Brittany M. Rudy

Predictors of treatment response to intensive cognitive-behavioral therapy for pediatric obsessive-compulsive disorder

Intensive outpatient treatments for pediatric obsessive-compulsive disorder (OCD) have demonstrated efficacy for treating youth with OCD and may be especially useful for youth with severe symptomology and/or those who are partial- or non-responders to other forms of intervention. However, participation in these treatments can present challenges for youth and their families, and it is unclear if intensive treatments are more appropriate for certain individuals than others. Identification of potential predictors of treatment response and viability of intensive treatment at an individual level may aid families in their decision to participate in intensive cognitive-behavioral therapy (CBT). The present study aimed to examine the effects of three categories of predictors (demographics, OCD symptom characteristics, and comorbidity) on key target outcomes (post-treatment symptom severity, remission, and treatment response). Participants included 78 youth with a primary diagnosis of OCD who received 14 sessions of family based intensive CBT treatment over 3 weeks. Of the entire sample, 88.5% were classified as treatment responders, with 62.8% of the sample achieving clinical remission. Results identified three significant predictor variables (i.e., symptom severity, family accommodation, and gender) for post-treatment symptom severity and remission status within the context of the examined predictive models. No variables were identified as predictive of treatment response, and comorbidity was not identified as a predictor variable for any treatment outcome.

Obsessions, Compulsions, and Repetitive Behavior: Autism and/or OCD

Autism spectrum disorder (ASD) and obsessive–compulsive disorder (OCD) share similar clinical features (e.g., obsessions, compulsions, restricted interests, repetitive behaviors), making accurate differential diagnosis challenging. Fairly high rates of comorbidity between the disorders further complicate the assessment procedures and present additional clinical concerns (e.g., increased psychosocial impairment). Given the clinical implications of their co-occurrence and similar symptom presentations, differentiating obsessive–compulsive symptoms from symptoms of ASD is essential. This chapter provides information on OCD and ASD individually and jointly. Diagnostic criteria for each disorder are reviewed, along with explanations of symptom overlap between OCD and ASD. Clinical examples of overlapping symptoms of OCD and ASD requiring a differential diagnosis are presented, and recommendations for techniques and queries within assessments are included. Commonly utilized measures to aid in the assessment of OCD and ASD symptoms are summarized, though there is still a paucity of measures that have been validated for concurrent use in both populations. A brief overview of treatment in individuals with OCD and ASD is presented, as well as a description of the Diagnostic and Statistical Manual of Mental Disorders—Fifth Edition (DSM-5) changes and associated implications. For each section, clinical implications of the overlap between OCD and ASD are discussed.

Phenomenology, Clinical Correlates, and Impairment in Emetophobia

Emetophobia, or a specific phobia of vomiting, is an underresearched disorder characterized by extensive avoidance and safety-seeking behaviors. Extant literature has primarily focused on online support groups and qualitative investigations, thereby limiting the generalizability of results. As such, this study sought to examine the clinical correlates, phenomenology, and impairment related to emetophobia in 436 undergraduate students. About 5% of the sample exhibited significant emetophobia symptoms (n = 21), with all participants in this subsample reporting an age of onset prior to adulthood. In addition, participants’ most distressing aspects of emetophobia were reported to be the somatic sensations of vomiting and the social impact of the disorder. For the entire sample (N = 436), emetophobia symptoms were associated with heightened anxiety, somatization, and depressive symptoms. In addition, functional impairment was observed across home/family, school/work, and social domains of life, even after controlling for the effects of anxiety and depressive symptoms. Detailed results and implications of the findings are discussed, and suggestions for future studies are presented.

Treatment of Symmetry in Childhood Obsessive-Compulsive Disorder

Pediatric obsessive-compulsive disorder (OCD) is a disabling disorder that interferes with the functioning of not only the child but also the entire family unit. Up to five separate dimensions of OCD symptomatology have been identified as distinct symptom clusters. The symmetry dimension of OCD involves magical thinking and compulsive behaviors such as tapping and evening out as well as “just not right” feelings. This dimension reportedly occurs more commonly in younger children than older cohorts. With that in mind, certain factors such as increased family accommodation and developmentally appropriate lack of metacognition, insight, and motivation often complicate the treatment process when treating younger children with OCD, making certain modifications necessary for successful treatment in most cases. The following case study is an example of creative use of behavioral and cognitive-behavioral techniques in combination with a heavy emphasis on parent training and parental involvement to treat symmetry OCD in a 7-year-old child.

A Case Series of Cognitive-Behavioral Therapy Augmentation of Antidepressant Medication for Anxiety in Children With Autism Spectrum Disorders

Objective: To provide preliminary estimates of the effectiveness of cognitive-behavioral therapy (CBT) in treating anxiety disorders among youth with autism spectrum disorders (ASD) whose anxiety remained clinically problematic following an adequate course of pharmacotherapy. Method: Seven youth with ASD and one or more comorbid anxiety disorders, who were non- or partial-responders to serotonin reuptake inhibitor (SRI) treatment delivered by their community provider (age range = 12–15 years), received 16 sessions of weekly CBT. Assessments were administered at baseline, approximately 17 weeks following baseline (pre-treatment), and after receiving CBT (post-treatment). Results: Four of seven participants were classified as treatment responders (much or very much improved) at post-treatment. Clinician severity ratings for 6 of 7 participants—as measured by the PARS, ADIS-IV-P, and CGI-Severity—decreased following CBT, with effect sizes ranging from 1.35 to 1.54. Parent-rated anxiety and ASD symptoms in the child were not significantly reduced. Conclusions: This study provides preliminary support for use of CBT in augmenting SRI treatment in youth with ASD and anxiety.

Preliminary study of family accommodation in 4–7 year-olds with anxiety: frequency, clinical correlates, and treatment response

Abstract Background: Childhood anxiety disorders are common in early childhood and are associated with marked impairment. Family accommodation, which contributes to the maintenance of child anxiety, has only been minimally examined in children under the age of 7 years with anxiety disorders. Aims: This study aimed at examining the frequency and clinical correlates of family accommodation in anxious children under the age of 7 years, as well as changes in family accommodation following cognitive-behavioral treatment. Method: Twenty-six children between the ages of 4 and 7 years diagnosed with at least one anxiety disorder participated in this study. A subsample of these children (n = 23) participated in 10 sessions of parent-led exposure therapy or treatment-as-usual (TAU). Results: Family accommodation occurred in 100% of the sample and was positively correlated with children’s externalizing behavior, but not with anxiety severity or parental distress. Family accommodation decreased following cognitive behavioral therapy but not TAU. Conclusions: Reductions in family accommodation were associated with greater improvements in child anxiety symptoms following treatment.

Introduction to the Special Issue: Considerations of the Effects of Extra-Symptom Variables Among Youth With Chronic Tic Disorders and Tourette’s Syndrome

The purpose of this special issue is to highlight and discuss individual and family factors that contribute to tic severity and impairment as well as the clinical implications of such factors among youth with chronic tic disorders (CTDs). Within the issue, authors discuss topics such as internalizing and externalizing comorbidity, tic behavior functions, caregiver strain, psychosocial implications in peer settings, quality of life, and cultural considerations of treatment. This introduction highlights the importance of each article within and provides a discussions of the implications of the included articles.