[The clinical assessment of obsessive-compulsive symptoms in children and adolescents - A study with the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS-D)]

Extended treatment of multimodal cognitive behavioral therapy in children and adolescents with obsessive-compulsive disorder improves symptom reduction: a within-subject design

BACKGROUND

Based on the current state of research regarding the treatment in pediatric obsessive-compulsive disorder (OCD), cognitive behavioral therapy (CBT) (in severe cases with additional pharmacotherapy) is considered as the first-line treatment according to internationally recognized guidelines. Research is mostly based on randomized controlled trials (RCTs; efficacy research). Thus, examined treatment conditions, especially the treatment duration, and patients' characteristics do not necessarily correspond to those found within routine care. Studies showed CBT packages as a whole to be efficacious, but less is known about the effects of individual CBT components. Furthermore, effects on comorbid symptoms or psychosocial impairment have been often neglected and different rater perspectives have been hardly considered in previous research.

METHODS

This effectiveness study aimed to examine the effects of multimodal CBT in children, adolescents, and young adults (age 6-20 years) with OCD (n = 38) within routine care. Effects on obsessive-compulsive and co-existing symptoms were evaluated in a within-subject design by comparing changes during the assessment phase with 12-week standard treatment and with individually tailored extended treatment. Additionally, within the standard treatment, non-exposure treatment was compared to exposure treatment. Multi-informant assessment was applied, and the analyses included multilevel modeling and t-tests for pre-post comparisons.

RESULTS

During the standard treatment and extended treatment, obsessive-compulsive symptoms, strain, and functional impairment significantly decreased. Moreover, a significant reduction of overall comorbid symptoms emerged, particularly regarding internalizing symptoms, including anxiety and depression. Comparisons of treatment components indicated that adding exposure with response prevention (ERP) has an additional positive effect. Clinical improvement and remission rates increased considerably when more treatment sessions were provided.

CONCLUSIONS

These results suggest that improvement after an initial 12-week course of treatment may not allow for the prediction of non-responders/non-remitters and for the termination of treatment. Overall, the findings show that results from randomized controlled trials are transferrable to routine care. Trial registration number This study was registered retrospectively at the German Clinical Trials Register ( https://drks.de/search/de/trial/DRKS00030050 ).

Webcam-Based Online Coaching with Children and Adolescents with Obsessive-Compulsive Disorders – A Single-Case Study

Abstract. Objective: Although there is clear evidence-based knowledge regarding state-of-the-art treatment for pediatric obsessive-compulsive disorder (OCD), two main issues remain in clinical practice: (1) Exposure-based cognitive behavioral therapy (CBT) is limited in terms of availability and accessibility or is not adequately provided, and (2) despite large effect sizes of exposure-based CBT, the achieved recovery rates of 50–60 % still show room for improvement. These issues have prompted an increasing focus on delivering exposure-based CBT in new and innovative ways. This study aims to evaluate an intensive therapist-administered online coaching program consisting of exposure with response prevention via video teleconferencing (VTC) as an add-on to weekly outpatient CBT (blended therapy). Method: The blended therapy is examined in n = 5 children and adolescents with OCD using an AB design and multi-informant ratings. Results: This single-case study shows promising results, indicating that a decrease in OCD severity and related functional impairment can be attributed to blended therapy. Moreover, satisfaction with online coaching was high. Conclusions: Despite some principal limitations, the results support the effectiveness and feasibility of blended therapy.

Psychometric evaluation of a parent-rating and self-rating inventory for pediatric obsessive-compulsive disorder: German OCD Inventory for Children and Adolescents (OCD-CA)

BACKGROUND

This study assesses the psychometric properties of the German version of the Padua Inventory-Washington State University Revision for measuring pediatric OCD.

METHODS

The parent-rating and self-rating inventory is assessed in a clinical sample (CLIN: n = 342, age range = 6-18 years) comprising an OCD subsample (OCDS: n = 181) and a non-OCD clinical subsample (non-OCD: n = 161), and in a community sample (COS: n = 367, age range = 11-18 years).

RESULTS

An exploratory factor analysis yielded a four-factor solution: (1) Contamination & Washing, (2) Catastrophes & Injuries, (3) Checking, and (4) Ordering & Repeating. Internal consistencies of the respective scales were acceptable to excellent across all samples, with the exception of the self-report subscale Ordering and Repeating in the community sample. The subscales correlated highly with the total score. Intercorrelations between the subscales were mainly r ≤ .70, indicating that the subscales were sufficiently independent of each other. Convergent and divergent validity was supported. Participants in the OCD subsample scored significantly higher than those in the non-OCD clinical subsample and the COS on all scales. In the COS, self-rating scores were significantly higher than parent-rating scores on all scales, while significant mean differences between informants were only found on two subscales in the OCD subsample.

CONCLUSION

The German version of the Padua Inventory-Washington State University Revision for measuring pediatric OCD is a promising, valid and reliable instrument to assess self-rated and parent-rated pediatric OCD symptoms in clinical and non-clinical (community) populations.