The prevalence of obsessive-compulsive disorder (OCD) is higher among young people with autism spectrum disorders (ASD). Case studies and randomized controlled trials show that modified cognitive behavioral therapy (CBT) can be effective for young people with OCD and co-morbid ASD. This case study describes modified CBT for an adolescent with severe, treatment-resistant OCD and co-morbid ASD, and highlights the importance of family accommodation and parental mental health in pediatric OCD. Modifications to the standard evidence-based CBT for OCD protocol included extended psychoeducation, visual session material, mini exposure and response prevention hierarchies and parallel parent sessions to address familial accommodation and parental mental health. Progress was measured at seven times points throughout treatment using clinician administered, youth and parent self-report measures. Outcome data indicated significant improvements in OCD symptoms, general functioning, and maternal mental health as well as significant reductions in family accommodation. Gains were maintained over a 12-month follow-up period. This case study illustrates that modified CBT can be effective in youth with OCD and ASD and discusses the importance of familial accommodation and parental mental health.

Background: Inequalities in access, and use of, mental health services by ethnic minorities have been consistently reported for Obsessive Compulsive Disorder (OCD). Mental health promotion may improve knowledge and help seeking. The present study trialled two methods of mental health promotion interventions for ethnic minority youth with OCD.Methods: Community organisations within an ethnically diverse area of London UK, were contacted; information stalls and teaching events on OCD were delivered as interventions. Participants completed questionnaires before and after the information stalls and teaching events. The questionnaires assessed knowledge of OCD, knowledge of identifying OCD in ethnic minorities and perceived help seeking. Participant questionnaire data collected through information stalls (N = 240) consisted predominantly of youth aged 18 years and under (51.2%) and of Black (39.0%) ethnicity. Participant questionnaire data collected at teaching events (N = 350) consisted predominantly of school staff (51.1%) where student ethnicity representation within the schools was 29.9% White, 34% Black, 13.5% South East Asian or Asian and 16.6% Mixed.Results: There were significant increases in knowledge of OCD, perceived help seeking or knowing how to seek help ratings pre to post information stalls and teaching events. Participants also rated their knowledge of identifying OCD in ethnic minority youth as higher after teaching events.Conclusions: Information stalls and teaching events may be useful in mental health promotion interventions in ethnic minority youth with OCD. Further research is needed to determine whether increase in knowledge and perceived help seeking led to increased referrals to mental health services.

Cognitive behavioural therapy (CBT) is a highly effective treatment for obsessive compulsive disorder (OCD). Identifying, challenging and monitoring interpretations of intrusions is considered a key element of CBT for OCD but preliminary research suggests that treatment does not always include identification and modification of misinterpretations. The present investigation explored ‘OCD-expert’ and ‘non-OCD-expert’ clinicians’ views on key elements of CBT for OCD to determine whether identifying and modifying key interpretations were considered important in therapy and whether clinicians who do not have specific expertise in OCD found working with interpretations difficult. Study 1 used a qualitative approach to investigate OCD-expert and non-OCD-expert clinician's views on key elements of CBT for OCD. Study 2 used a questionnaire to investigate what non-OCD-expert clinicians viewed as important and difficult aspects of CBT for OCD. Study 1 results showed that OCD-expert and non-OCD-expert clinicians reported working with interpretations was a key element of CBT for OCD. However, OCD-expert clinicians linked interpretations more closely to a formulation and intervention plan and reported using more techniques and questionnaires when working with interpretations compared with non-OCD-expert clinicians. Study 2 results showed that non-OCD-expert clinicians rated interpretations as both important and difficult to work with but no more important or difficult than other key elements of CBT for OCD. OCD-expert and non-OCD-expert clinicians identify working with interpretations as a key element of CBT for OCD. Non-OCD-expert clinicians may benefit from additional training on formulation tools that help identify, monitor and challenge interpretations of intrusions.