Yolanda E. Murphy

An Examination of Executive Functioning in Young Adults Exhibiting Body-Focused Repetitive Behaviors.

Abstract Body-focused repetitive behaviors (BFRBs), including hair pulling, nail biting, and skin picking are repetitive, habitual, and compulsive in nature. Although characteristic of disorders such as trichotillomania and skin picking disorder, BFRBs are associated with other psychiatric conditions as well. To date, research has failed to examine neurocognitive risk factors, particularly executive functioning, implicated in BFRBs utilizing a transdiagnostic approach. The present study recruited 53 participants (n = 27 demonstrating BFRBs and n = 26 randomly selected controls) from a larger sample of young adults. Participants completed an automated neurocognitive test battery including tasks of cognitive flexibility, working memory, and planning and organization. Results revealed that participants in the BFRB group demonstrated significantly poorer cognitive flexibility (d = 0.63) than controls. No differences were noted in other neurocognitive domains. However, planning and organization demonstrated a significant relationship with various BFRB severity measures. Implications, limitations, and avenues for further research are discussed.

Examining the Relationship Between Anxiogenic Parenting Practices and Cognitive Flexibility in Youth

Cognitive flexibility (CF), a subdomain of executive functioning (EF), involves abilities such as set shifting and reversal learning. Some variability in CF is normative across youth due to the gradual refinement of broader EF along with the prefrontal cortex. Prior research has suggested that a supportive parenting environment contributes to strong EF, whereas harsh/controlling parenting is associated with deficits. The current investigation explores whether certain parenting practices (e.g., parental accommodation, over-involvement, modeling) are associated with such deficits. Anxiogenic parenting and CF were assessed in 112 youth aged 9 to 17 years, with results demonstrating that parenting practices were not predictive of CF in these youth. Age accounted for the majority of differences in set shifting performance, potentially emphasizing the influence of parenting at different stages of development. Accordingly, future research is necessary to determine the potential impact of anxiogenic parenting at specific points in the development of CF.

An Investigation of Executive Functioning in Pediatric Anxiety

Although science’s understanding (e.g., etiology, maintaining factors, etc.) of pediatric anxiety and related problems has grown substantially over recent years, several aspects to anxiety in youths remain elusive, particularly with relation to executive functioning. To this end, the current study sought to examine several facets to executive functioning (i.e., cognitive flexibility, inhibition, planning, working memory) within a transdiagnostic sample of youths exhibiting varying degrees of anxiety symptoms. One hundred six youths completed a comprehensive battery, including several self-report measures (e.g., Multidimensional Anxiety Scale for Children [MASC] or MASC-2) and an automated neurocognitive battery of several executive functioning tasks (Intradimensional/Extradimensional [IDED], Stop Signal [SST], Spatial Span [SSP], Stockings of Cambridge [SOC] tasks). Regression analyses indicated that youths exhibiting marked anxiety symptoms demonstrated increased planning time and probability of inhibition compared with youths with minimal or no anxiety symptoms. Youths with marked anxiety symptoms similarly demonstrated better cognitive flexibility (i.e., set shifting) compared with youths with minimal anxiety. In addition, analyses indicated a trend such that youths exhibiting marked anxiety symptoms demonstrated poorer working memory compared with youths with no anxiety symptoms. Group classification did not predict remaining outcomes. Limitations and future areas of research are discussed.

IMPAIRED EXECUTIVE FUNCTIONING IN PEDIATRIC TRICHOTILLOMANIA (HAIR PULLING DISORDER).

No neurocognitive examinations of pediatric trichotillomania (hair pulling disorder; HPD) have taken place. As a result, sciences understanding of the underlying pathophysiology associated with HPD in youths is greatly lacking. The present study seeks to begin to address this gap in the literature via examination of executive functioning in a stimulant‐free sample of children with HPD.

Strategies to Manage Common Co-occurring Psychiatric Conditions

Abstract Obsessive-compulsive disorder (OCD) demonstrates substantial prevalence and significant impairment among youths. Though efficacious treatments are available, several limitations exist (e.g., some children are nonresponsive to treatment). One challenge to delivering efficacious treatments may be the frequent comorbidities found among children in this population. In efforts to provide comprehensive treatment, clinicians must carefully consider implications of comorbidities, as well as the appropriate treatment modifications. To this end, the present chapter seeks to identify and discuss several frequent comorbidities found among children with OCD (i.e., attention-deficit/hyperactivity disorder, oppositional defiant disorder, generalized anxiety disorder, and tic disorders) and further provide practical and flexible strategies for addressing such comorbidities within treatment. Notably, review of the current literature indicates several similarities, as well as unique differences, between OCD and these comorbidities, with critical implications for the therapy process (e.g., implications for recommended treatment approach; potential effects of comorbidity on treatment progress, etc.).

Relationship of Body-Focused Repetitive Behavior Disorders to OCD

Opinion statementObsessive-compulsive disorder (OCD) and body-focused repetitive behaviors (BFRBs) have demonstrated considerable presence and impact among clinical populations. As consistent with any treatment approach, necessary intervention among these disorders begins with a comprehensive evaluation of client’s symptoms, with particular attention placed on potential comorbidities. Common practice among clinicians identifies exposure and response prevention (ERP) as a first line treatment of OCD. However, among client’s demonstrating BFRBs, habit reversal therapy (HRT) or novel emotion-based treatments (e.g., acceptance-enhanced behavior therapy [AEBT], dialectical behavioral therapy [DBT]) are used. Such therapies have demonstrated significant efficacy among their respective disorders. Notably, depending upon disorder severity, medications may also be suggested. Given frequent comorbidity between OCD and BFRBs, it is recommended that clinicians adequately modify interventions when presented with clients demonstrating such comorbid behaviors, perhaps combining effective facets of multiple approaches (see discussion below). From a pharmacological perspective, burgeoning research identifies two potential interventions applicable to both OCD and BFRBs (e.g., silymarin and n-acetyl-cysteine); however, given the novelty of this research, we recommend caution with use of such therapies. While current studies suggest potential efficacy, further research examining such pharmacological interventions is necessary.