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With TV shows such as Hoarding buried alive, mainstream media depictions of hoarding disorder are presented mostly in the context of adults. Interestingly, however, studies have found that the onset of hoarding disorder often occurs in childhood between the ages of 8 and 10 (Morris et al., 2016). Since hoarding can onset at a young age, early intervention could help decrease the long‐term impairment of the disorder. According to the Diagnostic and statistical manual of mental disorders hoarding disorder is characterized as tending to collect items, difficulty in throwing items away despite the items' value or significance, and possessing an excessive number of items, leading to clutter (5th ed.; DSM–5; American Psychiatric Association, 2013). Despite a typical onset in childhood, most hoarding treatment and research has focused on adults because hoarding behaviors in youth can be challenging to identify due to family accommodation (Morris et al., 2016). In this article, we will review the prevalence of pediatric hoarding and provide a case example to describe clinical considerations for treating pediatric hoarding with exposure with response prevention (ERP). [ABSTRACT FROM AUTHOR]

This study tested whether a new training tool, the Exposure Guide (EG), improved in-session therapist behaviors (i.e., indicators of quality) that have been associated with youth outcomes in prior clinical trials of exposure therapy. Six therapists at a community mental health agency (CMHA) provided exposure therapy for 8 youth with obsessive-compulsive disorder (OCD). Using a nonconcurrent multiple baseline design with random assignment to baseline lengths of 6 to 16 weeks, therapists received gold-standard exposure therapy training with weekly consultation (baseline phase) followed by addition of EG training and feedback (intervention phase). The primary outcome was therapist behavior during in-session exposures, observed weekly using a validated coding system. Therapist behavior was evaluated in relation to a priori benchmarks derived from clinical trials. Additional outcomes included training feasibility/acceptability, therapist response to case vignettes and beliefs about exposure, and independent evaluator-rated clinical outcomes. Three therapists reached behavior benchmarks only during the EG (intervention) phase. Two therapists met benchmarks during the baseline phase; one of these subsequently moved away from benchmarks but met them again after starting the EG phase. Across all therapists, the percentage of weeks meeting benchmarks was significantly higher during the EG phase (86.4%) vs. the baseline phase (53.2%). Youth participants experienced significant improvement in OCD symptoms and global illness severity from pre- to posttreatment. Results provide initial evidence that adding the EG to gold-standard training can change in-session therapist behaviors in a CMHA setting. [ABSTRACT FROM AUTHOR]

Exposure‐based Cognitive Behavioral Therapy (CBT) is the gold standard of treatment for both anxiety disorders and Obsessive‐Compulsive Disorder (OCD). During exposure therapy, patients gradually confront and closely attend to feared stimuli while resisting safety behaviors or compulsions. [ABSTRACT FROM AUTHOR]

In an effort to improve patient conceptualization and targeted treatment, researchers have sought to accurately classify OCD subtypes. To date, the most common form of OCD classification has used the content of symptom topography as opposed to functional links between symptoms to categorize OCD. The aim of the current study was to explore the associations between these two forms of OCD classification. Participant topographical symptoms were self-reported using the Obsessive-Compulsive Inventory-Child Version (OCI-CV). Clinicians assessed whether participant symptoms were motivated by harm avoidance and/or incompleteness. Structural equation modeling was employed to explore the associations between harm avoidance and incompleteness and symptom dimensions in youth with OCD. Results showed that harm avoidance was significantly associated with doubting/checking, obsessing, and neutralizing symptoms, whereas incompleteness was associated with doubting/checking, ordering, and neutralizing symptoms. Findings are consistent with child and adult literature and highlight the importance of assessing the underlying function of OC behaviors. [ABSTRACT FROM AUTHOR]

This brief report examines the evidence for moderators of psychosocial treatment for youth with obsessive-compulsive disorder (OCD). Understanding treatment moderators can help clinicians select the most appropriate intervention for a particular patient and consequently increase the likelihood of initial response. A systematic search of the literature was conducted to identify randomized trials and meta-analyses reporting on moderators of psychosocial treatment for pediatric OCD. All studies included a comparison of cognitive-behavioral therapy (CBT) to active or control conditions. Few studies have evaluated moderators of psychosocial treatment for youth with OCD, and among those studies, few variables have demonstrated a differential effect on treatment response. Moderator analyses require large samples to garner the statistical power necessary to adequately evaluate differential responding in subgroups, and unfortunately, most reports of moderators in this review are post-hoc investigations of datasets from trials with relatively small sample sizes. Given the overwhelming number of CBT treatment variants and potential moderators, it would be impossible to conduct all the necessary head-to-head trials with sufficient sample sizes to develop helpful clinical guidelines. The best option for advancing the moderator literature is to utilize advanced statistical approaches for pooling existing data sets. Recommendations for leveraging emerging techniques in individual participant data meta-analysis (IPD-MA) are briefly discussed. [ABSTRACT FROM AUTHOR]