Martin E. Franklin's research while affiliated with Rogers Memorial Hospital and other places

Publications (216)

Article
Family-based cognitive behavioral therapy (CBT) is an effective treatment for obsessive compulsive disorder (OCD), but not all children respond. Children with early-onset OCD may exhibit poorer outcomes, possibly due to developmental factors that affect treatment engagement and distress tolerance, which may ultimately affect treatment dose. Homewor...
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Both anxiety and autism spectrum disorder (ASD) are associated with atypical physiological activity. Few studies have systematically assessed the resting physiological activity in ASD with co-occurring anxiety disorders. We tested 75 participants divided in four groups: youth with ASD, with (ASD + Anxiety = 22, 6F, 12.29 ± 2.83 years old) and witho...
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Family accommodation (FA) has been shown to relate to poorer treatment outcomes in pediatric obsessive compulsive disorder (OCD), yet few studies have examined the trajectory of change in FA throughout treatment and its relation to treatment outcomes. This study examined change in FA in relation to change in symptom severity and impairment in 63 yo...
Article
Objective A lack of universal definitions for response and remission in pediatric obsessive-compulsive disorder (OCD) has hampered the comparability of results across trials. To address this problem, we conducted an individual participant data diagnostic test accuracy meta-analysis to evaluate the discriminative ability of the Children’s Yale-Brown...
Chapter
This chapter assesses which treatment should be chosen as the first-line intervention for obsessive-compulsive disorder (OCD). Cognitive Behavioral Therapy (CBT) involving Exposure Plus Response Prevention (ERP) is the treatment with the most empirical support, and its effects appear to be both robust and durable. The chapter then reviews the data...
Article
Studies investigating the impact of depressive symptoms on obsessive-compulsive disorder (OCD) treatment have yielded mixed findings. The purpose of the study is to extend previous research, which primarily used outpatient samples, to determine whether depression affects OCD treatment outcome among patients receiving intensive residential treatment...
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Importance Evidence is lacking for viable treatment options for patients with difficult-to-treat obsessive-compulsive disorder (OCD). It has been suggested that D-cycloserine (DCS) could potentiate the effect of exposure and response prevention (ERP) treatment, but the hypothesis has not been tested among patients with difficult-to-treat OCD. Obje...
Article
We write with great concern in response to the recent systematic review and meta-analysis of cognitive-behavioral therapy (CBT) in pediatric obsessive-compulsive disorder (OCD) by Uhre et al.¹ Although the authors’ results consistently support the clinical efficacy of CBT for pediatric OCD, we expect that, much like ourselves, readers will be confu...
Article
This study measured therapist behaviors in relation to subsequent habituation within exposure tasks, and also tested their direct and indirect relationships (via habituation) with clinical outcomes of exposure therapy. We observed 459 videotaped exposure tasks with 111 participants in three clinical trials for pediatric obsessive–compulsive disorde...
Article
Objectives: In clinical trials of pediatric trichotillomania (TTM), three instruments are typically employed to rate TTM severity: (1) the Massachusetts General Hospital Hair Pulling Scale (MGH-HPS), (2) the National Institute of Mental Health Trichotillomania Severity Scale (NIMH-TSS), and (3) the Trichotillomania Scale for Children (TSC). These i...
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Purpose of review Obsessive-compulsive disorder (OCD) is a chronic condition associated with substantial morbidity, comorbidity, and functional impairment in affected youths. Fortunately, efficacy has been established for multiple pharmacotherapies; however, treatment response remains neither universal nor complete; hence, treatment development eff...
Article
Trichotillomania (TTM) involves the chronic pulling out of hair to the point of hair loss or thinning, which continues despite repeated attempts to stop. Behavior therapy is a promising treatment for the condition, but studies have been limited by the lack of a credible control condition, small sample sizes, follow-up periods of short duration, and...
Article
BACKGROUND: Trichotillomania (TTM) onset may occur across the lifespan; however, adolescent onset is most frequently reported. Several studies have explored clinical differences between TTM age-of-onset groups with mixed results. We investigated empirically defined age-of-onset groups in adults with TTM, and clinical differences between groups. ME...
Chapter
Innovations in CBT for Childhood Anxiety, OCD, and PTSD - edited by Lara J. Farrell April 2019
Article
Objective Although Avoidant/Restrictive Food Intake Disorder (ARFID) has existed since the publication of DSM‐5 in 2013, research on the descriptive psychopathology of treatment‐seeking patients with formal ARFID diagnoses is sparse, and limited to tertiary eating disorder‐focused treatment settings where most patients present with weight loss/maln...
Preprint
Objective: Anxiety disorders are common among youth with autism spectrum disorder (ASD). Both anxiety and ASD are associated with differences in physiological activity. To date, few studies have investigated the physiological profile of youth with ASD and even fewer have systematically assessed how the co-occurrence of anxiety disorders and ASD mod...
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 imp...
Article
Background: Pathological Skin Picking (PSP) may begin at any age, but the most common age of onset is during adolescence. Age of onset is a potentially useful clinical marker to delineate subtypes of psychiatric disorders. The present study sought to examine empirically defined age of onset groups in adults with PSP and assess whether groups diffe...
Article
Objective: This study measured a variety of within-exposure fear changes and tested the relationship of each with treatment outcomes in exposure therapy. Method: We coded 459 videotaped exposure tasks from 111 participants in 3 clinical trials for pediatric obsessive-compulsive disorder (OCD; POTS trials). Within exposures, fear level was observ...
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The present study explored the concept of tolerance for child distress in 46 children (ages 5–8), along with their mothers and fathers, who received family-based CBT for OCD. The study sought to describe baseline tolerance, changes in tolerance with treatment, and the predictive impact of tolerance on symptom improvement. Tolerance was rated by cli...
Chapter
The chapter starts with an overview of the treatment of anxiety disorders in the fields of child and adolescent clinical psychology and psychiatry. Before reviewing what is known about the treatment of anxiety disorders in adolescence, the chapter first provides a brief overview of the history and rationale for cognitive behavioral therapy, pharmac...
Chapter
The chapter starts by outlining what is already known about the ecology of adolescent development and culture and how it relates to the development of anxiety disorders in individuals. Identifying which young people are most at risk to develop anxiety disorders after experiencing negative life events, the chapter argues, is an important next step t...
Chapter
This chapter begins by stating the importance of considering the concept of anxiety and its heterogeneity. It defines anxiety to set the scene for the rest of the discussion in this chapter. The chapter then makes a distinction between anxiety and anxiety disorders. The chapter looks at research in the areas of anxiety and anxiety disorders. Recent...
Chapter
This chapter begins by introducing current thinking on the rationale for preventing anxiety disorders in youth. It explains risk and protective factors in youth and examines symptoms exhibited. An important set of impediments to developing successful prevention intervention is the lack of knowledge about the complex interrelations among the various...
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The Pediatric Obsessive-Compulsive Disorder Treatment Study II (POTS II) investigated the benefit of serotonin reuptake inhibitor (SRI) augmentation with cognitive behavioral therapy (CBT). Primary outcomes focused on OCD symptom change and indicated benefit associated with a full course of CBT. Given that the majority of youth with OCD suffer from...
Article
Background: A critical agenda of the National Institutes of Health Research Domain Criteria (RDoC) initiative is establishing whether domains within the RDoC matrix are truly transdiagnostic. Rates of anxiety disorders are elevated in autism spectrum disorder (ASD), but it is unclear whether the same mechanisms contribute to anxiety in individuals...
Article
Although research has consistently linked unidimensional anxiety with Trichotillomania (TTM) severity, the relationships between TTM severity and anxiety dimensions (i.e., cognitive and somatic anxiety) are unknown. This knowledge gap limits current TTM conceptualization and treatment. The current study examined these relationships with data collec...
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Researchers have demonstrated that quality of life (QOL) is an important construct to measure in individuals with mental health disorders, yet only a small amount of research has been dedicated to examining QOL and its response to treatment in children and adolescents with obsessive-compulsive disorder (OCD). The current study explored the psychome...
Article
Trichotillomania (hair pulling disorder, HPD) and pathological skin picking (PSP) are associated with significant rates of psychosocial impairment and distress. Little research has addressed the physical consequences and associated impairment in youth (e.g., poor body-esteem). The present study explores the relationship between body-esteem, skin pi...
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Studies have shown a high prevalence of autistic spectrum traits in both children and adults with psychiatric disorders; however the prevalence rate has not yet been investigated in young children with OCD. The aim of the current study was to (1) determine whether ASD traits indicated by the Social Communication Questionnaire (SCQ) and the Social R...
Article
Objective: Despite advances in supported treatments for early onset obsessive-compulsive disorder (OCD), progress has been constrained by regionally limited expertise in pediatric OCD. Videoteleconferencing (VTC) methods have proved useful for extending the reach of services for older individuals, but no randomized clinical trials (RCTs) have eval...
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Background One presentation of Avoidant/Restrictive Food Intake Disorder (ARFID) is characterized by picky eating, i.e., selective eating based on the sensory properties of food. The present study has two aims. The first is to describe distress and impairment in individuals with ARFID secondary to picky eating. The second is to determine whether ea...
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The diagnostic conceptualization of hoarding has recently changed, and yet the application of these changes to hoarding in youth remains to be clarified. In this review we examine the literature on hoarding in youth. We discuss issues related to the assessment of pediatric hoarding, and the nature of hoarding in youth. We consider evidence for hoar...
Article
Some have argued that hair pulling in trichotillomania (TTM) is triggered by traumatic events, but reliable evidence linking trauma to TTM is limited. However, research has shown that hair pulling is associated with emotion regulation, suggesting a connection between negative affect and TTM. We investigated the associations between trauma, negative...
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Although photographic assessment has been found to be reliable in assessing hair loss in Trichotillomania, the validity of this method is unclear, particularly for gauging progress in treatment. The current study evaluated the psychometric properties of photographic assessment of change in Trichotillomania. Photographs showing hair loss of adults w...
Article
The Milwaukee Inventory for Subtypes of Trichotillomania-Adult version (MIST-A; Flessner, Woods, Franklin, Cashin, Keuthen, & Trichotillomania Learning Center-Scientific Advisory Board, 2008) measures the degree to which hair pulling in Trichotillomania (TTM) can be described as “automatic” (i.e., done without awareness and unrelated to affective s...
Chapter
Trichotillomania (TTM) is an impulse-control disorder characterized by the pulling of scalp, facial, and/or body hair, resulting in noticeable hair loss. It is associated with significant functional impairment, such as poor school and work performance, disruption in family functioning, and social impairment. This chapter will focus on adults with T...
Article
Purpose: The prevalence and correlates of dental fear have been studied in representative population studies, but not in patients presenting for dental treatment. We hypothesized that dental fear among patients presenting at a large, urban college of dentistry would be similar to that of the population (e.g. 11% high dental fear, 17% to 35% modera...
Article
There is a dearth of knowledge on trichotillomania in youth, which is particularly problematic given that trichotillomania typically develops in childhood or early adolescence. Early identification and treatment may prevent adult morbidity and impairment. This paper presents the rationale, design, and methods of a randomized controlled trial (RCT)...
Chapter
Anxiety is known to be a commonly, co-occurring phenomenon with autism. Also, in daily practice, these symptoms often are confused with core symptoms of autism. Accurately determining OCD and anxiety from autism has important implications for treatment. This chapter reviews current methods and procedures available to help make these distinctions.
Article
Objective: Trichotillomania (TTM) is associated with significant embarrassment and is viewed negatively by others. A potentially important outcome variable that is often overlooked in treatment for TTM is appearance and social perception. Method: The present study tested whether participants in a randomized controlled trial of psychotherapy for T...
Chapter
Contamination is the most common concern in obsessive-compulsive disorder (OCD), with 50–55 % of those with OCD exhibiting contamination fear. Similarly, cleaning compulsions, the compulsions most linked to contamination OCD, are the second most common OCD symptom, second to compulsive checking. Various maladaptive cognitions, disgust sensitivity,...
Article
The Massachusetts General Hospital Hairpulling Scale (MGH-HPS) and the NIMH Trichotillomania Severity Scale (NIMH-TSS) are two widely used measures of trichotillomania severity. Despite their popular use, currently no empirically-supported guidelines exist to determine the degrees of change on these scales that best indicate treatment response. Det...
Article
The Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS) is the most commonly used instrument to assess the symptoms and severity of pediatric obsessive compulsive disorder (OCD). However, only one prior study has evaluated the psychometric properties of the CY-BOCS for assessing young children, ages 5 to 8 years. The limited available eviden...
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We examined outcomes from a residential treatment program emphasizing exposure and response prevention (ERP) to determine if the typically robust response to this treatment in outpatient settings extends to patients treated in this unique context. One hundred and seventy-two adolescents with primary Obsessive-compulsive disorder (OCD) completed mea...
Article
Pediatric obsessive-compulsive disorder (OCD) can be effectively treated with family-based intervention by expanding and enhancing family members' behavioral repertoire to more effectively manage OCD symptoms and affected family interactions. This article provides an overview and practical understanding of the implementation of family-based treatme...
Article
In the present study, we evaluated the Milwaukee Inventory for Subtypes of Trichotillomania-Adult Version (MIST-A) in a replication sample of clinically characterized hair pullers using exploratory factor analysis (EFA; N = 193). EFA eigenvalues and visual inspection of our scree plot revealed a two-factor solution. Factor structure coefficients an...
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Background: Diagnosis of Trichotillomania (TTM) requires meeting several criteria that aim to embody the core pathology of the disorder. These criteria are traditionally interpreted monothetically, in that they are all equally necessary for diagnosis. Alternatively, a dimensional conceptualization of psychopathology allows for examination of the re...
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Pediatric obsessive-compulsive disorder (OCD) is a chronic and impairing condition that can emerge early in childhood and persist into adulthood. The primary aim of this paper is to examine the characteristics of a large sample of young children with OCD (age range from 5 to 8). The sample will be described with regard to: demographics, OCD symptom...
Article
The efficacy of cognitive-behavioral therapy (CBT) for pediatric obsessive-compulsive disorder (OCD) has been the subject of much study over the past fifteen years. Building on a foundation of case studies and open clinical trials, the literature now contains many methodologically sound studies that have compared full CBT protocols to waitlist cont...
Chapter
Trichotillomania (TTM) is characterized by an inability to resist urges to pull hair from the scalp, eyebrows, eyelashes, pubic region, or other bodily regions, resulting in noticeable hair loss. Episodes of pulling are often linked to stress. TTM is associated with psychiatric comorbidity and significant functional impairment. Habit reversal train...
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Objective Prior research has shown that youth with co-occurring tic disorders and obsessive-compulsive disorder (OCD) may differ from those with non-tic-related OCD in terms of clinical characteristics and treatment responsiveness. A broad definition of “tic-related” was used to examine whether children with tics in the Pediatric OCD Treatment Stud...
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Objective: The purpose of this study was to examine the acute effectiveness of manualized exposure-based CBT with a family-based treatment, as an initial treatment for pediatric OCD delivered in regular community child and adolescents outpatient clinics. The report summarizes outcome of the first treatment step in the NordLOTS, which was conducted...
Article
Cognitive models of obsessive-compulsive disorder (OCD) posit that particular beliefs transform normal intrusions into disturbing obsessions. A wealth of data shows that such beliefs and obsessive-compulsive (OC) symptoms are related in adults. However, there is markedly less information regarding OCD-related beliefs in youth. The purpose of this s...
Article
Psychological Inflexibility (PI) is a construct that has gained recent attention as a critical theoretical component of Acceptance and Commitment Therapy (ACT). PI is typically measured by the Acceptance and Action Questionnaire-II (AAQ-II). However, the AAQ-II has shown questionable reliability in clinical populations with specific diagnoses, lead...
Article
We assessed anxiety consistent (i.e., "traditional") and inconsistent (i.e., "atypical") with diagnostic and statistical manual (DSM) definitions in autism spectrum disorder (ASD). Differential relationships between traditional anxiety, atypical anxiety, child characteristics, anxiety predictors and ASD-symptomology were explored. Fifty-nine partic...
Article
Importance: Cognitive behavior therapy (CBT) has been established as efficacious for obsessive-compulsive disorder (OCD) among older children and adolescents, yet its effect on young children has not been evaluated sufficiently. Objective: To examine the relative efficacy of family-based CBT (FB-CBT) involving exposure plus response prevention v...
Article
Trichotillomania (TTM) was long classified as an impulse-control disorder; however, the many characteristics it shares with obsessive-compulsive disorder (OCD) led to its recategorization in the DSM-V. The present study aimed to assess and inform the taxonomic placement of TTM through an examination of its neural correlates. While research has cons...
Article
Objective To examine associations between comorbid anxiety disorders and difficulties commonly attributed to both anxiety and ASD, including self-injury, depressive symptoms, functional communication, social skill deficits and parent stress, in a well-characterized sample of youth with ASD. Method Fifty-nine verbally fluent participants (7–17 year...
Article
Notes that advances in cognitive–behavioral and pharmacological treatments have greatly improved the prognosis for patients with obsessive–compulsive disorder (OCD). In this chapter, the authors first discuss diagnostic and theoretical issues of OCD and review the available treatments. Assessment procedures are then described and methods for implem...
Article
Given the burdens of early-onset obsessive-compulsive disorder (OCD), limitations in the broad availability and accessibility of evidence-based care for affected youth present serious public health concerns. The growing potential for technological innovations to transform care for the most traditionally remote and underserved families holds enormou...
Article
Pediatric obsessive-compulsive disorder (OCD) is associated with substantial morbidity, comorbidity, family difficulties, and functional impairment. Fortunately, OCD in youth has also been found responsive to cognitive behavioral therapy (CBT) both alone and in combination with medication. This paper highlights key areas a treatment provider must b...
Article
Full-text available
Trichotillomania (hair-pulling disorder) involves repetitive hair pulling that can cause significant distress and impairment in functioning. Both children and adults suffer from the disorder. Habit reversal training (HRT) is the trichotillomania treatment with the most empirical support. HRT begins with developing an in-depth understanding of the c...
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Efforts to understand the nature of "Not Just Right Experiences" (NJREs) have expanded the scientific understanding of obsessive-compulsive (OC) behavior. Approximately 80 % of unselected adults report experiencing NJREs and these experiences have been found to highly correlate with OC behavior. The purpose of this study was to assess NJREs in an u...
Article
In the present study, we examined the psychometric properties of the Skin Picking Impact Scale (SPIS; Keuthen, Deckersbach, Wilhelm et al., 2001), a 10 item self-report questionnaire designed to assess the psychosocial impact of skin picking disorder (SPD). Participants were 650 individuals who met criteria for SPD in an online survey. Exploratory...
Article
This article describes the long-term effects of augmenting serotonin reuptake inhibitors (SRIs) with exposure and ritual prevention or stress management training in patients with DSM-IV obsessive-compulsive disorder (OCD). Between November 2000 and November 2006, 111 OCD patients from 2 academic outpatient centers with partial SRI response were ran...
Article
Background: Obsessive-compulsive disorder (OCD) is a severe condition with varied symptom presentations. Currently, the cognitive-behavioral treatment with the most empirical support is exposure and ritual prevention (EX/RP); however, clinical impression and some empirical data suggest that certain OCD symptoms are more responsive to treatment tha...
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Full-text available
The aim was to investigate clinical characteristics of young children with a hair pulling problem. Parents/caregivers of young children (0-10 years old) with a hair pulling problem (N = 110) completed an online survey. The majority reported that their child experienced mild to moderate impairment/distress due to hair pulling, and overall clinical c...