Joshua M. Nadeau

Communication and Collaboration With Schools: Pediatricians’ Perspectives

The multifaceted effect of chronic illness in children has created a need for pediatricians and school personnel, specifically school psychologists, to engage in collaborative problem solving. However, the extent to which this collaboration actually occurs in practice is unknown. A survey was developed and administered to a national sample of members of the American Academy of Pediatrics to assess their type and frequency of communication and collaboration with school personnel, preferred methods of communication, primary school contact person, and their perceptions of the barriers to and benefits of collaborating with school personnel. Results of this survey yield strategies for school psychologists to facilitate communication and collaboration with pediatricians to assist in meeting the needs of children with pediatric health issues.

Family Cognitive-Behavioral Treatment for a Child With Autism and Comorbid Obsessive Compulsive Disorder

Cognitive-behavioral therapy (CBT) with exposure/response prevention is effective among youth with autism spectrum disorders (ASDs) and comorbid anxiety symptoms. This case illustrates the application of a modularized family-based CBT approach with a school-aged boy with autistic disorder and comorbid obsessive-compulsive disorder (OCD). Following 16 family sessions over 21 weeks, “Jerry,” a 9-year-old Caucasian male, showed significant reduction in obsessive-compulsive symptoms. Jerry’s parents also reported improvements in emotional regulation, participation in school activities, and in his parent–child relationships. This case study illustrates the use of family-based CBT, which has been modified to account for social and behavioral deficits endemic to ASDs, for school-aged youth with autism and comorbid OCD.

A Pilot Trial of Cognitive-Behavioral Therapy Augmentation of Antibiotic Treatment in Youth with Pediatric Acute-Onset Neuropsychiatric Syndrome-Related Obsessive-Compulsive Disorder

BACKGROUND This study reports an open trial of family-based cognitive-behavioral therapy (CBT) in children and adolescents with obsessive-compulsive disorder (OCD) exhibiting an onset pattern consistent with pediatric acute-onset neuropsychiatric syndrome (PANS). METHODS Eleven primarily Caucasian youth with PANS-related OCD (range=4-14 years; 6 boys) who were incomplete responders to antibiotic treatment, received family-based CBT delivered either face-to-face or via web camera. RESULTS All participants completing treatment (8 of 8) were considered improved at posttreatment, and average obsessive-compulsive symptom severity was reduced by 49%. Significant reductions in obsessive-compulsive symptom severity and in clinician- and parent-rated OCD-related impairment were noted. Reductions in parent- and child-rated anxiety, child-rated OCD-related impairment, and comorbid neuropsychiatric symptoms were not statistically significant. CONCLUSIONS Gains were maintained at follow-up, with 100% (6 of 6) of those assessed remaining improved. Implications for treatment and further research are discussed.

Frequency and Correlates of Suicidal Ideation in Pediatric Obsessive–Compulsive Disorder

This study examined the frequency and sociodemographic and clinical correlates of suicidal ideation in a sample of children and adolescents with obsessive–compulsive disorder (OCD). Fifty-four youth with OCD and their parent(s) were administered the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime, Children’s Yale-Brown Obsessive Compulsive Scale, and Children’s Depression Rating Scale-Revised. Children completed the Suicidal Ideation Questionnaire-Junior (SIQ-JR), Child Obsessive Compulsive Impact Scale-Child, and Multidimensional Anxiety Scale for Children; parents completed the Child Obsessive Compulsive Impact Scale-Parent, Swanson, Nolan, and Pelham-IV Parent Scale, and Young Mania Rating Scale-Parent Version. Seven youth endorsed clinically significant levels of suicidal ideation on the SIQ-JR. Suicidal ideation was significantly related to clinician-rated depressive symptoms, age, child-rated impairment and anxiety symptoms, and symmetry, sexuality/religiosity and miscellaneous symptom dimensions. There was no significant association between suicidal ideation and obsessive–compulsive symptom severity, comorbidity patterns, or several parent-rated indices (e.g., impairment, impulsivity). These results provide initial information regarding the frequency and correlates of suicidal ideation in treatment-seeking youth with OCD. Clinical implications are discussed, as well as directions for future research.

A Cognitive-Behavioral Approach for Anxiety in a Preschool-Aged Child With Autism Spectrum Disorder

Empirical support exists for behaviorally oriented psychosocial interventions to reduce functional impairment related to autism spectrum disorder (ASD) symptoms in young children, but little research exists examining the effectiveness of such treatments when applied to preschool-aged children with comorbid anxiety symptoms. With this in mind, the authors report on the case of “Marcus,” a 4-year-old boy with autistic disorder and impairing comorbid anxiety. Marcus participated in 8 weekly sessions of family-based cognitive-behavioral therapy, addressing his fear-based avoidance of social interactions and sensory stimuli, using an anxiety treatment protocol for youth with ASD modified to account for his young age. This protocol consisted of modular components addressing affective education, exposure, cognitive restructuring, and social coaching. At post-treatment assessment, Marcus exhibited markedly decreased impairment, as evidenced by parent responses to clinical interview and rating scales. In addition, Marcus displayed improvement in severity of anxiety symptoms as illustrated by a decrease in his scores on the Pediatric Anxiety Rating Scale from 17 at baseline to 8 at post-treatment. Therapeutic gains were maintained at 4-month follow-up. Implications and clinical considerations are discussed.

Quality of life and burden in caregivers of youth with obsessive-compulsive disorder presenting for intensive treatment

BACKGROUND Pediatric obsessive-compulsive disorder (OCD) is associated with deleterious familial effects; caregivers are often enmeshed in the disorder and can experience considerable burden and decreased quality of life (QoL). Consequently, this study examined burden and QoL in caregivers of youth with OCD enrolled in an intensive outpatient or partial hospitalization program. METHOD The relationships between caregiver QoL and burden and the following variables were investigated: OCD symptom severity, functioning (youth functional impairment, general family functioning), family (family accommodation, parental relationship satisfaction, positive aspects of caregiving), and comorbid psychopathology (caregiver anxiety and depressive symptoms, youth internalizing and externalizing behaviors). Seventy-two child and caregiver dyads completed clinician- and self-rated questionnaires. RESULTS Components of caregiver QoL correlated with caregiver-rated functional impairment, family accommodation, youth externalizing behaviors, and caregiver psychopathology. Aspects of caregiver burden correlated with child OCD symptom severity, functional impairment related to OCD, as well as caregiver and child comorbid psychopathology. Caregiver depressive symptoms predicted caregiver QoL, and caregiver depressive symptoms and child externalizing symptoms both predicted caregiver burden. Caregiver burden did not mediate the relationship between obsessive-compulsive symptom severity and caregiver QoL. CONCLUSION Ultimately, elucidating factors associated with increased caregiver burden and poorer QoL is pertinent for identifying at-risk families and developing targeted interventions.

An Initial Case Series of Intensive Cognitive–Behavioral Therapy for Obsessive–Compulsive Disorder in Adolescents with Autism Spectrum Disorder

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.

Symptom correspondence between clinicians and patients on the Yale-Brown Obsessive Compulsive Scale.

The present study examined concordance between the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and its self-report version (Y-BOCS-SR), as well as theoretically derived moderators. Sixty-seven adults (ages 18-67) with obsessive-compulsive disorder (OCD) were administered the Y-BOCS prior to completing self-report measures. The Y-BOCS-SR generated lower scores relative to the clinician-administered Y-BOCS (5.3 points lower). Strong correspondence was shown between the Y-BOCS and Y-BOCS-SR; however, many items exhibited fair to moderate agreement, particularly the resistance and control against obsessions/compulsions items. Depression significantly moderated correspondence such that Y-BOCS-SR scores significantly predicted Y-BOCS scores in the presence of low and average depression levels in our sample, but not for patients with high levels of depression relative to the rest of our sample; gender, generalized anxiety and obsessionality did not significantly impact agreement. Synthesizing the present data, the Y-BOCS-SR demonstrates modest agreement with the Y-BOCS and may underestimate clinical severity especially for those with high levels of depression.

Psychometric properties of the Autism Mental Status Examination in a pediatric sample

ABSTRACT The Autism Mental Status Examination (AMSE) is an 8-item assessment in which the clinician evaluates the presence of autism spectrum symptoms in the context of a brief, observational, clinical exam. Given the need for accurate, timely, and cost-effective clinical evaluation, the brief nature of the AMSE may aid in filling this gap in developmental assessment. However, other than two studies by the measure developers, no other research group has examined the psychometric properties of the AMSE. The current study examined the psychometric properties of the AMSE in 68 children seeking developmental evaluation and/or services related to anxiety in the context of autism spectrum disorders (ASD). The AMSE exhibited adequate internal consistency and excellent inter-rater reliability. Known groups validity was supported and there was preliminary evidence for convergent validity. The current data partially supports the AMSE as a psychometrically sound assessment tool.

Correlates and Mediators of Life Satisfaction Among Youth With Attention-Deficit/Hyperactivity Disorder

The current study examined factors associated with life satisfaction among 111 youth, ages 8–17 years, presenting for outpatient treatment of attention-deficit/hyperactivity disorder (ADHD). Youth completed the Students’ Life Satisfaction Scale, Vanderbilt ADHD Diagnostic Rating Scale–Child, and the Generalized Anxiety Disorder (GAD) and Major Depressive Disorder (MDD) modules of the Revised Child’s Anxiety and Depression Scale. A primary caregiver completed a standard demographic form, and the Vanderbilt ADHD Diagnostic Rating Scale–Parent. Results indicated that child-rated ADHD symptoms, depressive symptoms, and generalized anxiety symptoms were negatively related to life satisfaction. Parent-rated ADHD symptoms in the child were related to child-rated ADHD symptoms but not to depressive symptoms, generalized anxiety symptoms, or life satisfaction. Depressive symptoms predicted life satisfaction above and beyond parent-rated ADHD symptom severity; however, neither depressive nor generalized anxiety symptoms were found to uniquely predict life satisfaction above and beyond child-rated ADHD symptom severity. Depressive symptoms mediated the relationship between child-rated ADHD symptom severity and life satisfaction. Assessment and treatment implications are discussed; specifically, we highlight how the variables of interest may impact clinical presentation and treatment course.