Avoidance, Insight, Impairment Recognition Concordance, and Cognitive-Behavioral Therapy Outcomes in Pediatric Obsessive-Compulsive Disorder - 24/04/20
Doi : 10.1016/j.jaac.2019.05.030
Robert R. Selles, PhD a, ⁎ 
, Davið R.M.A. Højgaard, PhD b, Tord Ivarsson, PhD c, Per Hove Thomsen, MD b, Nicole Michelle McBride, MPH d, Eric A. Storch, PhD e, Daniel Geller, MBBS, FRACP f, Sabine Wilhelm, PhD f, Lara J. Farrell, PhD g, Allison M. Waters, PhD g, Sharna Mathieu, BPsych g, S. Evelyn Stewart, MD a
, Davið R.M.A. Højgaard, PhD b, Tord Ivarsson, PhD c, Per Hove Thomsen, MD b, Nicole Michelle McBride, MPH d, Eric A. Storch, PhD e, Daniel Geller, MBBS, FRACP f, Sabine Wilhelm, PhD f, Lara J. Farrell, PhD g, Allison M. Waters, PhD g, Sharna Mathieu, BPsych g, S. Evelyn Stewart, MD a a University of British Columbia and BC Children’s Hospital, Vancouver, BC, Canada
b Aarhus University Hospital, Denmark
c University of Gothenburg, Sweden
d University of Arkansas for Medical Sciences, Little Rock
e Baylor College of Medicine, Houston, TX
f Harvard Medical School and Massachusetts General Hospital, Boston, MA
g Griffith University, Queensland, Australia
∗Correspondence to Robert R. Selles, PhD, BC Children’s Hospital Research Institute, A3–938 West 28th Avenue, Vancouver, BC V5Z 4H4BC Children’s Hospital Research InstituteA3–938 West 28th AvenueVancouverBCV5Z 4H4
Abstract |
Objective |
Insight and avoidance are commonly discussed factors in obsessive-compulsive disorder (OCD) that have demonstrated associations with increased severity as well as reduced treatment response in adults, but these factors have not been sufficiently examined in pediatric OCD. This study examined the impacts of avoidance, insight, and impairment recognition concordance on cognitive-behavioral therapy (CBT) outcomes as well as impacts of CBT on insight and avoidance in a large sample of youths affected by OCD.
Method |
Data from 573 OCD-affected youths enrolled in CBT trials were aggregated. Children’s Yale-Brown Obsessive-Compulsive Scale items measured treatment response, insight, and avoidance. Standardized differences between child and parent ratings of impairment were used to calculate impairment recognition concordance. Binary logistic regression was used to identify variables associated with treatment response.
Results |
Greater avoidance, limited child recognition of impairment, older age, and lower baseline severity predicted reduced likelihood of treatment response, but insight did not. Both insight and avoidance improved significantly following CBT. Response rates were lower when posttreatment insight and avoidance were worse.
Conclusion |
Contrasting with prevailing belief, poor insight does not appear to limit CBT response potential in pediatric OCD. Avoidance and impairment recognition are understudied CBT response predictors and warrant further consideration in pediatric OCD. Clinicians should attend to these factors to optimize outcomes for children affected by this common, debilitating illness.
Le texte complet de cet article est disponible en PDF.Key words : exposure and response prevention, mega-analysis, predictors, symptom recognition, treatment response
Plan
| This work was supported by a fellowship from the BC Children’s Hospital Research Institute to Dr. Selles. In addition, the original studies from which data were aggregated in the present study report the following funding: DCS-CBT was supported by grants from the National Institute of Mental Health (NIMH) to Drs. Storch (1R01MH093381) and Geller (5R01MH093402). Griffith received funding from the National Health and Medical Research Council (NHMRC), Foundation for Children, and Rotary Foundation. Nord-LOTS was supported by the TrygFonden, Danish Council for Strategic Research, Pulje til styrkelse af psykiatrisk Forskning i Region Midtjylland, Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Stiftelsen Clas Groschinskys Minnesfond, and Norwegian Research Council, Helse and Rehabilitering, Norge. UBC-POP was supported by the Michael Smith Foundation for Health Research (MSFHR) and British Columbia Provincial Health Services Administration. The funding organization was not involved in the design or conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, and approval of the manuscript. |
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| This study was presented as an abstract at the American Academy of Child and Adolescent Psychiatry 65th Annual Meeting; October 22-27, 2018; Seattle, Washington. |
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| Author Contributions: Dr. Selles had full access to the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Selles, Stewart. Acquisition, analysis, or interpretation of data: All authors. Drafting of the manuscript: Selles. Critical revision of the manuscript for important intellectual content: All authors. Administrative, technical, or material support: Selles, Stewart. Study supervision: Selles, Stewart. |
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| Disclosure: Dr. Selles has received research support from the Michael Smith Foundation for Health Research, has received speaking honoraria from The AnxietyNZ Trust, and is on the Scientific Advisory Committee for AnxietyCanada. Dr. Thomsen has served on the Advisory Board for the Tryg Foundation and has received speaking honoraria from Medice and Shire within the last 3 years. Dr. Storch has received research support from the National Institutes of Health (NIH), Agency for Healthcare Research and Quality, International OCD Foundation, and All Children’s Hospital Research Foundation. He has received royalties from Elsevier Publications, Springer Publications, American Psychological Association, Wiley, Inc., and Lawrence Erlbaum. He has served as a consultant for Rijuin Hospital, China. He has served on the Speaker’s Bureau and Scientific Advisory Board for the International OCD Foundation. He has received research support from the All Children’s Hospital Guild Endowed Chair. Dr. Geller has received grant support or funding from NIH, Neurocrine Bioscience, and Biohaven Pharmaceuticals; book honorarium from the American Academy of Child and Adolescent Psychiatry (AACAP); and speaking honoraria for Advanced Institute lectures from AACAP and Massachusetts General Hospital Psychiatry Academy in educational programs supported through independent medical education grants from pharmaceutical companies. Dr. Wilhelm has received grant support from NIH and has been a presenter for the Massachusetts General Hospital Psychiatry Academy in educational programs supported through independent medical education grants from pharmaceutical companies. She has received royalties from Elsevier Publications, Guilford Publications, New Harbinger Publications, and Oxford University Press. She has received salary support from Novartis. She has received speaking honoraria from various academic institutions and foundations, including the International Obsessive-Compulsive Disorder Foundation and Tourette Syndrome Association. She has received payment from the Association for Behavioral and Cognitive Therapies for her role as Associate Editor of Behavior Therapy and from John Wiley and Sons, Inc., for her role as Associate Editor of Depression and Anxiety. Dr. Farrell has received research funding from grants from NHMRC, Australian Research Council, Foundation for Children Australia, Australian Rotary Mental Health Fund, Griffith Health, Gold Coast Hospital Foundation, and Menzies Health Institute of QLD. She has received payment from Springer for her role as Associate Editor on Child Psychiatry and Human Development. Dr. Stewart has received grants and research funding from the Anxiety Disorders Association of America, Canadian Institutes of Health Research, AACAP, and MSFHR. She has received honoraria from Aarhus University for service as an external examiner and speaking honoraria from Yale University and National Institutes of Mental Health and Neurosciences. She has served as a member of the Scientific and Clinical Advisory Board of the International OCD Foundation. Drs. Højgaard, Ivarsson, Waters, and Mss. McBride and Mathieu have reported no biomedical financial interests or potential conflicts of interest. |
© 2019
American Academy of Child and Adolescent Psychiatry. Publié par Elsevier Masson SAS. Tous droits réservés.
Vol 59 - N° 5
P. 650 - mai 2020 Retour au numéro
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