Caleb W. Lack

Quality of life in youth with Tourette's syndrome and chronic tic disorder.

This study sought to examine quality of life (QoL) in clinic-referred children and adolescents (n = 59, M age = 11.4±2.6 years) with a chronic tic disorder. The QoL scores for tic patients were lower than for healthy controls but higher than for the psychiatric sample on the majority of domains. Childrens self-reported QoL scores and a measure of tic severity were moderately and inversely correlated. Parent reports of their childs QoL were weakly related to tic severity. Correlations between parent and child ratings of QoL for children ages 8 to 11 years were generally higher than those for youth ages 12 to 17 years. Finally, externalizing behavior moderated the relations between tic severity and parent-rated QoL, such that tic severity was significantly associated with parent-rated QoL for children with below average externalizing symptoms but not for children 3with above average externalizing symptoms.

Quality of life in children and adolescents with obsessive-compulsive disorder: base rates, parent–child agreement, and clinical correlates

The presence of obsessive-compulsive disorder (OCD) has been linked to decreased quality of life (QoL) among adults, yet little is known about the impact of OCD on QoL in pediatric patients. Sixty-two youth with OCD and their parent(s) were administered the Children’s Yale-Brown Obsessive Compulsive Scale following a clinical interview. Children completed the Pediatric Quality of Life Inventory and parents completed the Pediatric Quality of Life Parent Proxy Inventory and Child Behavior Checklist. QoL scores for OCD patients were significantly lower than for healthy controls, but similar to QoL in a general psychiatric sample on the majority of domains. Parent–child agreement on QoL was moderate to strong across age groups. Results indicate that, in youth with OCD, QoL is reduced relative to healthy controls, related to OCD symptom severity per parent-report, and are strongly predicted by the presence of comorbid externalizing and internalizing symptoms.

Rage Attacks in Pediatric Obsessive-Compulsive Disorder: Phenomenology and Clinical Correlates.

OBJECTIVE Rage attacks have been documented in youth with varied psychiatric disorders, but few data have been reported on the clinical characteristics and correlates of rage attacks among children with obsessive-compulsive disorder (OCD). METHOD Participants were 86 children (ages 6-16 years) with a primary diagnosis of OCD. Patients and their primary caregiver were administered clinician-rated measures of obsessive-compulsive severity and rage severity. Children completed the Center for Epidemiologic Studies Depression Scale and the Child Sheehan Disability Scale-Child, whereas parents completed the Rage Attacks Questionnaire, Aberrant Behavior Checklist-Irritability Scale, Childrens Affective Lability Scale, and Child Sheehan Disability Scale-Parent. RESULTS Rage was common among youth with OCD and was associated with varied clinical characteristics. Rage severity accounted for functional impairment beyond the influence of obsessive-compulsive symptom severity; however, these relations were explained by the impact of family accommodation. CONCLUSIONS These data suggest that rage attacks are relatively common, have a negative impact on illness presentation, and contribute to functional impairment above and beyond obsessive-compulsive symptom severity. Rage may contribute to family accommodation of symptoms, which may further affect obsessive-compulsive symptom severity and impairment.

Mood Disorders in Children and Adolescents

Childhood mood disorders such as major depression, dysthymia, and bipolar disorder have been found to be highly prevalent among children and adolescents. The emotional and behavioral dysfunction associated with these mood disorders can cause impairments across areas of functioning, including academic and social arenas. This article reviews the course, possible causes, assessment, and treatment of this group of disorders in youth and concludes by examining the implications for nurses and other health care providers of youth with mood disorders.

Attributions, Coping, and Exposure as Predictors of Long-term Posttraumatic Distress in Tornado-Exposed Children

Previous research has implicated a number of factors in why a child might or might not develop a negative reaction to a traumatic situation. The current study was designed to examine multiple factors and their effect on the long-term distress in children 8–12 years old who were exposed to a devastating tornado. The factors of initial exposure to the tornado, attributions about the tornado, and coping style were examined using multiple regression analyses, the number and types of attributions a child makes were found to explain the most amount of variance in long-term distress.

The use of computers in the assessment and treatment of obsessive-compulsive disorder

This article reviews the empirical literature related to the use of computer-administered, cognitive-behaviorally based assessment and treatment for obsessive-compulsive disorder (OCD). Such research has increased steadily over the years, and has shown that treatments such as BT STEPS are effective at both assessing for and treating OCD. More large-scale studies examining the utility of such programs are needed, but initial research shows moderate to large effect sizes for reduction of OCD symptoms and impairment in functioning. The article concludes with recommendations for future directions for both clinical work and research in this area, including expansion of such services to assist in gaining more knowledge of how effective such treatments are, expand the number of people who could benefit from receiving such services, and examining the use of computers in treatments for other anxiety disorders to suggest new ways to move forward with OCD treatment.

Obsessive-compulsive disorder: Evidence-based treatments and future directions for research

Over the past three decades, obsessive-compulsive disorder (OCD) has moved from an almost untreatable, life-long psychiatric disorder to a highly manageable one. This is a very welcome change to the 1%-3% of children and adults with this disorder as, thanks to advances in both pharmacological and psychological therapies, prognosis for those afflicted with OCD is quite good in the long term, even though most have comorbid disorders that are also problematic. We still have far to go, however, until OCD can be described as either easily treatable or the effective treatments are widely known about among clinicians. This review focuses on the current state of the art in treatment for OCD and where we still are coming up short in our work as a scientific community. For example, while the impact of medications is quite strong for adults in reducing OCD symptoms, current drugs are only somewhat effective for children. In addition, there are unacceptably high relapse rates across both populations when treated with pharmacological alone. Even in the cognitive-behavioral treatments, which show higher effect sizes and lower relapse rates than drug therapies, drop-out rates are at a quarter of those who begin treatment. This means a sizable portion of the OCD population who do obtain effective treatments (which appears to be only a portion of the overall population) are not effectively treated. Suggestions for future avenues of research are also presented. These are primarily focused on (1) increased dissemination of effective therapies; (2) augmentation of treatments for those with residual symptoms, both for psychotherapy and pharmacotherapy; and (3) the impact of comorbid disorders on treatment outcome.

Psychometric Properties of the Hoarding Assessment Scale in College Students

This study examined the psychometric properties of the Hoarding Assessment Scale (HAS; Shytle & Sheehan, 2004) using a college sample. The HAS, Savings Inventory Revised (SI-R), Florida Obsessive Compulsive Inventory (FOCI), and Beck Depression Inventory (BDI-II), were administered to 268 students at a large university in the southeastern United States. Results demonstrated strong psychometric properties of the instrument, including positive and significant correlations with the SI-R, FOCI, and BDI-II. Implications of this study on the assessment of hoarding are discussed.

Treatment of Comorbid Anxiety Disorders Across the Life span

Decades of research on people with anxiety disorders has shown that comorbidity is the rule, not the exception. While not surprising, given the overlap in symptoms and etiology, this has a number of implications in both clinical and research realms. This chapter will examine how comorbidity influences treatment, as well as how treatment can influence comorbidity. Overall, research in the past 15 years has shown that both transdiagnostic and specific treatments can be effective, although much research remains before we have a full understanding of which works better.

Biobehavioral assessment of the anxiety disorders: Current progress and future directions

It is difficult to accurately assess and differentially diagnose the anxiety disorders. The current system of assessment relies heavily on the subjective measures of client self-report, clinical observation, and clinical judgment. Fortunately, recent technological advances may enable practitioners to utilize objective, biobehavioral measures of assessment in a clinical setting. The current body of literature on two of these biobehavioral tools (eye-tracking and electrocardiogram devices) is promising, but more validation and standardization research is needed to maximize the utility of these devices. Eye-tracking devices are uniquely capable of providing data that can be used to differentially diagnose anxiety disorders from both other commonly comorbid and misdiagnosed disorders. Both eye-tracking and electrocardiogram devices are able to provide change-sensitive assessment information. This objective, real-time feedback can assist clinicians and researchers in assessing treatment efficacy and symptom fluctuation. Recently developed wearable and highly portable electrocardiogram devices, like the wearable fitness and behavior tracking devices used by many consumers, may be particularly suited for providing this feedback to clinicians. Utilizing these biobehavioral devices would supply an objective, dimensional component to the current categorical diagnostic assessment system. We posit that if adequate funding and attention are directed at this area of research, it could revolutionize diagnostic and on-going assessment practices and, in doing so, bring the field of diagnosis out of the 20th century.