Cognitions in children with OCD. A pilot study for age specific relations with severity

Inflated Responsibility Beliefs in Paediatric OCD: Exploring the Role of Parental Rearing and Child Age

Cognitive-behavioural models of obsessive-compulsive disorder (OCD) propose that inflated responsibility beliefs are central to the maintenance of the disorder and are proposed to originate during early childhood via experiences of harsh and/or controlling parenting. The current study aimed to examine the associations between perceived parental rearing behaviours, inflated responsibility/threat beliefs, and OCD severity and impairment in children (aged 7-12 years) and adolescents (aged 13-17 years) with OCD (n = 136). Results indicated that for younger children, greater child perceptions of overprotection and anxious rearing were each associated with increased inflated responsibility beliefs. For older children, these positive associations remained, and furthermore, inflated responsibility beliefs mediated the association between perceived maternal anxious rearing and OCD impairment. Results highlight the role of the family in the development of inflated responsibility bias and OCD-related impairment.

Mediating Mechanisms in Cognitive Behavioral Therapy for Childhood OCD: The Role of Dysfunctional Beliefs

Reframing cognitions is assumed to play an important role in treatment for obsessive-compulsive disorder (OCD). However, there hardly is any empirical support for this assumption, especially for children. The aim of this study was to examine if changing dysfunctional beliefs is a mediating mechanism of cognitive behavioral therapy (CBT) for childhood OCD. Fifty-eight children (8-18 years) with OCD received CBT. Dysfunctional beliefs (OBQ-CV) and OCD severity (CY-BOCS) were measured pre-treatment, mid-treatment, post-treatment, and at 16-week follow-up. Results showed that OCD severity and dysfunctional beliefs decreased during CBT. Changes in severity predicted changes in beliefs within the same time interval. Our results did not support the hypothesis that changing dysfunctional beliefs mediates treatment effect. Future studies are needed to replicate these findings and shed more light on the role of explicit and implicit cognitions in treatment for childhood OCD.

Obsessive-Compulsive Disorder in Paediatric and Adult Samples: Nature, Treatment and Cognitive Processes. A Review of the Theoretical and Empirical Literature

The appraisal model of obsessive-compulsive disorder (OCD) suggests that six key appraisal domains contribute to the aetiology and maintenance of OCD symptoms. An accumulating body of evidence supports this notion and suggests that modifying cognitive appraisals may be beneficial in reducing obsessive-compulsive symptomatology. This literature review first summarises the nature of OCD and its treatment, followed by a summary of the existing correlational and experimental research on the role of cognitive appraisal processes in OCD across both adult and paediatric samples. While correlational data provide some support for the relationship between cognitive appraisal domains and OCD symptoms, results are inconclusive, and experimental methods are warranted to determine the precise causal relationship between specific cognitive appraisal domains and OCD symptoms.

Obsessive-Compulsive Symptoms and Beliefs in Adolescents: A Cross-Sectional Examination of Cognitive Models

Cognitive models of obsessive-compulsive disorder (OCD) posit that particular beliefs transform normal intrusions into disturbing obsessions. A wealth of data shows that such beliefs and obsessive-compulsive (OC) symptoms are related in adults. However, there is markedly less information regarding OCD-related beliefs in youth. The purpose of this study was to assess the relation between OCD-related beliefs and OC symptoms in unselected adolescents (ages 13-18 years; N = 159). Findings from questionnaires completed on the Internet were consistent with previous findings in adults. Increased levels of OCD-related beliefs were related to increased levels of OC symptoms. Perfectionism and certainty beliefs had a specific relation with symmetry and ordering symptoms. Contrary to expectation, levels of OCD-related beliefs in this unselected sample were similar to those found in prior studies of youth diagnosed with OCD. Implications, limitations, and future directions for the study of OCD-related beliefs in youth are discussed.

Cognitive biases and obsessive-compulsive symptoms in children: examining the role of maternal cognitive bias and child age

OBJECTIVE

Multiple cognitive biases associated with adult obsessive-compulsive disorder (OCD) were tested in a clinical sample of children (ages 7-11) and adolescents (12-17) and their mothers. This study examined (a) the associations between child cognitive biases and OCD severity, (b) maternal cognitive biases and child OCD severity, and (c) maternal cognitive bias and child cognitive bias. It was hypothesized that age would significantly moderate these relationships, with stronger associations with OCD severity for cognitive bias in adolescents (relative to children), and maternal cognitive bias in younger children (relative to adolescents).

METHOD

Forty-six children and adolescents diagnosed with OCD and their mothers completed questionnaires assessing responsibility bias, thought-action fusion (TAF), thought suppression, and metacognitive beliefs. OCD symptoms were assessed using structured diagnostic interviews and semistructured symptom interviews.

RESULTS

As predicted, age significantly moderated associations between (a) child cognitive variables and OCD severity-specifically between child responsibility and child metacognition, which were associated with OCD severity for adolescents only; (b) maternal cognitive biases and child OCD severity-specifically for maternal responsibility and thought suppression, which were significantly and positively associated with child OCD severity but not adolescent OCD severity; and (c) maternal cognitive biases and child cognitive bias-such that significant associations were evident only in the younger child sample, and only between maternal TAF self and metacognition, with child suppression and child TAF moral, respectively.

CONCLUSION

Maternal cognitive biases are more consistently linked to greater OCD severity among younger children, whereas personal cognitive biases are associated with greater OCD symptoms in adolescents. Treatments for pediatric OCD are likely to be improved by age-specific considerations for the role of maternal and child cognitive biases associated with OCD.

Childhood Experiences and Adult Beliefs in Obsessive-Compulsive Disorder: Evaluating a Specific Etiological Model

Cognitive accounts of obsessive-compulsive disorder (OCD) propose that an individual’s early experiences contribute to the development of different belief domains, which in turn represent fertile ground for the development of the disorder (e.g., Salkovskis, Shafran, Rachman, & Freeston, 1999). This study examined the proximal relationship between specific, narrowly defined childhood experiences (CEs) and distinct adult OCD-related beliefs (Obsessive Beliefs Questionnaire-87 [OBQ-87]) through the self-reports of 83 participants with OCD and 213 unselected student participants. CEs variables were operationalized via theoretical groupings of items on an early experience questionnaire (QEE) relevant to distinct OBQ belief domains. These proximal relationships were assessed according to predictions from both a specific and a nonspecific vulnerability hypothesis. Correlational analyses were supportive of both but mostly of a nonspecific vulnerability model. Results are discussed regarding the understanding of the possible multideterministic pathways to OCD development.

Psychometric properties of a Dutch version of the Obsessive Beliefs Questionnaire--Child Version (OBQ-CV)

To improve research in cognitive theories of childhood OCD, a child version of the Obsessive Beliefs Questionnaire (OBQ-CV) has been developed (Coles et al., 2010). In the present study, psychometric properties of the Dutch OBQ-CV were examined in a community sample (N=547; 8-18 years) and an OCD sample (N=67; 8-18 years). Results revealed good internal consistency and adequate retest reliability (retest interval 7-21 weeks and 6-12 weeks, respectively). Children with OCD reported more beliefs than non-clinical children. Obsessive beliefs were related to self-reported OCD symptoms, but not to clinician-rated OCD severity. Beliefs were also related to anxiety and depression. This is the first study examining the factor structure of the OBQ-CV. Confirmatory factor analyses revealed best fit for four factors representing Perfectionism/Certainty, Importance/Control of Thoughts, Responsibility, and Threat, and a higher-order factor. This is in line with results from adult samples. These results support the reliability and validity of the Dutch OBQ-CV.

Clinical and cognitive correlates of depressive symptoms among youth with obsessive compulsive disorder

Depression is the most common comorbidity among adults with obsessive compulsive disorder (OCD), yet little is known about depressive symptoms in childhood OCD. This study examined clinical and cognitive variables associated with depressive symptomatology in 71 youths (62% male, M age = 12.7 years) with primary OCD. Youths presented with a range of depressive symptoms, with 21% scoring at or above the clinical cutoff on the self-report measure of depression. Higher levels of depressive symptoms were associated with higher levels of cognitive distortions assessed on measures of insight, perceived control, competence, and contingencies. Depressive symptoms were also linked to older age and more severe OCD. Low perceived control and self-competence and high OCD severity independently predicted depression scores.