Predictors of treatment response to intensive cognitive-behavioral therapy for pediatric obsessive-compulsive disorder

Rudy, Brittany M.; Lewin, Adam B.; Geffken, Gary R.; Murphy, Tanya K.; Storch, Eric A.

doi:10.1016/j.psychres.2014.08.002

Cited by 54 publications

(34 citation statements)

References 30 publications

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“…Accommodation in pediatric OCD and anxiety has been inconsistently related to child age with some finding inverse relations [25] and others finding no significant relationship [22][23][24]28]. Among youth with OCD, family accommodation is negatively associated with cognitivebehavioral [32,33] and pharmacological outcomes [32], and reductions in family accommodation were associated with improved cognitive-behavioral therapy outcome [33,34].…”

mentioning

confidence: 99%

An initial study of family accommodation in children and adolescents with chronic tic disorders

Storch

Johnco

McGuire

et al. 2016

Eur Child Adolesc Psychiatry

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This initial study examined the nature, incidence, and clinical correlates of family accommodation in youth with tic disorders, and validated a brief self-report measure of tic-related family accommodation, the Tic Family Accommodation Scale (TFAS). Seventy-five youth aged 6-18 who were diagnosed with a tic disorder and their parent completed a diagnostic clinical interview, and clinician and parent-report measures of tic severity, depressive symptoms, anxiety symptoms, behavioral problems, family accommodation and impairment. An exploratory factor analysis of the TFAS showed a two-factor structure, with good internal consistency for the Total score, Modification of Child Environment and Modification of Parent Environment subscales (α = 0.88, 0.86, and 0.81, respectively). Family accommodation was not associated with tic severity. Family accommodation was associated with increased anxiety and depressive symptoms, higher externalizing, rule breaking, aggressive behaviors and social problems, and with greater tic-related functional impairment. Anxiety and externalizing problems (but not depressive symptoms) predicted family accommodation when controlling for tic severity. Family accommodation predicted high levels of functional impairment over and above the effect of tic severity, anxiety, depression and externalizing problems. Family accommodation is a common phenomenon for youth with tic disorders, with modifications typically encompassing changes to the child and/or parent environments. Accommodation was not associated with tic severity, but was related to higher levels of anxiety, depressive symptoms, externalizing symptoms, aggression, and rule breaking behaviors. Results suggest that other emotional symptoms are more likely to drive accommodation practices than the tic symptoms per se.

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confidence: 99%

An initial study of family accommodation in children and adolescents with chronic tic disorders

Storch

Johnco

McGuire

et al. 2016

Eur Child Adolesc Psychiatry

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“…In a study of intensive family-based CBT (N = 78 [13]), post-treatment symptom severity scores did not differ by race/ethnicity. No medicationonly studies have examined the impact of SES or race/ ethnicity on treatment outcomes.…”

Section: Other Demographicsmentioning

confidence: 91%

“…CBT In a study of intensive family-based CBT (N = 78 [13]), gender did not predict status as a treatment responder (=88.5 %) but uniquely predicted post-treatment OCD severity and remission status, with males showing greater improvement than females. Other studies that examined gender as a predictor of CBT response found no significant association [14-16, 17•].…”

Section: Gendermentioning

confidence: 98%

“…In the largest study of CBT monotherapy (N = 257 youth), higher levels of OCD symptom severity and functional impairment at baseline were each associated with poorer response [17•]. In a recent study of intensive family-based CBT (N = 78), greater pretreatment symptom severity but not impairment predicted greater post-treatment symptom severity; neither symptom severity nor impairment predicted responder status (which was positive for 88.5 % of the sample) or remission [13]. An open trial of CBT (N = 42) found that pretreatment obsession severity and OCD-related impairment in school functioning only were associated with poorer outcome [16].…”

Section: Disorder-specific Characteristics Ocd Severitymentioning

confidence: 99%

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Personalizing the Treatment of Pediatric Obsessive-Compulsive Disorder: Evidence for Predictors and Moderators of Treatment Outcomes

Caporino

Storch

2016

Curr Behav Neurosci Rep

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Cognitive behavioral therapy (CBT), delivered alone or with a serotonin reuptake inhibitor (SRI), is efficacious for treating pediatric obsessive-compulsive disorder (OCD), but not all youth respond optimally. Research to understand for whom a given intervention is beneficial can inform efforts to personalize treatment or tailor it to specific youths to enhance outcomes. We review studies that examined potential predictors/moderators of response to CBT, medication, and multimodal treatment for pediatric OCD: demographics, disorder-specific characteristics, general illness characteristics, neuropsychological functioning, biomarkers, family factors, and non-specific therapy factors. Methodological differences across studies make it challenging to synthesize findings and more research with large samples is needed. However, family factors have emerged as relatively consistent and strong predictors of treatment outcomes and there is preliminary support for attention to the presence of tics in treatment selection. There is little evidence for age and other demographic differences in treatment response.

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“…In der NordLOTS zeigte sich nur das Alter als signifikanter Prädiktor: Präpubertäre Kinder sprachen besser auf die Behandlung an als älte-re [Torp et al, 2015]. Rudy et al [2014] untersuchten 3 potenzielle Prädiktorkategorien: demografische Daten (Alter, Geschlecht, Ethnie), Charakteristika der Zwangsstörung (Symptomschwere, Beeinträchtigung, familiäre Akkomodation) und Komorbiditäten. Keine dieser 3 Kategorien erwies sich als Prädiktor, wohingegen sich die Faktoren weibliches Geschlecht, Symptomschwere und familiäre Akkomodation als Negativprädiktoren herausstellten.…”

Section: Empirische Evidenz Zur Behandlungunclassified

Fortschritte in der Behandlung von Zwangsstörungen bei Kindern und Jugendlichen: Empirische Evidenz, Behandlungsprobleme und Verbesserungsmöglichkeiten

Simons

Vloet

2017

Verhaltenstherapie

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Obwohl Zwangsstörungen im Kindes- und Jugendalter mittlerweile als gut behandelbar gelten, sind die Behandlungsergebnisse in der Praxis häufig unbefriedigend. Dies liegt daran, dass nachweislich wirksame Interventionen nicht oder unzureichend angewendet werden. Die vorliegende Arbeit gibt eine Übersicht über evidenzbasierte psychotherapeutische und medikamentöse Behandlungsmöglichkeiten. Die Behandlung der Wahl ist die Kognitive Verhaltenstherapie mit Exposition und Reaktionsverhinderung, die, falls erforderlich, um eine Pharmakotherapie mit einem selektiven Serotonin-Wiederaufnahme-Hemmer ergänzt wird. Befunde zu Prädiktoren, Moderatoren und Mediatoren der Behandlung sind uneinheitlich. Neue Entwicklungen in der Psychotherapie beinhalten Anwendungen der Expositionsbehandlung, die nicht einem Habituationsrational folgen, sondern auf Angsthemmung und Angsttoleranz sowie auf kognitive (Erwartungsverletzung) oder metakognitive Veränderungen abzielen. Bei Kindern mit geringer Behandlungsmotivation und starker Einbindung der Familie in die Zwänge des Kindes sind elternbezogene Interventionen indiziert. Behandlungsfehler in der Expositionsbehandlung sollten in der Ausbildung von Kinder- und Jugendlichenpsychotherapeuten besonders berücksichtigt werden.

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Predictors of treatment response to intensive cognitive-behavioral therapy for pediatric obsessive-compulsive disorder

Cited by 54 publications

References 30 publications

An initial study of family accommodation in children and adolescents with chronic tic disorders

An initial study of family accommodation in children and adolescents with chronic tic disorders

Personalizing the Treatment of Pediatric Obsessive-Compulsive Disorder: Evidence for Predictors and Moderators of Treatment Outcomes

Fortschritte in der Behandlung von Zwangsstörungen bei Kindern und Jugendlichen: Empirische Evidenz, Behandlungsprobleme und Verbesserungsmöglichkeiten

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