Test-retest reliability of the survey form of the Leyton Obsessional Inventory-Child Version

Measurement Issues: The measurement of obsessive compulsive disorder in children and young people in clinical practice

BACKGROUND

If left untreated, obsessive compulsive disorder (OCD) can cause significant distress and impact on functioning throughout the lifespan. Despite the severity of the disorder, there is often a significant delay between the onset of symptoms and successful treatment. This is in part due to delays in recognising OCD symptoms in young people, particularly if the symptom forms are less common. Once OCD is accurately diagnosed, cognitive behavioural therapy (CBT) is known to be an efficacious treatment, sometimes in combination with medication, producing good long-term prognosis. It is therefore important to accurately detect OCD in children and young people so that they can be offered timely intervention. Use of the best tools in clinical and research settings improves detection and diagnosis, as well as enabling the tracking of progress through treatment. The aim of this current paper was to review measurement tools for OCD in young people with a focus on the practicalities of using tools in busy child mental health clinical settings.

METHOD

To discover what measurement tools are available for OCD in young people, we conducted a pragmatic literature of measurement tools for OCD in young people. We searched PsycINFO, Med-Line and the Cochrane databases for reports relating to the measurement of OCD. Additionally, we sought information from the National Institute for Health and Care Excellence (NICE) guidance, the Child Outcomes Research Consortium (CORC) website and the Children and Young People's Improving Access to Psychological Therapies (CYP IAPT) Programme. We also reviewed large trials and meta-analyses of the treatment of OCD in young people and communicated with relevant researchers/clinicians.

RESULTS

Seventeen questionnaire measurement tools, with variable psychometric properties, and four commonly used semistructured clinician administered interview measures were identified.

CONCLUSIONS

There are several measurement tools with good psychometric properties that are useful for initial screening/identification of OCD, as well as formal diagnosis, symptom tracking and treatment evaluation. With the availability of brief screens, as well as online diagnostic measures, such tools should not be a burden on clinical practice, but rather a helpful aid to support clinicians' assessment and treatment of OCD.

Obsessive-compulsive symptoms in a normative Chinese sample of youth: prevalence, symptom dimensions, and factor structure of the Leyton Obsessional Inventory--Child Version

BACKGROUND

Chinese adolescents face life stresses from multiple sources, with higher levels of stress predictive of adolescent mental health outcomes, including in the area of obsessive-compulsive disorders (OCD). Valid assessment of OCD among this age group is therefore a critical need in China. This study aims to standardise the Chinese version of the Leyton short version scale for adolescents of secondary schools in order to assess this condition.

METHODS

Stratified randomly selected adolescents were selected from four high schools located in Beijing, China. The Chinese version of the Leyton scale was administered to 3221 secondary school students aged between 12 and 18 years. A high response rate was achieved, with 3185 adolescents responding to the survey (98.5 percent). Exploratory factor analysis (EFA) extracted four factors from the scale: compulsive thoughts, concerns of cleanliness, lucky number, repetitiveness and repeated checking. The four-factor structures were confirmed using Confirmatory Factor Analysis (CFA).

RESULTS

Overall the four-factor structure had a good model fit and high levels of reliability for each individual dimension and reasonable content validity. Invariance analyses in unconstrained, factor loading, and error variance models demonstrated that the Leyton scale is invariant in relation to the presence or absence OCD, age and gender. Discriminant validity analysis demonstrated that the four-factor structure scale also had excellent ability to differentiate between OCD and non-OCD students, male and female students, and age groups.

LIMITATIONS

The dataset was a non-clinical sample of high school students, rather than a sample of individuals with OCD. Future research may examine symptom structure in clinical populations to assess whether this structure fits into both clinical and community population.

CONCLUSIONS

The structure derived from the Leyton short version scale in a non-clinical secondary school sample of adolescents, suggests that a four-factor solution can be utilised as a screening tool to assess adolescents׳ psychopathological symptoms in the area of OCD in mainland Chinese non-clinical secondary school students.

The Leyton Obsessional Inventory-Child Version Survey Form does not demonstrate adequate psychometric properties in American youth with pediatric obsessive-compulsive disorder

The psychometric properties of the Leyton Obsessional Inventory-Child Version Survey Form (LOI-CV Survey Form) and the Short Leyton Obsessional Inventory-Child Version Survey Form (Short LOI-CV Survey Form) were examined in a clinical sample of 50 children and adolescents with obsessive-compulsive disorder (OCD). The internal consistency of the LOI-CV and Short LOI-CV Survey Forms were acceptable and poor, respectively (α=.79 and .65). The LOI-CV Survey Form was significantly and moderately correlated with child-rated OCD-related impairment, but was not significantly correlated with any other measures of OCD symptom frequency or severity, OCD-related impairment, global symptom severity, child reports of anxiety and depressive symptoms, and parent reports of children's obsessive-compulsive, internalizing, and externalizing symptoms. Modest support for the cognitive-behavioral treatment sensitivity of the LOI-CV Survey Form (Cohen's d=0.98) but not the Short LOI-CV Survey Form (Cohen's d=0.09) was demonstrated. Diagnostic sensitivity was poor for the LOI-CV Survey Form at both pre- (0.14) and post-treatment (0.06). Overall, these results suggest that the psychometric properties of the LOI-CV and Short LOI-CV Survey Forms are not adequate for use as a screening instrument or in assessing symptom severity in pediatric OCD.

Children's Florida Obsessive Compulsive Inventory: psychometric properties and feasibility of a self-report measure of obsessive-compulsive symptoms in youth

This report describes the development and psychometric properties of the Children's Florida Obsessive Compulsive Inventory (C-FOCI). Designed specifically as a brief measure for assessing obsessive-compulsive symptoms, the C-FOCI was created for use in both clinical and community settings. Study 1 included 82 children and adolescents diagnosed with primary Obsessive-Compulsive Disorder, and their parents. The Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) was administered to assess symptom severity. Thereafter, parents completed the Child Obsessive-Compulsive Impact Scale-Parent Version and Child Behavior Checklist, and youth completed the C-FOCI, Child Obsessive-Compulsive Impact Scale-Child Version, Multidimensional Anxiety Scale for Children, and Children's Depression Inventory-Short Form. A subgroup of 21 individuals was retested with the C-FOCI after completing 14 sessions of intensive cognitive-behavioral therapy. Construct validity of the C-FOCI was supported vis-à-vis evidence of treatment sensitivity, and moderate relations with clinician-rated symptom severity, the CY-BOCS Symptom Checklist, child- and parent-rated functional impairment, child-rated anxiety, and parent-rated internalizing symptoms. Discriminant validity was evidenced by weak relationships with parent-reports of externalizing symptoms. For Study 2, 191 non-clinical adolescents completed the C-FOCI to assess the feasibility of internet administration. Overall, internal consistency was acceptable for the C-FOCI Symptom Checklist and Severity Scale, and respondents were able to complete the measure with little difficulty. Taken together, the findings of Studies 1 and 2 provide initial support for the reliability and validity of the C-FOCI for the assessment of pediatric obsessive-compulsive symptoms.

Evidence for a heritable unidimensional symptom factor underlying obsessionality

The division of obsessive-compulsive symptoms (OCS) into specific factors is now widely accepted. However, the utility of these categories for genetic studies remains unclear, as studies examining their heritability have been inconsistent. Less attention has been paid to the possibility that clinically significant obsessionality is primarily determined by a "core" group of OCS that crosses the boundaries between symptom subgroups. The aim of this study is to determine whether such a core group exists, and to compare its heritability to that of the more traditionally derived symptom factors. We examined the properties and heritability of obsessive-compulsive symptoms in college students, medical students, and obsessive-compulsive disorder (OCD) families using the Leyton Obsessional Inventory. In each of the three samples, we identified a core group of symptoms that comprised a single unique construct and accounted for over 90% of the variation of the four more traditional symptom factors. This core construct was highly correlated with OCD in our families and had a heritability estimate of 0.19 when OCD was not included as a covariate and 0.49 when OCD was included as a covariate. In contrast, the four symptom factors were not heritable. There appears to be an underlying unidimensional component to obsessionality, both in non-clinical and clinical samples. This component, which is heritable, accounts for the majority of the variation of the more traditionally derived symptom factors in our sample, and is composed of OCS that are not specific to any of the symptom subgroups.

A school-based treatment model for pediatric obsessive-compulsive disorder

School psychologists have expertise in the realm of school-based assessment and intervention for behavioral, educational, and psychological difficulties. Recent evidence indicates that many school psychologists lack evidenced based knowledge about assessment and treatment of pediatric Obsessive-Compulsive Disorder (OCD). Pediatric OCD is a relatively common disorder that contributes to substantial impairment in educational and psychosocial domains. Evidence based treatment of pediatric OCD, particularly cognitive-behavioral therapy, has shown to be efficacious. Therefore, the aims of this paper are to provide a review of empirically established treatments for pediatric OCD, and present a school-based problem-solving model that school psychologists can utilize to conceptualize, assess, and treat OCD.

[Validation of the short version of the Leyton obsessional inventory for children and adolescents in Bucaramanga, Colombia]

OBJECTIVE

To determine the internal consistency, factorial structure, reproducibility and validity of criterion of the Leyton Obsessional Inventory in children and adolescents.

DESIGN

Study of validation with probabilistic sampling.

SETTING

Secondary schools in Bucaramanga, Colombia.

PARTICIPANTS

A total of 581 students selected at random, of whom 38 did not answer, 8 were excluded because they were over 17, and 33 did not attend the clinical interview.

MAIN MEASUREMENTS

The Inventory and the Structured Clinical Interview for axis I of the DSM-IV (SCID-I), clinical version, were used. Cronbach's alpha, factorial analysis, sensibility, specificity, probability, and Lin' s coefficient were calculated.

RESULTS

The prevalence of obsessive-compulsive disorder was 11.8% (95% CI, 8.9-14.6). Cronbach's alpha was 0.803 and just one factor with 3.60 eigenvalue explained 74.8% of variance. The area under the ROC curve was 0.799 (95% CI, 0.752-0.847) and the best cut-off point was 12, with sensitivity at 69.5% (95% CI, 56.0-80.5) and specificity at 77.7% (95% CI, 72.9-88.9). Its reproducibility was acceptable (Lin's coefficient at 0.752; 95% CI, 0.714-0.790).

CONCLUSION

The Leyton Obsessional Inventory is a fair screening tool for detecting obsessive-compulsive disorder in Colombian children and adolescents.

Diagnostik von Zwangsstörungen im Kindes- und Jugendalter

Zusammenfassung. Die Komplexität von Zwangsstörungen macht eine umfassende Diagnostik erforderlich. Die Diagnostik von Zwangsstörungen ist in eine multimodale Verhaltens- und Psychodiagnostik integriert, die eine detaillierte Erfassung der individuellen Zwangssymptomatik, einschließlich ihrer aufrechterhaltenden Bedingungen, Beeinträchtigungen, komorbiden Störungen und Probleme impliziert. Die spezifischen Aspekte des diagnostischen Vorgehens bei Kindern und Jugendlichen mit Zwangsstörungen sowie deren Bezugspersonen (einschließlich Beziehungsaufbau, Exploration familiärer Beziehungen, der Zwangssymptomatik sowie komorbider Auffälligkeiten des Kindes bzw. Jugendlichen und psychischer Auffälligkeiten der Bezugspersonen, Exploration eines gemeinsamen Störungskonzeptes, Behandlungsziele und Behandlungsplanung) werden dargelegt. Die deutschsprachigen spezifischen diagnostischen Verfahren, einschließlich neuer Verfahren, werden detailliert beschrieben.

Assessment of pediatric obsessive-compulsive disorder: a critical review of current methodology

Obsessive-compulsive disorder (OCD) is a relatively common disorder among children and adolescents, and is associated with increased risk for concurrent and future distress and impairment. Many youth who suffer from OCD go undiagnosed or misdiagnosed, and do not attain appropriate treatment in a timely manner. As a result, researchers have focused greater attention to the assessment of pediatric OCD. This paper provides an overview of recent advances in this area, including an introduction to several new assessment instruments. Descriptions of new and commonly used instruments and their clinical/research utility are described. Psychometric properties are also reported. Finally, a critical review is offered of major trends in the assessment of pediatric OCD (e.g., diagnostic interviews, self-report and parent-report measures, and clinician-administered inventories).

Executive functioning in children with autism and Tourette syndrome

The main aims of this study were to investigate if children with high-functioning autism (HFA) and children with Tourette syndrome (TS) can be differentiated in their executive functioning (EF) profile compared to normal controls (NCs) and compared to each other and to investigate whether children with HFA or children with TS and a comorbid group of children with both disorders are distinct conditions in terms of EF, Four groups of children participated in this study: HFA, TS, comorbid HFA + TS, and a NC group. All children were in the age range of 6 to 13 years. The groups were compared on five major domains of EF: inhibition, visual working memory, planning, cognitive flexibility, and verbal fluency. Children with HFA scored lower than NC children on all the EFs measured. Children with TS and NC children showed the same EF profile. The HFA group scored lower than the TS group for inhibition of a prepotent response and cognitive flexibility. Children with HFA performed poorer than children with comorbid HFA + TS on all functions, with the exception of inhibiting an ongoing response, interference control, and verbal fluency. Children with TS and children with comorbid HFA + TS could not be differentiated from one another in terms of EF. This study indicates that EF deficits are highly characteristic of children with HFA in comparison to children with TS and NC. The results suggest that for the comparison between HFA and TS groups, it is important to take into account comorbidity. A reevaluation of the EF hypothesis in children with TS is suggested.

Executive Functioning in Children with an Autism Spectrum Disorder: Can We Differentiate Within the Spectrum?

The aim of this study was to investigate whether children with high-functioning autism (HFA), Asperger's syndrome (AS), and pervasive developmental disorder not otherwise specified (PDDNOS) can be differentiated from each other and from normal controls on their neurocognitive executive functioning (EF) profile. Children with HFA and AS showed the most EF deficits. The EF profile of the PDDNOS group was more disturbed that the normal control group, but was less disturbed than the profile of the HFA and AS groups. Little difference was found between the three PDD subtypes with respect to EF. This study supports the view that executive dysfunctioning plays an important role in autism. The usefulness of a distinction between different PDD subtypes was not demonstrated.

An immunological marker (D8/17) associated with rheumatic fever as a predictor of childhood psychiatric disorders in a community sample

BACKGROUND

Previous studies have documented that various behavioral disturbances accompany Sydenham's chorea, a neurologic variant of rheumatic fever. Further, an immunological marker associated with rheumatic fever (monoclonal antibody D8/17) has been reported to be elevated in several neuropsychiatric disorders, most frequently tics and obsessive-compulsive disorder. We examined this association in a community sample of children previously identified as being D8/17 positive or negative. It was hypothesized that D8/17 positivity would predict increased rates of tics and obsessive-compulsive disorder, even in the absence of Sydenham's chorea. Possible associations with other disorders accompanying Sydenham's chorea--hyperactivity, anxiety, and depression, also were explored.

METHOD

From 1991 to 1995, 2631 children (mean age = 9.6 +/- 1.6 years) from a low socioeconomic area of Mexico City were screened for the D8/17 marker. In a 2- to 5-year follow-up of 240 of these children (108 positive and 132 negative), structured psychiatric interviews and rating scales were administered to the child and main caretaker. Assessments were conducted and scored blind to the child's D8/17 status.

RESULTS

No association was seen between D8/17 positivity and tics or OCD.

CONCLUSION

This study failed to provide support for the generalized use of D8/17 as a marker of susceptibility to tics and OCD in a community sample.

The preliminary development of a new self-report measure for OCD in young people

The aim of this study was to develop a reliable self-report instrument to assess obsessive-compulsive disorder (OCD) in young people. The children's Obsessional Compulsive Inventory (CHOCI) had good internal consistency, criterion validity and was significantly correlated with the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS). This preliminary new measure could serve to provide a more efficient and accessible way of assessing OCD in young people.