastornos alimenticios, problemas somáticos y primer episodio de psicosis.
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Early-onset obsessive-compulsive disorder (OCD) is more severe than later-onset OCD. There are no reports of any early-onset OCD patients being cured, especially with respect to preschoolers. In this case report, we describe the successful treatment and cure of a 6-year-old preschool girl with severe OCD since the age of 3. At the age of 3, the patient began to fear contamination and danger to herself and her family, leading to excessive hand-washing, and several months later, ritualized checking. The OCD symptoms waxed and waned for about 3 years and thereafter worsened gradually over a few weeks, culminating in a refusal to eat and dress. At the age of 6, after a week of inpatient pediatric treatment with no improvement, the patient was transferred to Osaka City University Hospital to seek psychiatric treatment. The patient fully recovered from OCD following family-based cognitive-behavioral therapy (CBT) and short-term use of low-dose fluvoxamine in an inpatient setting. After treatment, the OCD symptoms disappeared with complete remission for over 3 years. Now, aged 9, the patient has good global functioning and is well adjusted in her daily life with no need for any treatment. To the best of our knowledge, this is the first report of preschool-onset OCD with long-term complete remission with inpatient treatment in a preschooler with severe OCD. Some preschoolers with very early-onset OCD may have good prognosis without continuous pharmacotherapy, although the symptoms with the onset are severe enough to require hospitalization. Preschool-onset OCD is likely to be misdiagnosed as separation anxiety disorder. Our findings suggest that family-based CBT, which is the treatment of choice for preschool-onset OCD, can be applicable to inpatient treatment. Early detection and intensive intervention of OCD in preschoolers may improve the chance of remission.
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Objective: This sequential multiple assignment randomized trial (SMART) tested the effect of beginning treatment of childhood OCD with fluoxetine (FLX) or group cognitive-behavioral therapy (GCBT) accounting for treatment failures over time. Methods: A two-stage, 28-week SMART was conducted with 83 children and adolescents with OCD. Participants were randomly allocated to GCBT or FLX for 14 weeks. Responders to the initial treatment remained in the same regimen for additional 14 weeks. Non-responders, defined by less than 50% reduction in baseline Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) scores, were re-randomized to either switch to or add the other treatment. Assessments were performed at baseline, 7, 14, 21, and 28 weeks. Results: Among the 43 children randomized to FLX who completed the first stage, 15 (41.7%) responded to treatment and 21 non-responders were randomized to switch to (N = 9) or add GCBT (N = 12). Among the 40 children randomized to GCBT who completed the first stage, 18 (51.4%) responded to treatment and 17 non-responders were randomized to switch to (N = 9) or add FLX (N = 8). Primary analysis showed that significant improvement occurred in children initially treated with either FLX or GCBT. Each time point was statistically significant, showing a linear trend of symptom reduction. Effect sizes were large within (0.76-0.78) and small between (-0.05) groups. Conclusions: Fluoxetine and GCBT are similarly effective initial treatments for childhood OCD considering treatment failures over time. Consequently, provision of treatment for childhood OCD could be tailored according to the availability of local resources.
Article
Obsessive-Compulsive Disorder (OCD) with comorbid Obsessive-Compulsive Personality Disorder (OCPD) is associated to greater impairment than OCD alone. No research examined comorbid OCPD as a predictor of outcomes in resistant OCD. The current study investigated whether inpatients with resistant OCD and comorbid OCPD could benefit from an inpatient intensive CBT program (II-CBT). Fifty-six inpatients with resistant OCD were enrolled. Twenty had OCPD. Participants underwent a 5-week II-CBT including daily and prolonged ERP sessions. SCID-I and SCID-II were administered at baseline, Y-BOCS, and BDI-II at baseline and post-treatment. Treatment effects were large [unbiased Hedges’ g = 1.11]. An interaction effect emerged between baseline Y-BOCS scores and comorbid OCPD on outcomes (F = 4.05, p<.05). Inpatients with more severe Y-BOCS scores and comorbid OCPD had greater pre-posttreatment changes on Y-BOCS (B =.85, t = 2.01, p<.01), but not on BDI-II. II-CBT seemed to be a strategy tailored for inpatients with resistant OCD with comorbid OCPD. However, II-CBT did not seem to target comorbid depression. © 2016, Giunti O.S. Organizzazioni Speciali. All rights reserved.
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Objective: Although the symptomatology of obsessive compulsive disorders is clear, the essential problem is not. Understanding this can have consequences for treatment. Method: Two psychological models are discussed as well as recent research into effectiveness of treatment. Results: The cognitive model of OCD has not been conclusively established, but it has led to an influential form of treatment (cognitive therapy). The model, in which behaviour (repetition) is the central problem, has been experimentally proved. Based on this model, exposure and response prevention are key to the treatment strategy. A recent meta-analysis has shown that cognitive behavioural therapy (CBT) and the combination of CBT with medication can have large effects. Cognitive Bias Modification (CBM) and Intensive Therapy are new treatment modalities. Conclusion: Research into models of OCD is important for improving treatment. CBT is effective, but should be given by specialists. Whether the combination of CBT and medication is more effective than CBT has not been established. Parents should be involved in the treatment.
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Se presentan los resultados de un estudio cualitativo de revisión de la eficacia de los tratamientos cognitivo-conductuales utilizados en el trastorno obsesivo-compulsivo en niños y adolescentes. Se localizaron y recuperaron un total de 84 estudios, de los cuales 17 consistían en informes de caso, 37 en diseños de caso único, 19 estudios pre-experimentales con diseño pre-postest, 6 estudios cuasi-experimentales y 5 estudios experimentales con grupo de control. El procedimiento más utilizado en los diferentes estudios ha sido la exposición con prevención de respuesta, siendo además el de mayor eficacia. Se constata la baja representación de estudios de comparación tanto cuasi-experimentales como experimentales, al igual que la escasez de medidas de seguimiento a medio y largo plazo, la falta de utilización de medidas observacionales y el escaso control de la sintomatología encubierta y trastornos comórbidos.
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Research in etiology, neurobiology, genetics, clinical correlates, and evidence-based treatments in children and adolescents with obsessive-compulsive disorder indicate a need for the revision of the Practice Parameters for the Assessment and Treatment of Children and Adolescents with Obsessive-Compulsive Disorder first published a decade ago. The present article highlights the clinical assessment and reviews and summarizes the evidence base for treatment. Based on this evidence, specific recommendations are provided for assessment, cognitive behavioral therapy, pharmacotherapy, combined treatment, and other interventions.
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The serotonin reuptake inhibitors are the treatment of choice for patients with obsessive-compulsive disorder; however, empirical support for this assertion has been weaker for children and adolescents than for adults. To evaluate the safety and efficacy of the selective serotonin reuptake inhibitor sertraline hydrochloride in children and adolescents with obsessive-compulsive disorder. Randomized, double-blind, placebo-controlled trial. One hundred eighty-seven patients: 107 children aged 6 to 12 years and 80 adolescents aged 13 to 17 years randomized to receive either sertraline (53 children, 39 adolescents) or placebo (54 children, 41 adolescents). Twelve US academic and community clinics with experience conducting randomized controlled trials. Sertraline hydrochloride was titrated to a maximum of 200 mg/d during the first 4 weeks of double-blind therapy, after which patients continued to receive this dosage of medication for 8 more weeks. Control patients received placebo. The Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS), the National Institute of Mental Health Global Obsessive Compulsive Scale (NIMH GOCS), and the NIMH Clinical Global Impressions of Severity of Illness (CGI-S) and Improvement (CGI-I) rating scales. In intent-to-treat analyses, patients treated with sertraline showed significantly greater improvement than did placebo-treated patients on the CY-BOCS (adjusted mean, -6.8vs -3.4, respectively; P=.005), the NIMH GOCS (-2.2 vs -1.3, respectively; P=.02), and the CGI-I (2.7 vs 3.3, respectively; P=.002) scales. Significant differences in efficacy between sertraline and placebo emerged at week 3 and persisted for the duration of the study. Based on CGI-I ratings at end point, 42% of patients receiving sertraline and 26% of patients receiving placebo were very much or much improved. Neither age nor sex predicted response to treatment. The incidence of insomnia, nausea, agitation, and tremor were significantly greater in patients receiving sertraline; 12 (13%) of 92 sertraline-treated patients and 3 (3.2%) of 95 placebo-treated patients discontinued prematurely because of adverse medical events (P=.02). No clinically meaningful abnormalities were apparent on vital sign determinations, laboratory findings, or electrocardiographic measurements. Sertraline appears to be a safe and effective short-term treatment for children and adolescents with obsessive-compulsive disorder.
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Several methods are available to estimate the total and residual amount of heterogeneity in meta-analysis, leading to different alternatives when estimating the predictive power in mixed-effects meta-regression models using the formula proposed by Raudenbush (1994, 2009). In this paper, a simulation study was conducted to compare the performance of seven estimators of these parameters under various realistic scenarios in psychology and related fields. Our results suggest that the number of studies (k) exerts the most important influence on the accuracy of the results, and that precise estimates of the heterogeneity variances and the model predictive power can only be expected with at least 20 and 40 studies, respectively. Increases in the average within-study sample size (N¯) also improved the results for all estimators. Some differences among the accuracy of the estimators were observed, especially under adverse (small k and N¯) conditions, while the results for the different methods tended to convergence for more optimal scenarios.
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Behavioral therapy utilizing exposure and response prevention (ERP) is considered the psychosocial treatment of choice for obsessive-compulsive disorder (OCD). Individual ERP treatment is the most common therapy format, and much of the empirical support for ERP is based upon studies of OCD subjects treated individually. However, there are numerous advantages of delivering this effective intervention in a group format, including cost savings to patients and time-efficiency for ERP therapists. This review summarizes the 12 adult trials and 4 adolescent trials of group behavioral therapy for OCD conducted to date. The paper also describes a typical group therapy protocol in detail and describes the costs and benefits of delivering ERP for OCD in a group format. [Brief Treatment and Crisis Intervention 3:217–229 (2003)] KEY WORDS: obsessive-compulsive disorder, CBT, group therapy. Individual behavioral exposure and response prevention (ERP) for obsessive-compulsive dis-order (OCD) is well established as an effective treatment method (Rachman & Hodgson, 1980; Foa, Franklin, & Kozak, 1998). However, the de-livery of such cognitive-behavioral treatment (CBT) in a group format is relatively new and is less well studied. The group format holds prom-ise in terms of cost-effectiveness, efficient use of the scarce resource of skilled CBT therapists for OCD, and the potential clinical advantages of the group milieu. Shortcomings to the group ap-proach may include the practical challenge of assembling groups, difficulties with group het-erogeneity, and the possible reluctance of some group candidates to share symptom details. This article reviews the literature to date on group behavioral interventions for OCD, provides a de-scription of typical group treatment protocols, and further highlights some of the advantages and disadvantages of this treatment delivery format.
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The benefits of cognitive–behavioral treatment for obsessive–compulsive disorder (OCD) have been evidenced by several meta-analyses. However, the differential effectiveness of behavioral and cognitive approaches has shown inconclusive results. In this paper a meta-analysis on the effectiveness of psychological treatment for OCD is presented by applying random- and mixed-effects models. The literature search enabled us to identify 19 studies published between 1980 and 2006 that fulfilled our selection criteria, giving a total of 24 independent comparisons between a treated and a control group. The effect size index was the standardized mean difference in the posttest. The effect estimates for exposure with response prevention (ERP) alone (d+ = 1.127), cognitive restructuring (CR) alone (d+ = 1.090), and ERP plus CR (d+ = 0.998) were very similar, although the effect estimate for CR alone was based on only three comparisons. Therapist-guided exposure was better than therapist-assisted self-exposure, and exposure in vivo combined with exposure in imagination was better than exposure in vivo alone. The relationships of subject, methodological and extrinsic variables with effect size were also examined, and an analysis of publication bias was carried out. Finally, the implications of the results for clinical practice and for future research in this field were discussed.
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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 form of CBT, instructions in CBT delivered in the context of medication management. A 12-week randomized controlled trial conducted at 3 academic medical centers between 2004 and 2009, involving 124 pediatric outpatients between the ages of 7 and 17 years with OCD as a primary diagnosis and a Children's Yale-Brown Obsessive Compulsive Scale score of 16 or higher despite an adequate SRI trial. Participants were randomly assigned to 1 of 3 treatment strategies that included 7 sessions over 12 weeks: 42 in the medication management only, 42 in the medication management plus instructions in CBT, and 42 in the medication management plus CBT; the last included 14 concurrent CBT sessions. Whether patients responded positively to treatment by improving their baseline obsessive-compulsive scale score by 30% or more and demonstrating a change in their continuous scores over 12 weeks. The medication management plus CBT strategy was superior to the other 2 strategies on all outcome measures. In the primary intention-to-treat analysis, 68.6% (95% CI, 53.9%-83.3%) in the plus CBT group were considered responders, which was significantly better than the 34.0% (95% CI, 18.0%-50.0%) in the plus instructions in CBT group, and 30.0% (95% CI, 14.9%-45.1%) in the medication management only group. The results were similar in pairwise comparisons with the plus CBT strategy being superior to the other 2 strategies (P < .01 for both). The plus instructions in CBT strategy was not statistically superior to medication management only (P = .72). The number needed-to-treat analysis with the plus CBT vs medication management only in order to see 1 additional patient at week 12, on average, was estimated as 3; for the plus CBT vs the plus instructions in CBT strategy, the number needed to treat was also estimated as 3; for the plus instructions in CBT vs medication management only the number needed to treat was estimated as 25. Among patients aged 7 to 17 years with OCD and partial response to SRI use, the addition of CBT to medication management compared with medication management alone resulted in a significantly greater response rate, whereas augmentation of medication management with the addition of instructions in CBT did not. clinicaltrials.gov Identifier: NCT00074815.
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Cognitive behaviour therapy (CBT) for young people with obsessive compulsive disorder (OCD) has become the treatment of first choice. However, the literature is largely based on studies emphasising exposure and response prevention. In this study, we report on a randomised controlled trial of CBT for young people carried out in typical outpatient clinic conditions which focused on cognitions. A randomised controlled trial compares 10 sessions of manualised cognitive behavioural treatment with a 12-week waiting list for adolescents and children with OCD. Assessors were blind to treatment allocation. 21 consecutive patients with OCD aged between 9 and 18 years were recruited. The group who received treatment improved more than a comparison group who waited for 3 months. The second group was treated subsequently using the same protocol and made similar gains. In conclusion, CBT can be delivered effectively to young people with OCD in typical outpatient settings.
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ABSTRACT A 10-week double-blind, placebo-controlled design was employed to investigate the effectiveness of clomipramine (CMI) versus placebo in 16 outpatients (ages 10-18 years) with obsessive-compulsive disorder (OCD). While a trend favoring clomipramine was observed, the difference in efficacy between clomipramine (N=8) and placebo (N=8) did not reach statistical significance, partly due to small sample size (N = 6,8). Post-hoc exclusion of two clomipramine-resistant subjects with subtle neurological impairments did, however, yield a statistically significant improvement with drug treatment. Neurological impairments are commonly seen in children with OCD, and may be a risk factor for the disorder during childhood. Speculatively, subtle neurological impairments may also predict resistance to CMI therapy in some patients, and influence the outcome of clinical and research medication trials, depending on differences in neurological inclusion and exclusion criteria.
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To assess the distribution and severity of obsessions and compulsions in a nonclinical adolescent population. During preinduction military screening, 861 sixteen-year-old Israelis completed a questionnaire regarding the lifetime presence of eight obsessive-compulsive (OC) symptoms and three severity measures. The presence or absence of obsessive-compulsive disorder (OCD) or subclinical OCD was ascertained by an independent interview. Although only 8.0% and 6.3% of respondents reported disturbing and intrusive thoughts, respectively, 27% to 72% of subjects endorsed the six remaining OCD symptoms. Twenty percent of subjects regarded the symptoms they endorsed as senseless and 3.5% found them disturbing; 8% reported spending more than an hour daily on symptoms. OCD and subclinical OCD cases differed significantly from non-OCD cases, but not from each other, in distress and mean number of symptoms. Although the distribution of nine of the items differed for noncases, compared with OCD and subclinical OCD cases, the distributions for all items overlapped markedly across the three groups. OC phenomena appear to be on a continuum with few symptoms and minimal severity at one end and many symptoms and severe impairment on the other. Defining optimal cutoff points for distinguishing between psychiatric disorder and OC phenomena that are common in the general population remains an open question.
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This chapter provides an overview of software Comprehensive Meta‐Analysis (CMA) and shows how to use it to implement the ideas. The same approach could be used with any other program as well. The chapter also provides a sense for the look‐and‐feel of the program. CMA features a spreadsheet view and a menu‐driven interface. As such, it allows a researcher to enter data and perform a simple analysis in a matter of minutes. At the same time, it offers a wide array of advanced features, including the ability to compare the effect size in subgroups of studies, to run meta‐regression, to estimate the potential impact of publication bias, and to produce high‐resolution plots. The program is designed to work with studies that compare an outcome in two groups or that estimate an outcome in one group.
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This article discusses the results of a meta-analysis of the effectiveness of psychological treatment, by itself or in combination with drugs, of the obsessive-compulsive disorder. Twenty-three European articles meeting the selection criteria were included, offering a total of 43 independent studies. Standardized mean difference was calculated between the pretest and postest means. The global mean effect size, d+ = 1.443, showed a clear efficacy for reducing obsessions and compulsions as well as symptoms of depression, anxiety, and social adjustment, although the latter was reduced to a lesser extent. The most effective treatments consisted of combining exposition and response prevention techniques or cognitive restructuring with antidepressants (d+ = 2.044 and d+ = 2.953, respectively), such as clomipramine or fluvoxamine. A predictive model of the efficacy is proposed as a function of the different treatments and the methodological quality of studies. Finally, the practical, clinical, and research implications of the results are discussed.
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This paper presents the results a qualitative review study on effectiveness of cognitive-behavioural therapy for obsessive-compulsive disorder in children and adolescents. A total of 84 studies were located and retrieved, of which 17 were case reports, 37 were single case designs, 19 were quasi-experimental one-group studies, 6 were quasi-experimental comparison studies and 5 randomized controlled trials. The most widely treatment procedure, in the studies, was exposure with response prevention, which also was the most effective. We found a low representation of comparison studies, both quasi-experimental and experimental designs, as well as a lack of medium and long-term follow-ups, observational measures and a poor control of covert symptomatology and comorbidity.
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Introduction: Childhood obsessive-compulsive disorder (OCD) is a prevalent, distressing, and impairing illness that extends through adolescence and into adulthood. The lifetime prevalence rate of OCD in youth is estimated to be between 2 and 3% (Rapoport et al. 2000), which is more common than expected. Childhood OCD resembles adult-onset OCD in the symptom picture and in its waxing and waning course. Like adults, children report obsessions pertaining to fears of germs or contamination, followed by fears of harm to self or others, as well as excessive focus on moral or religious themes. Not all obsessions are anxiety provoking, however. Some children and adults describe vague feelings of discomfort that something is not “just right” until there is a sense of symmetry, closure, or completion. Common rituals experienced by children include washing, repeating, checking, touching, counting, and ordering (Swedo et al. 1989). The mean age of onset for childhood OCD may range from 6 to 11 years, as indicated by clinic (Hanna 1995) and community-based (Rapoport et al. 2000) studies. Children who have an onset of OCD before the age of 7 years are more likely to be male and to have a family history of OCD than those with OCD of a later onset, suggesting that genetics may play a role in early-onset OCD (Swedo et al. 1989).
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IntroductionIndividual studiesThe summary effectHeterogeneity of effect sizesSummary points
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Publication bias is the tendency to decide to publish a study based on the results of the study, rather than on the basis of its theoretical or methodological quality. It can arise from selective publication of favorable results, or of statistically significant results. This threatens the validity of conclusions drawn from reviews of published scientific research. Meta-analysis is now used in numerous scientific disciplines, summarizing quantitative evidence from multiple studies. If the literature being synthesised has been affected by publication bias, this in turn biases the meta-analytic results, potentially producing overstated conclusions. Publication Bias in Meta-Analysis examines the different types of publication bias, and presents the methods for estimating and reducing publication bias, or eliminating it altogether. Written by leading experts, adopting a practical and multidisciplinary approach. Provides comprehensive coverage of the topic including: • Different types of publication bias, • Mechanisms that may induce them, • Empirical evidence for their existence, • Statistical methods to address them, • Ways in which they can be avoided. • Features worked examples and common data sets throughout. • Explains and compares all available software used for analysing and reducing publication bias. • Accompanied by a website featuring software, data sets and further material. Publication Bias in Meta-Analysis adopts an inter-disciplinary approach and will make an excellent reference volume for any researchers and graduate students who conduct systematic reviews or meta-analyses. University and medical libraries, as well as pharmaceutical companies and government regulatory agencies, will also find this invaluable.
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Previous research has recommended several measures of effect size for studies with repeated measurements in both treatment and control groups. Three alternate effect size estimates were compared in terms of bias, precision, and robustness to heterogeneity of variance. The results favored an effect size based on the mean pre-post change in the treatment group minus the mean pre-post change in the control group, divided by the pooled pretest standard deviation.
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Because as many as 50% of obsessive–compulsive disorder (OCD) cases have had onset by age 15, interest in its detection in childhood is strong. Clinical experience indicates that children often try to keep their OCD secret and that parental report may give marked underestimates. The authors examined the prevalence of childhood OCD in the NIMH Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study, a four-site community survey which allowed comparison of both parent and child report of the child's OCD and related symptoms and disorders. OCD cases, based on structured interviews (DISC-2.3 with DSM-III-R criteria) with 1,285 caretaker-child pairs, were identified separately for parent and child (aged 9 through 17) informants from the MECA database. Cases were then examined for demographic characteristics, for obsessive–compulsive symptoms and other diagnoses reported in cases “missed” by one reporter, and for comorbid disorders. Of a total of 35 (2.7%) identified cases, four (0.3%) were identified by the parent and 32 (2.5%) were identified by the child, with only one overlapping case. In general, when OCD cases were “missed” by one reporter, that reporter did not substitute another disorder. These findings support clinical data that children with OCD often hide their illness and underscore the importance of child interviews for its detection.
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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 clinical considerations for treating OCD in young children (ages 5–8), including cognitive developmental differences, family context, unique symptom correlates, and initial contact with the mental health system. A family-based treatment program consisting of psychoeducation about OCD in young children, parent education, and exposure with response prevention for young children and their parents is described. Issues to consider regarding implementation of this treatment, research with a young population, and future directions for research are presented.
Article
We aimed to assess the prevalence (at three levels of severity) and other epidemiological data of OCD in a sample of 1,514 Spanish non-referred children. The estimated prevalence was 1.8% for OCD, 5.5% for subclinical OCD and 4.7% for OC symptomatology. We did not find significant differences between genders or academic grade regarding OC symptoms and OCD, but more subclinical prevalence was found in males than in females. Socio-demographic variables were not related to any level of OCD, but academic performance was significantly lower in clinical OCD. The co-morbidity between OCD and any psychiatric disorder was high (85%) and higher for emotional disorders than for behavioral disorders. The impairment was associated with comorbidity and was worse for OCD with comorbid emotional problems. The results suggest that OCD is not rare in school children and adolescents and that it has an impact on their personal functioning. We suggest the possibility of an early diagnosis and treatment.
Cognitive behaviour therapy (CBT) and selective serotonin reuptake inhibitors have both been established as effective interventions for paediatric obsessive-compulsive disorder (OCD), with CBT being the recommended first-line treatment in most cases. While the majority of young people respond well to these treatments, a significant proportion remain symptomatic. Although the research on treatment-resistant OCD remains limited, increasing empirical attention is being paid to predictors of treatment outcome in young people with OCD, and efforts are being made to identify the factors that hinder recovery. This article outlines potential barriers in treatment and highlights strategies for optimising outcome, with particular focus on cognitive behavioural techniques.
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IntroductionDefinition of the Failsafe NExamplesAssumptions of the Failsafe NVariations on the Failsafe NSummary of the ExamplesApplications of the Failsafe NConclusions AcknowledgementReferences
Article
The last decade has seen a noticeable increase in the number of treatment outcome studies for pediatric obsessive-compulsive disorder (OCD). The present article describes a meta-analysis of this literature with the aim of quantifying treatment effects and examining the extent to which various patient or treatment variables are related to outcome. Results showed that pharmacotherapy with serotonergic antidepressants and cognitive-behavioral therapy involving exposure and response prevention are each effective in reducing OCD symptoms. Cognitive-behavioral therapy produced larger effect sizes and greater rates of clinically significant improvement compared to medication, although there were methodological differences between medication and psychotherapy studies.
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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.
Article
To examine the efficacy of exposure-based cognitive-behavioral therapy (CBT) plus a structured family intervention (FCBT) versus psychoeducation plus relaxation training (PRT) for reducing symptom severity, functional impairment, and family accommodation in youths with obsessive-compulsive disorder (OCD). A total of 71 youngsters 8 to 17 years of age (mean 12.2 years; range, 8-17 years, 37% male, 78% Caucasian) with primary OCD were randomized (70:30) to 12 sessions over 14 weeks of FCBT or PRT. Blind raters assessed outcomes with responders followed for 6 months to assess treatment durability. FCBT led to significantly higher response rates than PRT in ITT (57.1% vs 27.3%) and completer analyses (68.3% vs. 35.3%). Using HLM, FCBT was associated with significantly greater change in OCD severity and child-reported functional impairment than PRT and marginally greater change in parent-reported accommodation of symptoms. These findings were confirmed in some, but not all, secondary analyses. Clinical remission rates were 42.5% for FCBT versus 17.6% for PRT. Reduction in family accommodation temporally preceded improvement in OCD for both groups and child functional status for FCBT only. Treatment gains were maintained at 6 months. FCBT is effective for reducing OCD severity and impairment. Importantly, treatment also reduced parent-reported involvement in symptoms with reduced accommodation preceding reduced symptom severity and functional impairment. CLINICAL TRIALS REGISTRY INFORMATION: Behavior Therapy for Children and Adolescents with Obsessive-Compulsive Disorder (OCD); http://www.clinicaltrials.gov; NCT00000386.
Article
The purpose of this open clinical trial was to examine the efficacy of cognitive-behavioral treatment involving exposure and ritual prevention for pediatric obsessive-compulsive disorder (OCD). Children and adolescents with diagnosed OCD (N = 14) received cognitive-behavioral treatment, seven patients received intensive treatment (mean = 18 sessions over 1 month) and seven received weekly treatment (mean = 16 sessions over 4 months). Eight of these patients received concurrent treatment with serotonin reuptake inhibitors and six received cognitive-behavioral treatment alone. Outcome was assessed via interviewer ratings on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Obsessive Compulsive Rating Scales for Main Fear and Main Ritual, and Hamilton Depression Rating Scale. Cognitive-behavioral treatment was effective in ameliorating OCD symptoms. Twelve of the 14 patients were at least 50% improved over pretreatment Y-BOCS severity, and the vast majority remained improved at follow-up; mean reduction in Y-BOCS was 67% at posttreatment and 62% at follow-up (mean time to follow-up = 9 months). Results suggest that cognitive-behavioral treatment by exposure and ritual prevention is effective for pediatric OCD. Controlled studies with random assignment to conditions are warranted to evaluate the relative efficacy of cognitive-behavioral pharmacological, and combined treatments.
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This study reports a waitlist controlled randomized trial of family-based cognitive-behavioral therapy delivered via web-camera (W-CBT) in children and adolescents with obsessive-compulsive disorder (OCD). Thirty-one primarily Caucasian youth with OCD (range=7-16years; 19 male) were randomly assigned to W-CBT or a Waitlist control. Assessments were conducted immediately before and after treatment, and at 3-month follow-up (for W-CBT arm only). Primary outcomes included the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS), clinical global improvement rates, and remission status. When controlling for baseline group differences, W-CBT was superior to the Waitlist control on all primary outcome measures with large effect sizes (Cohen's d≥1.36). Thirteen of 16 youth (81%) in the W-CBT arm were treatment responders, versus only 2/15 (13%) youth in the Waitlist arm. Similarly, 9/16 (56%) individuals in the W-CBT group met remission criteria, versus 2/15 (13%) individuals in the Waitlist control. Gains were generally maintained in a naturalistic 3-month follow-up for those randomized to W-CBT. This preliminary study suggests that W-CBT may be helpful in reducing obsessive-compulsive symptoms in youth with OCD. Given considerable access issues, such findings hold considerable promise for treatment dissemination.