Amita Jassi

Cognitive behavior therapy for comorbid obsessive-compulsive disorder in high-functioning autism spectrum disorders: a randomized controlled trial.

High rates of anxiety disorders, particularly obsessive compulsive disorder (OCD) are reported in people with Autism spectrum disorders (ASD). Group cognitive behavioral treatment (CBT) has been found effective for anxiety in young people with ASD but not been OCD specific. One uncontrolled pilot study of individual CBT for OCD for adults with ASD showed good treatment efficacy.

Outcomes of cognitive behaviour therapy for obsessive-compulsive disorder in young people with and without autism spectrum disorders: A case controlled study

Obsessive-compulsive disorder (OCD) and autism spectrum disorders (ASD) are highly co-morbid. It is suggested that youth with ASD will respond less well to cognitive behaviour therapy (CBT), as compared to their typically developing counterparts. To date there is no empirical evidence to support this view. The current study sought to compare CBT for OCD outcomes among youth with and without ASD. 22 young people with ICD-10 diagnoses of OCD and ASD (OCD+ASD) were matched with 22 youth with OCD, but no ASD (OCD+NoASD) according to base line OCD symptom severity, age, and gender. Outcomes were assessed for the two groups following a course of individually tailored, but protocol-driven CBT for OCD. While both groups responded to treatment the OCD+ASD groups outcomes were inferior to the OCD+NoASD group, as indicated by a significantly smaller decrease in symptoms over treatment (38.31% vs. 48.20%) and lower remission rates at post-treatment (9% vs. 46%). Overall, young people experiencing OCD in the context of ASD benefitted from CBT, but to a lesser extent than typically developing children. Recent efforts to modifying standard CBT protocols for OCD in ASD should continue in order to optimise outcomes among youth with this particular dual psychopathology.

Illness perception, help-seeking attitudes, and knowledge related to obsessive–compulsive disorder across different ethnic groups: a community survey

PurposeDespite similar prevalence rates across ethnicities, ethnic minorities with obsessive–compulsive disorder (OCD) are under-represented in research and clinical settings. The reasons for this disproportion have been sparsely studied. We explored potential differences in illness perception, help-seeking attitudes, illness knowledge, and causal attributions that could help explain the lower uptake of treatment for OCD amongst ethnic minorities.MethodsTwo-hundred and ninety-three parents (139 White British, 61 Black African, 46 Black Caribbean, and 47 Indian) were recruited from the general population in South-East London, UK. Using a text vignette methodology, participants completed a survey including questions on illness perception, help-seeking attitudes, OCD knowledge, and causal attributions.ResultsThe groups did not differ in socio-demographic characteristics and family history of OCD. White British parents perceived that the OCD difficulties would have more negative impact on their children and that treatment would be more helpful, compared to the ethnic minorities; the largest differences were observed between White British and Indian parents. Ethnic minorities were more prone to say that would seek help from their religious communities. Black African parents were more in favor of not seeking help for the described difficulties and, in general, perceived more treatment barriers. White British parents seemed to be better informed about OCD than ethnic minority parents.ConclusionsThe results offer some plausible explanations for the large inequalities in access to services amongst ethnic minorities with OCD. Clinicians and policy-makers need to be aware of these socio-cultural factors when designing strategies to encourage help-seeking behaviors in these populations.

Ethnic inequalities in the use of secondary and tertiary mental health services among patients with obsessive–compulsive disorder

BACKGROUND Obsessive-compulsive disorder (OCD) has similar prevalence rates across ethnic groups. However, ethnic minorities are underrepresented in clinical trials of OCD. It is unclear whether this is also the case in clinical services. AIMS To explore whether ethnic minorities with OCD are underrepresented in secondary and tertiary mental health services in the South London and Maudsley (SLaM) NHS Foundation Trust. METHOD The ethnic distribution of patients with OCD seen between 1999 and 2013 in SLaM (n = 1528) was compared with that of the general population in the catchment area using census data. A cohort of patients with depression (n = 22 716) was used for comparative purposes. RESULTS Ethnic minorities with OCD were severely underrepresented across services (-57%, 95% CI -62% to -52%). The magnitude of the observed inequalities was significantly more pronounced than in depression (-29%, 95% CI -31% to -27%). CONCLUSIONS There is a clear need to understand the reasons behind such ethnic inequalities and implement measures to reduce them.

How resistant is ‘treatment-resistant’ obsessive-compulsive disorder in youth?

OBJECTIVES Obsessive-compulsive disorder (OCD) is often perceived as being difficult to treat. This study aimed to test the hypothesis that treatment non-response in routine clinical practice is often due to failures in the delivery of treatment, and that most patients who are apparently treatment-resistant will respond to treatment if adequately delivered. DESIGN Retrospective cohort data analysis. METHODS Forty-three young people with severe, treatment-resistant OCD (defined as Childrens Yale-Brown Obsessive-Compulsive Scale [CY-BOCS] scores ≥ 30 and non-response to previous cognitive behaviour therapy [CBT] and selective serotonin reuptake inhibitors) were referred to a specialist clinic and completed a course of manualized CBT, with (N = 21) or without (N = 22) optimization of medication. A sub-sample (N = 15) completed a semi-structured interview to determine characteristics of their previous CBT; quality was assessed according to pre-determined criteria. RESULTS Specialist treatment was associated with significant reductions in OCD symptoms at post-treatment with gains maintained at 3-month follow-up. At the 3-month follow-up, 58% of patients showed a meaningful clinical response (≥ 35% drop on the CY-BOCS) and 22% were in remission (≤ 12 on the CY-BOCS). Patients whose medication was optimized tended (non-significantly) to have better responses. The quality of previous CBT was assessed in a sub-group of participants and rated as inadequate in 95.5% of cases. The most common inadequacy was insufficient focus on exposure techniques. CONCLUSIONS These findings provide support for the notion that treatment non-response in routine practice may be due to technical treatment failures and highlight the need to disseminate good quality evidence-based treatment among this population. Research is also needed to understand factors that impede outcome to further improve response and remission rates. PRACTITIONER POINTS Among young people with OCD, failure to respond to treatment in routine clinical practice may often reflect the nature of the treatment received. Exposure techniques may often be overlooked in CBT for OCD, potentially resulting in poor therapeutic response. Most young people with severe and apparent treatment-resistant OCD respond to outpatient CBT incorporating E/RP. Further research is needed to establish effective methods for disseminating good quality CBT for OCD.

‘Oh No He Doesn’t!’, ‘Oh Yes He Does!’: Comparing Parent and Teacher Perceptions in Tourette’s Syndrome

Tourette’s syndrome is a complex and distressing condition characterized by vocal and motor tics. It is also associated with attentional and obsessional difficulties, which may be of greater concern than the tics to the child and their family. Parents attending specialist clinics report that attentional and learning difficulties are their greatest concern. Teachers are also concerned with attentional problems. However, overall, they report fewer behaviours as being of concern and rate those that they do report as less severe than parents. This can lead to conflict, with parents often feeling blamed and criticized for poor parenting. The article emphasizes the need for comprehensive and systemic assessment of children incorporating multiple perspectives. The need for a combination of treatment approaches, including the provision of educational material to help teachers understand the complex nature of Tourette’s syndrome, is described.

Modified Cognitive Behavior Therapy for Severe, Treatment‐Resistant Obsessive‐Compulsive Disorder in an Adolescent With Autism Spectrum Disorder

There is a high rate of comorbidity between obsessive-compulsive disorder (OCD) and autism spectrum disorders (ASD). Standard cognitive-behavior therapy (CBT) protocols have been shown to be less effective in treating OCD in young people with ASD than in typically developing youth. This case study describes the treatment of an adolescent boy with severe, treatment-resistant OCD and ASD using a modified CBT approach. Modifications to a standard evidence-based CBT for OCD protocol included extended psychoeducation about anxiety; regular home-based sessions; and increased involvement of systems, including family and school. Multi-informant outcome data indicated significant improvements in OCD symptoms over the course of treatment with gains being maintained over a 12-month follow-up period. These findings demonstrate the potential efficacy of modified CBT for pediatric OCD in the context of ASD.

Increasing Knowledge about Obsessive Compulsive Disorder and Support for Parents and Schools: Evaluation of Initiatives.

Objective: Obsessive compulsive disorder (OCD) in children can be difficult to detect. Schools and families need to be made aware of the signs and symptoms of OCD in order to facilitate access to treatment. Parents of children with OCD may require support as well as knowledge. This study evaluated two initiatives aimed at increasing knowledge and support for parents and teachers. Method: This study was carried out in two parts. First, to raise awareness of the signs and symptoms of OCD, 266 schools in London were supplied with information packs. Knowledge of OCD was evaluated using a quiz before and after the dissemination of the packs. Second, groups of parents were given the opportunity to log into specially designed webinars that made it possible for them to learn about OCD and interact with other families. Feedback on webinars was collected through a survey. Results: Both the information packs and webinars were well received. One hundred and twenty seven teachers completed the quiz on OCD; knowledge of OCD increased after reading information packs. Twenty six parents attended webinars; parents reacted positively to being able to ask specialists questions and receive support from other families. Conclusion: Overall, the initiatives evaluated in this study appeared to lead to an increase in knowledge of OCD in teachers and provided access to further support for parents of children with OCD.

Working With Challenging Young People and Families

Abstract This chapter explores common factors relating to characteristics of the young person, their family, and broader environment that may pose challenges when undertaking cognitive-behavior therapy for obsessive-compulsive disorder (OCD). Challenges examined include characteristics of OCD symptoms, motivation issues, disruptive behavior, comorbidity, atypical developmental profiles, risk, parental mental health, unhelpful family dynamics, and social deprivation. The chapter draws on the available evidence base as well as clinical experience to highlight each issue and propose strategies for managing these challenges in order to optimize treatment outcomes.

Perceived treatment barriers and experiences in the use of services for obsessive–compulsive disorder across different ethnic groups: a thematic analysis

BACKGROUND Patients from ethnic minority backgrounds are underrepresented in clinical settings. Factors like cost of treatment, poor knowledge of the health system, geographic availability of services, lack of mental health literacy, differences in health beliefs, and social barriers have been identified as reasons for these inequalities. The aim of this study was to identify and compare barriers that parents from different ethnic groups face when accessing specialist services for obsessive-compulsive disorder (OCD) for their children. METHOD Ten parents from White backgrounds and 10 from ethnic minority backgrounds were recruited from the National and Specialist OCD, BDD, and Related Disorders Clinic for Young People, London, United Kingdom. They were interviewed about their opinions and experiences when accessing treatment. RESULTS Using thematic analysis, several common barriers for both groups were identified. These included a lack of knowledge of OCD, lack of resources within the health system, previous negative experiences, lack of trust in the mental health system, lack of time and financial issues, no support out of hours, bullying, and inconvenient location of services. In addition, there were several barriers that were endorsed by ethnic minority groups but not by the parents from White backgrounds, namely stigma and discrimination from within their communities, shame and denial, a general lack of trust in the health system by their cultural group, different beliefs about mental health issues, and discrimination from within the system. CONCLUSIONS Policy-makers and clinicians should be aware of the additional barriers minority patients may face in accessing treatment and should support interventions designed to overcome them.