Mary L. Keeley

Clinical predictors of response to cognitive-behavioral therapy for obsessive–compulsive disorder

This paper reviews predictors of treatment response in open and controlled trials of cognitive-behavioral therapy for obsessive-compulsive disorder (OCD). We focus on demographic characteristics, aspects of OCD symptoms, comorbidity, family factors, cognitive influences, and treatment-specific characteristics as predictor variables. Although inconsistent findings characterize much of the literature, several relatively consistent and salient predictors have emerged, including symptom severity, symptom subtype, severe depression, the presence of comorbid personality disorders, family dysfunction, and the therapeutic alliance. Implications of findings and recommendations for future research are discussed.

Trichotillomania: A current review.

This review provides a broad and thorough synthesis of the Trichotillomania (TTM) literature as a resource for health professionals seeking the most current and complete information available. For the treatment provider, up to date information can help inform assessment, treatment, or referral decisions. For the student, this review provides a general overview and broad background information necessary to better understand hair-pulling and associated problems. For the researcher, information can help inform study planning. Prevalence, gender distributions, comorbidities, subtypes, and phenomenological characteristics are presented. Etiological theories are reviewed, and assessment and treatment options are offered. The validity of current DSM requirements is discussed and psychological and psychiatric treatment options are presented and evaluated for their strength of recommendation. Challenges to research and treatment are presented and directions for future research are suggested.

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.

Anxiety disorders in youth.

Anxiety disorders are one of the most prevalent categories of childhood and adolescent psychopathology. Due to their distressing, time-consuming, and/or debilitating nature, impairments in academic, social, and family functioning are often substantial. This article reviews the nature, etiology, assessment, and treatment of anxiety disorders in youth. We conclude by reviewing implications for nurses involved in the care of youth with anxiety disorders.

The therapeutic alliance in the cognitive behavioral treatment of pediatric obsessive–compulsive disorder ☆

Although cognitive-behavioral therapy (CBT) for pediatric obsessive-compulsive disorder (OCD) is considered a first-line treatment, not all youth have a positive treatment response, suggesting need for investigating factors that may enhance or reduce treatment effects. Few studies have investigated predictors of treatment response in pediatric OCD, and there is an absence of studies examining the influence of treatment process variables (e.g., therapeutic alliance [TA]) on treatment outcome. Using a multiple-informant and multiple-time point design, the current study examined the role of the TA in family-based CBT for pediatric OCD. Analyses examined (1) the predictive value of the TA on OCD symptom reduction and (2) whether changes in the TA over time predict treatment response. Findings indicated that (1) stronger child-rated, parent-rated, and therapist-rated TAs were predictive of better treatment outcome and (2) larger and more positive early alliance shifts (as rated by changes in child-rated TA between sessions 1 and 5) were predictive of better treatment outcome. Implications for the treatment of youth with OCD within family-based CBT are discussed.

Psychosocial Functioning in Youth with Glycogen Storage Disease Type I

OBJECTIVE To assess the quality of life and psychosocial functioning among pediatric patients with Glycogen Storage Disease (GSD) types Ia and Ib. METHODS Thirty-one youth with GSD types Ia and Ib and 42 healthy controls participated. Quality of life ratings from the GSD types Ia and Ib sample were compared with a previously reported clinical comparison sample. Children completed measures of quality of life, loneliness, family functioning, and sibling relationship quality (e.g., warmth, conflict). Parents completed measures of parental distress, parenting stress, child adaptive behavior, and child emotional and behavioral functioning. RESULTS Quality of life was generally lower in youth with GSD relative to healthy controls but similar to those with a chronic illness. Children with GSD were rated as having more internalizing symptoms, social problems, and lower independent functioning relative to healthy controls. Parents reported greater distress and parenting stress relative to healthy controls. CONCLUSIONS The presence of GSD types Ia and Ib are associated with reduced quality of life and independent functioning, and elevated levels of internalizing distress and parental stress relative to healthy peers. Relative to their children, parents generally reported that their child was more impaired, which suggests the need for multiple informants during assessment and active parental involvement during psychological treatment. These points should be kept in mind when assessing and treating youth with this disease and their families as psychological interventions that target areas of concern (e.g., adherence, coping with having a chronic disease) may be helpful for improving child and family outcomes.

Parental adherence to child psychologists' recommendations from psychological testing.

Nonadherence to prescribed regimens is a significant cause of treatment failure across pediatric andpsychological/psychiatric childhood conditions. Although a modest literature exists for medical condi-tions, the literature on adherence to psychologists’ recommendations is sparse. We review the extantliterature on this topic, highlighting areas for further study and intervention. Implications for policy andthe practice of psychoeducational assessment are also discussed.

PEDIATRIC OBSESSIVE-COMPULSIVE DISORDER: A GUIDE TO ASSESSMENT AND TREATMENT

Obsessive-compulsive disorder (OCD) is an anxiety disorder characterized by recurrent or persistent thoughts, impulses, or images that are experienced as intrusive or distressing (obsessions), and repetitive behaviors or mental acts (compulsions) often performed in response to an obsession. Recent epidemiological studies have found lifetime prevalence of pediatric OCD to be approximately 1-4% in the USA. OCD begins before the age of 18 years for as many as 80% of cases and follows a chronic, unremitting course. Due to the distressing, time-consuming, and debilitating nature of OCD, impairments in academic, social, and family functioning are often substantial. Despite the relatively high prevalence rate of OCD, dissemination about effective assessment and treatment has lagged. Increasing the awareness of OCD symptoms and its treatment among nurses and other health professionals will enhance identification of children presenting with unrecognized or untreated symptoms of OCD and will stimulate appropriate referrals for treatment to improve childrens psychological functioning and overall quality of life. This paper reviews the nature, etiology, assessment, and treatment of OCD, highlighting clinical implications for nurses involved in mental health care.

Behavioural activation for the treatment of low-income, African American adolescents with major depressive disorder: a case series.

Behavioural activation (BA) is a psychosocial treatment that has shown promise in the treatment of adults suffering from major depressive disorder (MDD). Recent studies have shown that BA may also be effective for treating depressed adolescents. There are no studies that have reported on the BA treatment of depressed and low-income African American adolescents; thus, the current study reports on the effectiveness of a version of BA adapted for the treatment of African American adolescents who were diagnosed with MDD (n = 3). Participants were allowed to attend a maximum of 17 sessions of weekly psychotherapy. Based on results taken from structured interviews, two of the three participants no longer met criteria for MDD at the end of treatment, and the severity of clinician-rated depressive symptoms and impairment decreased for all participants at post-treatment assessment. Additionally, all participants and their caregivers reported satisfaction with treatment. Implications of these findings, study limitations and suggestions for future directions are discussed.

Psychosocial Functioning in Youth With Barth Syndrome

This pilot study assessed the quality of life and psychosocial functioning of pediatric patients with Barth Syndrome. Thirty-four boys with Barth Syndrome and 22 healthy male controls were administered a measure of verbal ability and completed measures of quality of life, loneliness, perceived peer support, and sibling relationship quality. Parents completed measures of parental distress, parenting stress, child academic functioning, child adaptive behavior, and child emotional and behavioral functioning. Quality of life ratings were consistently lower in youth with Barth Syndrome relative to both healthy controls and a previously reported sample of youth with cardiac disease. Compared to healthy controls, children with Barth Syndrome were rated as having more internalizing and externalizing symptoms, social problems, loneliness, and lower independent functioning. Parents of boys with Barth Syndrome reported greater distress and parenting stress relative to healthy controls. In addition, parents reported a significant need for academic accommodations, given their sons illness and associated impairments. Boys with Barth Syndrome and their parents appear to be affected by the presence of the illness in numerous ways. Results suggest the need for interventions aimed at helping children and families cope with illness-related stressors to enhance quality of life and overall functioning.