Abstract There are little data concerning clinical characteristics of women with Tourette disorder and chronic tic disorders in the extant literature and what is available mostly focuses on ...treatment-seeking individuals. The present research was conducted to provide a phenomenological characterization of tic disorders among 185 adult women with tic disorders. In addition to providing a descriptive overview of specific tic symptoms, tic severity, self-reported history of other psychiatric conditions, and impairment/lifestyle impact due to tics, this study compares 185 women and 275 men between 18 and 79 years old with tic disorders (who completed an identical battery of measures) based on demographic, social/economic status indicators, psychiatric variables (comorbidity, family psychiatric history, symptom presentation), adaptive functioning/quality of life, and impairment variables among a nonclinical adult sample. Finally, this research examines the relationship between tic severity and impairment indicators among women with tics. Sixty-eight percent of women in our sample reported severe motor tics and 40% reported severe phonic tics. Our exploratory data suggest that a sizeable number of adult women with persistent tics are suffering from psychiatric comorbidity and psychosocial consequences such as underachievement and social distress. Tic severity in women may be associated with lifestyle interference as well as with symptoms of depression and anxiety, and such symptoms may be more common among women with tics than in men with tics.
We examined parental experience of having a child with obsessive-compulsive disorder (OCD) in 62 parent–child dyads. Youth with a primary diagnosis of OCD and their parent(s) were administered the ...CY-BOCS jointly by a trained clinician. Parents completed several measures about their child’s OCD-related impairment and accommodation, emotional and behavioral functioning, parental distress, caregiver stress, and parental experiences of having a child with OCD. Results indicated that parents of children with OCD are considerably distressed about their child’s condition. As expected, negative parental experiences (e.g., anxiety about child’s condition, uncertainty about their future) were directly related to OCD symptom severity and impairment, as well as child internalizing and externalizing problems, family accommodation of symptoms, and caregiver strain. The presence of emotional resources was negatively related to most outcomes, although some of these relationships did not achieve statistical significance. The presence of internalizing symptoms mediated the relationship between parental experiences and parental distress. Given these findings, addressing parental experiences as part of a family based cognitive-behavioral treatment program for pediatric OCD may help reduce parental distress and improve patient prognosis.
This study examined the nature and psychosocial correlates of peer victimization in a clinical sample of children with Learning Disabilities (LD). A total of 303 patient charts were searched at a ...university child psychiatry clinic, and 77 participants met LD diagnostic criteria. Data collected included the Child Behavior Checklist (which contains items assessing peer victimization), Conners Parent Rating Scale, Revised Children’s Manifest Anxiety Scale, and Children’s Depression Inventory. Peer victimization was positively correlated with parent reports of withdrawal, anxiety, depressive symptoms, social problems, thought problems, attention problems, and disruptive behavior. Children with LDs who had comorbid psychiatric diagnoses reported a significantly higher amount of peer victimization than children without a comorbid psychiatric condition. Implications of this study regarding the role of peer victimization and healthy psychological adjustment among children with LDs are discussed.
This study aimed to determine the effect of a multimodal residential treatment program for severe adolescent anxiety, and examine whether treatment outcome was associated with pre-treatment anxiety, ...comorbid disorders, or participant age or gender. Participants were 70 adolescents (61.4% female, mean age = 15.4 years) with a primary anxiety disorder who received residential treatment involving cognitive behavioral therapy and medication management. Treatment outcome was assessed both as the change in adolescent-reported anxiety symptoms, and using treatment response criteria. Results indicated a strong effect of the intervention on symptoms of anxiety, depression, and anxiety-related life interference. Most pre-treatment variables were not associated with treatment outcome. However, higher adolescent-reported pre-treatment anxiety was associated with a greater reduction in anxiety at post-treatment, and the presence of a comorbid anxiety disorder was associated with poorer odds of treatment response. Findings indicate that residential treatment is a robust intervention for adolescent anxiety.
This study examined the phenomenology and predictors of early response and remission among youth with obsessive-compulsive disorder (OCD) receiving cognitive-behavioral therapy (CBT).
One hundred and ...thirty-nine youth with a current primary diagnosis of OCD participated in this study. Participants received 10 sessions of CBT augmented by either placebo or d-cycloserine (DCS) as part of a randomized double-blind multi-site clinical trial. Early response and remission status were determined by clinician-rated global symptom improvement (CGI-I) and severity (CGI-S), respectively.
At the mid-treatment assessment, 45.3% of youth were early responders, and 28.1% were early remitters. At post-treatment assessment, 79.1% of youth were responders and 67.6% were remitters. Early response predicted a higher likelihood of post-treatment response and remission; early remission significantly predicted a higher likelihood of post-treatment remission. Bivariate logistic regressions showed that early response was predicted by lower baseline clinician-rated global severity (CGI-S) and lower depression severity; however, only depression severity remained a significant predictor in the multivariable logistic regression model. Furthermore, bivariate logistic regressions showed that early remission was predicted by lower baseline clinician-rated global severity (CGI-S), lower depression severity, and lower obsessive-compulsive symptom severity (CY-BOCS); however, only global severity remained a significant predictor in the multivariable logistic regression model.
Lower OCD and depression symptom severity predicted a greater likelihood of early treatment response and remission to CBT. Findings suggest that low OCD and depression symptom severity could serve as baseline characteristics to identify potential candidates for lower-intensity initial interventions in a stepped care approach. The modest predictive value of the variables examined suggests that additional factors could add to prediction of treatment response and remission.
clinicaltrials.gov Identifier: NCT00864123.
•We report on predictors of early response/remission to CBT for childhood OCD.•At mid-treatment, 45.3% of youth were early responders, and 28.1% were early remitters.•At post-treatment, 79.1% of youth were responders and 67.6% were remitters.•OCD and depression symptom severity predicted early treatment response and remission.
This study reports on the development and initial psychometric properties of the Children’s Saving Inventory (CSI), a parent-rated measure designed to assess child hoarding behaviors. Subjects ...included 123 children and adolescents diagnosed with primary Obsessive–Compulsive Disorder (OCD) and their parents. Trained clinicians administered the Children’s Yale-Brown Obsessive–Compulsive Scale (CY-BOCS), items assessing Family Accommodation and the Clinical Global Impressions—Severity index. Parents completed the CSI, Child Obsessive–Compulsive Impact Scale (COIS)—Parent Version and Child Behavior Checklist. Youth completed the COIS—Child Version, Obsessive–Compulsive Inventory Child Version (OCI-CV), Multidimensional Anxiety Scale for Children, and Children’s Depression Inventory—Short Form. A four factor solution was identified; factors were named Discarding, Clutter, Acquisition, and Distress/Impairment. Internal consistency for the CSI Total and factor scores were good. One-week test–retest reliability (
n
= 31) from a random subsample was excellent. Known groups validity was supported vis-à-vis higher CSI scores for those endorsing hoarding on the CY-BOCS Symptom Checklist. Convergent and discriminant validity was evidenced by weak relationships with OCI-CV Checking and Contamination factors but strong relationships with the OCI-CV Hoarding factor and with hoarding obsession/compulsions on the CY-BOCS. These findings provide initial support for the reliability and validity of the CSI for the assessment of hoarding behaviors among youth with OCD. Future studies are needed to extend these findings to non-OCD samples of youth.
Abstract Family accommodation is a salient phenomenon within pediatric obsessive–compulsive disorder (OCD), with a large number of families engaging in behaviors and modifying family routines in ...response to the youth’s OCD symptoms. Family accommodation is commonly considered as a unidimensional construct, resulting in limited research on the phenomenological aspects of family accommodation and how different facets (i.e., participation, modification, and distress/consequences) may impact pediatric OCD. As such, the present study sought to examine the extent to which family accommodation, as a whole and within subtypes, was related to OCD symptom severity and symptom dimensions, youth clinical characteristics (i.e., internalizing/externalizing symptoms, depressive symptoms), and family factors (i.e., cohesion and conflict). Family accommodation was related to OCD symptom severity and the contamination symptom dimension, youth depressive symptoms (but not the participation domain), and youth internalizing/externalizing symptoms. Youth externalizing symptoms mediated the relationship between OCD symptom severity and family accommodation. After controlling for OCD symptom severity, youth externalizing symptoms predicted family accommodation in general, as well as the distress/consequences domain. Family cohesion predicted participation in OCD symptoms, above and beyond OCD symptom severity. Detailed results and implications of the findings are discussed.
Abstract Objective This study was conducted to examine whether pediatric patients with obsessive-compulsive disorder (OCD) and hoarding symptoms differed in terms of clinical characteristics from ...pediatric OCD patients without hoarding symptoms. Method Eighty children and adolescents with OCD (range, 7-17 years) completed clinician-administered and parent- and child-report measures of OCD symptom severity, impairment, and emotional and behavioral symptoms. Results Twenty-one youth endorsed significant hoarding symptoms. Relative to nonhoarders, youth with hoarding symptoms had worse insight, more magical thinking obsessions, and ordering/arranging compulsions than nonhoarders, higher levels of anxiety, aggression, somatic complaints, and overall externalizing and internalizing symptoms. Higher rates of panic disorder were found in youth with hoarding symptoms although other comorbidity rates did not differ. Conclusions These findings in children are partially consistent with studies in adults, and suggest that pediatric patients with hoarding symptoms may exhibit a unique clinical presentation.
