Assessing Acute Secondary Treatment Outcomes in Early-Onset Obsessive-Compulsive Disorder

Secondary outcomes of enhanced cognitive behavioral therapy (eCBT) for children and adolescents with obsessive-compulsive disorder

Background

Obsessive-compulsive disorder (OCD) is a debilitating mental health condition usually presenting with a high degree of comorbid symptoms in the majority of cases. Although face-to-face cognitive-behavioral therapy (CBT) is considered the therapeutic golden standard for pediatric OCD, its accessibility, availability, and consistency in delivery are still limited. To address some of these challenges, an enhanced CBT (eCBT) package was created and introduced. This study explored eCBT's broad-based impact on OCD-related comorbid symptoms, functional impairment, quality of life and family accommodation among youth with OCD.

Methods

This open trial involved 25 pediatric patients with OCD (7-17 years), assessed between January 2018 to February 2020. All patients received eCBT for 14 weeks. Secondary outcomes were assessed at baseline, post-treatment, and 3-, 6-, and 12-month follow-up co-occurring symptoms were evaluated using the Strengths and Difficulties Questionnaire (SDQ), Screen for Child Anxiety-Related Emotional Disorders (SCARED), and Mood and Feelings Questionnaire (MFQ). Quality of life was measured using the KINDL-R, functional impairment through the Child Obsessive-Compulsive Impact Scale Revised (COIS-R), and family accommodation by the Family Accommodation Scale (FAS). Linear mixed-effects models were applied to analyze treatment effects.

Results

Results indicated a significant decrease in OCD-related comorbid symptoms post-treatment, with SDQ mean reduce of 3.73 (SE = 1.10, child) and 4.14 (SE = 1.19, parent), SCARED mean reduce of 10.45 (SE = 2.52, child) and 8.40 (SE = 2.82, parent), MFQ mean reduce of 3.23 (SE = 1.11, child) and 2.69 (SE = 1.18, parent). Family accommodation declined with clinician scored FAS mean reduction of 13.25 (SE = 2.31). Quality-of-Life improved significantly post-treatment, with KINDL mean increase of 8.15 (SE = 2.87, children), and 10.54 (SE = 3.07, parents). These positive improvements were further amplified at the 3-month follow-up and remained consistent at the 12-month follow-up.

Conclusion

A significant reduction was observed in all secondary outcomes employed and OCD-related functional impairments from baseline to post-treatment, which was maintained through 12-month follow-up. These results imply that after receiving eCBT, children and adolescents experienced substantial decrease in the negative impacts of OCD-related symptoms on their daily life, including home, school, and social interactions.

Treatment of preschool children with obsessive compulsive disorder

The aim was to examine the clinical features of Obsessive-Compulsive Disorder (OCD) in preschool and the effectiveness of aripiprazole with a standardized Cognitive-Behavioral Family Therapy (CBFT) in the treatment of preschoolers with OCD. Twelve preschool children, 36-72 months of age were diagnosed with OCD according to the Diagnostic and Statistical Manual of Mental Disorders, the Fifth Edition criteria by a fellowship-trained child and adolescent psychiatrist. They were evaluated with Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children Present and Lifetime version and Childhood Yale-Brown Obsessive Compulsive Scale (CY-BOCS) at baseline, at the end of the 12th and 24th weeks of treatment. The baseline mean of total CY-BOCS score decreased from 33.67 to 13.83 at the 12th week and 5.58 at the end of the 24th week of treatment. Also, 66.7% of them had at least one psychiatric comorbidity. Overall, this study revealed the effect of aripiprazole with CBFT in preschool-aged children with OCD. Also, the presence of comorbidity that is seen frequently in preschoolers with OCD may complicate the treatment. Therefore, there is a need to increase awareness of OCD and its comorbidities in preschoolers to supply treatment at an early age.

Family involvement and treatment for young children with Obsessive-Compulsive Disorder: Randomized control study

Background/Objective

The aim of this paper was to evaluate the diferential efficacy of cognitive behavioral family treatment in children under 8 years of age with Obsessive-Compulsive Disorder (OCD) in the reduction of obsessive-compulsive responses and secondary outcomes in three treatment conditions: (a) Treatment of parents and child, (b) Treatment of mother and child, and (c) Treatment of mother.

Method

Forty-four children with obsessive-compulsive disorder, aged 5.2-7.9 years old and their parents, were randomized to one of three groups in a 1:1:1 ratio. Seventy-five percent was male and 100% Caucasian (White-European). Treatment involved 12 individual sessions of is Cognitive-Behavioral Family-Based Treatment delivered.

Results

The three conditions produced clinical improvements in post-test and follow-up in the primary (symptom severity OCD) and secondary outcomes. The results showed no intergroup differences in variables related to OCD symptom severity, although statistically significant differences were found in groups in Internalizing and Externalizing problem, mother and fathers accomodation.

Conclusions

The most efficient condition was that including a greater number of family members even when there was high family accommodation. The direct involvement of the child in the psychological treatment was important in achieving better results.