Behavioral treatment of childhood obsessive-compulsive disorder

Working with Children with Obsessive Compulsive Disorder

1. Children with OCD are a special challenge for nursing staff. 2. Children with OCD often are unable to comply with preexisting behavior management programs at child psychiatric units. 3. Each child who enters an inpatient unit must be viewed as an individual, separate from his or her diagnosis, and what works for one patient with a particular diagnosis may not work for another patient with the same diagnosis. 4. A special plan devised with input from the entire nursing team is the best way to ensure that continuity of care is carried out among all staff on the unit.

Obsessive-complusive disorder: pharmacological treatment

Obsessive-compulsive disorder (OCD) in children and adolescents is often a disabling condition, which demands treatment with medication. Research shows that serotonin is involved in the disorder and empirical treatment studies show that antidepressants with serotonin activity are effective. The first choice of treatment in the psychopharmacological approach to OCD in children and adolescents are the SSRI agents, which have been documented as being effective as well as well-tolerated in children and adolescents. The best-documented SSRI to this point is sertraline. However, fluoxetine and fluoxamine have also undergone systematic studies in children and adolescents. Clomipramine has been proven effective, however, side effects caused by this agent would suggest that an SSRI is a better choice. Treatment with an SSRI seems to have effect in approximately 75 % of patients with OCD. There are still no systematic studies analyzing augmenting medication for children and adolescents with OCD. Research indicates that the combination of medication and psychotherapy (cognitive behavioural therapy) is important in most cases. Based on a few long-term follow-up studies on OCD children and adolescents there is not evidence that all children and adolescents suffer a lifetime course of the disease. It is therefore recommended that discontinuation is attempted after 1-1.5 years of successful treatment.

Practice parameters for the assessment and treatment of children and adolescents with obsessive-compulsive disorder. AACAP

These practice parameters describe the assessment and treatment of obsessive-compulsive disorder based on a detailed literature review and expert consultation. Obsessive-compulsive disorder is a disorder of heterogeneous origin characterized by intrusive thoughts or compulsive urges or behaviors that are distressing, time-consuming, or functionally impairing. In children and adolescents, the disorder often is accompanied by a wide range of comorbidity, including mood, anxiety, attentional, and learning difficulties, and/or tic disorder. These parameters describe the relevant areas of assessment, especially symptomatology, onset, and course, other associated psychopathology, and developmental, family, and medical history (including postinfectious onset or exacerbations). Two modalities have been systematically assessed and empirically shown to ameliorate core symptoms: cognitive-behavioral therapy (primarily exposure/response prevention) and serotonin reuptake inhibitor medication. Data regarding the indications, efficacy, and implementation of these modalities are reviewed. Because OCD frequently occurs in the context of other psychopathology and adaptive difficulties, additional individual and family psychotherapeutic, pharmacological, and educational interventions often are necessary. Treatment planning guidelines are provided.

Treatment of obsessive-compulsive disorder in children and adolescents. A review of the literature

The literature on treatment of childhood and adolescent obsessive-compulsive disorder is reviewed. Most studies concerning treatment of obsessive-compulsive disorder has been based on experience from adult patients. Only a few controlled trials using medication with obsessive-compulsive children have been produced. No controlled study has as yet documented the effect of behavioural therapy alone. The most effective treatment seems to be a combination of behavioural therapy and medication with a serotonin reuptake inhibitor. In the treatment of children with OCD, it is important to consider the child's personality and comorbid disorders.

The physiological threat of compulsive syndromes

Compulsive syndromes, especially obsessive-compulsive disorder, are much more common than previously believed. The behaviours that are a part of these syndromes can lead to physiologically threatening conditions whose medical consequences range from minor to fatal. It is crucial that not only mental health professionals, but all health professionals better understand the nature and consequences of compulsive disorders and their importance to general health.

Cognitive-behavioral psychotherapy for children and adolescents with OCD: a review and recommendations for treatment

OBJECTIVE

To critically review the published literature on cognitive-behavioral psychotherapy for obsessive-compulsive disorder (OCD) in children and adolescents.

METHOD

The psychiatric and psychological literature was systematically searched for "studies" applying cognitive-behavioral principles to children and adolescents with OCD.

RESULTS

Thirty-two investigations, most of them single case reports, were identified. Despite manifold differences in terminology and theoretical framework, all but one showed some benefit for cognitive-behavioral interventions. Graded exposure and response prevention form the core of treatment; anxiety management training and OCD-specific family interventions may play an adjunctive role. Poor compliance, inadequately documented and inconsistently applied treatment, and lack of exportability were recurrent problems.

CONCLUSIONS

Abundant clinical and emerging empirical evidence suggest that cognitive-behavioral psychotherapy, alone or in combination with pharmacotherapy, is an effective treatment for OCD in children and adolescents. Future research in this area will need to focus on comparisons of cognitive-behavioral psychotherapy to other treatments, on component analyses, and on the application of exportable protocol-driven treatments to divergent patient populations.

An analysis of response prevention and flooding procedures in the treatment of adolescent obsessive compulsive disorder

Flooding and response prevention have been widely used in the treatment of adult obsessive compulsive disorder but have been overlooked in favor of less restrictive procedures when treating children. The present case investigates the utility of these procedures in an adolescent with severe compulsive handwashing. Treatments were introduced hierarchically to minimize subject distress; graded exposure decreased the frequency of handwashing, but flooding was required to eliminate the compulsion. Guidelines for the ethical use of flooding and exposure therapies with children are offered.

Treatment of an adolescent with obsessive-compulsive disorder by alternating response prevention and cognitive therapy: an empirical analysis

This paper reports on the treatment of a 14-year-old boy with severe obsessive-compulsive disorder. Baseline measures indicated that two checking behaviors were of extreme frequency. Personal discomfort was severe and parental ratings of anxiety and depression were high. Treatment employed an alternating design of response prevention and cognitive therapy. Parent and client ratings of levels of anxiety and depression were taken daily in addition to frequency levels of the compulsive behaviors. The treatment procedures over 24 sessions eliminated the compulsive behaviors and reduced self-reported anxiety. The study is unique in demonstrating that the cognitive therapy had a significant influence in diminishing the obsessive-compulsive behaviors.