The COVID-19 pandemic has brought about significant stress and anxiety for many parents around the world. Psychological flexibility and self-care are fundamental aspects of psychological health. For parents, shaping these processes may help promote family nurturance, support children's prosocial behavior, and provide effective and consistent use of evidence-based parenting "kernels." The goal of this article is to provide practitioners with evidence-based tools that will support psychological flexibility, self-care, and positive parenting behaviors in caregivers during COVID-19 and beyond.
Objective-To examine the relative efficacy of family-based cognitive-behavioral therapy (CBT) versus family-based relaxation treatment (RT) for young children ages 5 to 8 years with obsessive-compulsive disorder (OCD).Method-Forty-two young children with primary OCD were randomized to receive 12 sessions of family-based CBT or family-based RT. Assessments were conducted before and after treatment by independent raters blind to treatment assignment. Primary outcomes included scores on the Children's Yale-Brown Obsessive Compulsive Scale and Clinical Global ImpressionsImprovement.Results-For the intent-to-treat sample, CBT was associated with a moderate treatment effect (d = 0.53), although there was not a significant difference between the groups at conventional levels. For the completer sample, CBT had a large effect (d = 0.85), and there was a significant group difference favoring CBT. In the intent-to-treat sample, 50% of children in the CBT group achieved remission as compared to 20% in the RT group. In the completer sample, 69% of children in the CBT group achieved a clinical remission compared to 20% in the RT group. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptConclusions-Results indicate that children with early-onset OCD benefit from a treatment approach tailored to their developmental needs and family context. CBT was effective in reducing OCD symptoms and in helping a large number of children achieve a clinical remission. Keywordsobsessive-compulsive disorder; cognitive-behavioral therapy; family-based treatmentObsessive-compulsive disorder (OCD) has been observed in children as young as age 3 years. 1, 2 OCD with an onset before age 9 years, herein referred to as early childhood-onset OCD, is associated with significant functional impairment in a number of critical domains. Furthermore, this impairment may compound over time to derail the acquisition and mastery of other important developmental milestones.2 -6 If left untreated or if inadequately treated, young children have an increased likelihood that OCD will severely disrupt normative development, impair functioning, and extend into adulthood. Despite the significant risk of compounding problems for this population of children over time, there are no empirically supported treatments for OCD in early childhood.Exposure with response prevention (EX/RP) is the behavioral treatment of choice for OCD in both adults and children, 7 but previous studies have not adequately addressed the efficacy of EX/RP for children with early childhood-onset OCD. Although children as young as age 7 have been included in previous randomized controlled trials of EX/RP, they were underrepresented in those samples relative to older children and adolescents. For example, in the Pediatric OCD Treatment Study I, 18 of 112 (16%) children were younger than age 9, 11 of 18 (10%) of children younger than age 9 received a CBT-containing condition, and the mean age of the sample was 11.8 years.8 This is important because young children with OCD ...
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