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Background: Major depressive disorder (MDD) is common in youth and among the most frequent comorbid disorders in pediatric obsessive-compulsive disorder (OCD), but it is unclear whether the presence of OCD affects the symptom presentation of MDD in youth., Methods: A sample of youth with OCD and MDD (n = 124) and a sample of youth with MDD but no OCD (n = 673) completed the Patient Health Questionnaire for Adolescents (PHQ-A). The overall and symptom-level presentation of MDD were examined using group comparisons and network analysis., Results: Youth with MDD and OCD, compared to those with MDD and no OCD, had more severe MDD (Cohen's d = 0.39) and more reported moderate to severe depression (75 % vs 61 %). When accounting for demographic variables and the overall severity of MDD, those with comorbid OCD reported lower levels of anhedonia and more severe difficulties with psychomotor retardation/agitation. No significant differences in the interconnections among symptoms emerged., Limitations: Data were cross-sectional and self-reported, gold standard diagnostic tools were not used to assess OCD, and the sample size for the group with MDD and OCD was relatively small yielding low statistical power for network analysis., Conclusions: Youth with MDD and OCD have more severe MDD than those with MDD and no OCD and they experience more psychomotor issues and less anhedonia, which may relate to the behavioral activation characteristic of OCD., Competing Interests: Declaration of competing interest Ms. Strouphauer, Mr. Valenzuela-Florez, Mr. Elmore, and Drs. Minhajuddin, Slater, Riddle, Guzick, Hettema, Wakefield, Pinciotti, Tonarelli, and Gushanas do not have any conflicts to declare. Dr. Soutullo reports for the period 2018–2022 non-personal research funds from Lundbeck and Janssen; is a consultant/advisory board member of Editorial Médica Panamericana, EUNETHYDIS (European Network on Hyperkinetic Disorder), NeuroTech Solutions Ltd. (Israel), Limbix Health DSMB (United States), MEDEA (Spain), Tech Innosphere Engineering LTD (Germany), and Shire/now part of Takeda (Spain); received speaker's bureau fees from Bial (Portugal), Cuquerella Medical Consulting (Spain), Medice (Germany), Rubio (Spain), Tecnofarma (Peru), and Shire/now part of Takeda (Spain), and royalties from Editorial Médica Panamericana (Spain). Dr. Goodman receives research fundings from NIH, Biohaven, and the McNair Foundation, royalties from Proem related to the licensing of the YBOCS scales, and consulting fee from Biohaven. Dr. Trivedi has provided consulting services to Acadia Pharmaceuticals, Alkermes Inc., Alto Neuroscience Inc, Axsome Therapeutics, Biogen MA Inc, Cerebral Inc., Circular Genomics Inc., Compass Pathfinder Limited, GH Research, GreenLight VitalSign6 Inc, Heading Health, Janssen Pharmaceutical, Legion Health, Merck Sharp & Dohme Corp., Mind Medicine Inc., Myriad Neuroscience, Naki Health Ltd, Navitor, Neurocrine Biosciences Inc., Noema Pharma AG, Orexo US Inc., Otsuka America Pharmaceutical Inc, Perception Neuroscience Holdings, Pharmerit International, Policy Analysis Inc., Praxis Precision Medicines Inc, PureTech LYT Inc, Relmada Therapeutics Inc., Rexahn Pharmaceuticals, Inc., SAGE Therapeutics, Signant Health, Sparian Biosciences, Titan Pharmaceuticals, Takeda Pharmaceuticals Inc, WebMD. He has received grant/research funding from NIMH, NIDA, NCATS, American Foundation for Suicide Prevention, Patient-Centered Outcomes Research Institute (PCORI), and Blue Cross Blue Shield of Texas. Additionally, he has received editorial compensation from Engage Health Media, and Oxford University Press. Dr. Storch reports receiving research funding to his institution from the Ream Foundation, International OCD Foundation, and NIH. He was formerly a consultant for Brainsway and Biohaven Pharmaceuticals in the past 12 months. He owns stock less than $5000 in NView. He receives book royalties from Elsevier, Wiley, Oxford, American Psychological Association, Guildford, Springer, Routledge, and Jessica Kingsley Dr. Cervin receives research support from the Swedish Research Council for Health, Working Life and Welfare, the Lindhaga Foundation, Stiftelsen Clas Grochinskys Minnesfond, the Crown Princess Lovisa's Association, Region Skåne, Fonden för Psykisk Hälsa, and Skåne University Hospital's Foundations and Donations; and financial compensation from Springer for editorial work outside of the submitted work., (Copyright © 2024. Published by Elsevier B.V.)

Background: Misophonia is a complex condition characterized by extreme emotional distress in response to specific sounds or specific visual stimuli. Despite a growing body of clinical and neuroscientific literature, the etiology of this condition remains unclear. Hyperarousal, that is, a state of heightened alertness and disinhibition, as a core feature of misophonia is supported by behavioral and neuroimaging literature and might represent a viable clinical target for the development of both behavioral and pharmacological interventions. The aim of this study was to investigate how hyperarousal might be linked to neurocognitive processes associated with vigilance and stimulus discrimination in youth with misophonia., Methods: We compared 72 children and adolescents with misophonia (13.74 ± 2.44 years) (64 % female) and 89 children and adolescents with anxiety (12.35 ± 2.57 years) (58.4 % female) on behavioral and signal detection performance of the immediate memory task (IMT). Anxiety patients were used as a clinical control group to distinguish attentional processes specific for misophonia., Results: Both groups demonstrated similar behavioral performance, including response rate and reaction time. However, misophonia was associated with elevated stimulus discrimination (d prime), which in turn was positively correlated with the severity of misophonia trigger reports., Conclusions: Our findings are in line with previous cognitive and neuroimaging studies, and support an arousal-based model of misophonia, where individuals with misophonia experience a state of heightened vigilance, being more aware of stimuli in the environment. Our findings provide a neurocognitive basis for future study of neurochemical imaging that might further progress towards clinical targets., Competing Interests: Declaration of competing interest N. Murphy has received grants/research support from NIMH (1R21MH119441-01A1); REAM Misophonia Research Fund (The REAM Foundation - YR01); Caroline Wiess Law Fund for Research in Molecular Medicine, and has previously received research support as a subinvestigator for clinical research for Neurocrine Biosciences Inc. M. Cervin receives research support from the Swedish Research Council for Health, Working Life and Welfare, the Lindhaga Foundation, Stiftelsen Clas Grochinskys Minnesfond, the Crown Princess Lovisa's Association, Region Skåne, and Skåne University Hospital's Foundations and Donations; and financial compensation from Springer for editorial work outside of the submitted work. Dr. Guzick receives grant support from the REAM Foundation/Misophonia Research Fund as well as the Texas Higher Education Coordinating Board. Dr. Storch reports receiving research funding to his institution from the Ream Foundation, International OCD Foundation, and NIH. He is a consultant for Brainsway and Biohaven Pharmaceuticals. He owns stock less than $5000 in NView (for distribution of the Y-BOCS and CY-BOCS) and Limbix. He receives book royalties from Elsevier, Wiley, Oxford, American Psychological Association, Guildford, Springer, Routledge, and Jessica Kingsley., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: To prospectively chart pathways of risk and resiliency following childhood trauma studies need to address three limitations of prior work: 1) recruit beyond social service/ treatment settings; 2) include broad spectrum of trauma types and 3) cast a broad longitudinal measurement framework of both clinical diagnoses and traumatic exposures. The Texas-Childhood Trauma Research Network (TX-CTRN) is a multi-site collaboration that addresses these limitations. In this baseline-only report, we examined domains of trauma and evaluated the concurrent predictive validity of various traumatic event scoring schemas for clinical diagnoses., Methods: Broad-base recruitment of 8-20 year-olds (N = 1289) included trauma centers, emergency departments, pediatric and primary care clinics, and other community settings. Assessments were comprehensive and based on clinical interviews by trained research interviewers., Results: Factor analyses supported a five-factor solution of trauma domains including unintentional/acute, intentional/interpersonal, bullying, in-home versus community witnessed interpersonal harms. Trauma burden scoring schemas were examined for their predictive superiority. Domain-specific counts of traumas that met DSM-5 post-traumatic-stress disorder (PTSD) Criterion-A was the best overall schema in distinguishing among youth with no diagnosis, comorbidities, those with depression, suicidality, substance misuse, and PTSD., Limitations: There were no assessments of neglect., Conclusions: Findings largely aligned with earlier studies on the relative importance of intentional interpersonal traumas and showed bullying may be an important source of traumatic stress that independently adds to prediction of several diagnoses and should be considered in clinical practice., Competing Interests: Declaration of competing interest Drs. Aksan Clark, Dodd, Taylor, Shahidullah, Richmond, Wagner, Cisler, Cross, Garza, have reported no biomedical financial interests or potential conflicts of interest. PJR serves on a data safety monitoring board for Sunovion Pharmaceuticals. DJN has received research support from Eli Lilly, Glaxo SmithKline (GSK), Janssen, the National Alliance for Research on Schizophrenia and Depression (NARSAD), Navitor, Sage Therapeutics, Takeda Pharmaceuticals, the Texas Health & Human Services Commission, and Wyeth. He has served on speakers' bureaus and/or received honoraria from Astra-Zeneca, Eli Lilly, GSK, Pfizer and Wyeth. He has served on advisory boards for GSK, Janssen, Merck, and Sage Therapeutics. He has served as a consultant to Sage Therapeutics. Neither he nor family members have ever held equity positions in biomedical or pharmaceutical corporations. CBM, in the last three years, served as a consultant to AbbVie, ANeuroTech (division of Anima BV), Signant Health, Magstim, Inc., Intra-Cellular Therapies, Inc., EMA Wellness, Sage, Silo Pharma, Engrail Therapeutics, Pasithea Therapeutic Corp., EcoR1, GoodCap Pharmaceuticals, Inc., Senseye, Clexio, EmbarkBio, SynapseBio, BioXcel Therapeutics. He is a stockholder with Seattle Genetics, Antares, Inc., Corcept Therapeutics Pharmaceuticals Company, EMA Wellness, Precisement Health, Relmada Therapeutics. He has served on advisory boards for ANeuroTech (division of Anima BV), Brain and Behavior Research Foundation (BBRF), Anxiety and Depression Association of America (ADAA), Skyland Trail, Signant Health, Laureate Institute for Brain Research (LIBR), Inc., Heading Health, Pasithea Therapeutic Corp., Sage. He has served on the Board of Directors for Gratitude America, ADAA, Lucy Scientific Discovery, Inc. He holds the following patents: Method and devices for transdermal delivery of lithium (US 6375,990B1); Method of assessing antidepressant drug therapy via transport inhibition of monoamine neurotransmitters by ex vivo assay (US 7148,027B2)., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: Evidence suggests that depressive symptoms tend to improve concurrently with obsessive-compulsive disorder (OCD) symptoms during cognitive behavioral therapy (CBT), despite depression not being the primary target of intervention. Studies examining the temporal or mediational relationships of OCD and depressive symptoms have indicated a bidirectional relationship, as prior levels of OCD symptoms influenced subsequent levels of depression, and vice versa. Deep transcranial magnetic stimulation (dTMS) has recently emerged as a treatment option for OCD. Whether dTMS affects depression symptoms similarly to CBT remains to be examined., Methods: The current study employed a random intercept cross-lagged panel model (RI-CLPM) to examine the relationship of OCD and depression symptoms in 94 treatment refractory patients, undergoing dTMS or sham treatment., Results: Both OCD and depression symptoms improved significantly. However, a stable, cross-lagged relationship between the variables was not supported. Changes in one symptom domain could not be used to predict the other., Limitations: The present study was conducted in a treatment refractory population, meaning the present findings may not generalize to treatment naïve patients or those with less severe OCD symptoms. It is unclear whether the study was sufficiently powered to detect the effects of interest, and this concern also meant that examining the dTMS and sham groups independently was not feasible., Conclusions: When treating OCD with dTMS, depression symptoms appear likely to diminish but should be monitored throughout, and additional interventions applied if needed., Competing Interests: Declaration of competing interest Dr. Storch reports receiving research funding to his institution from the Ream Foundation, International OCD Foundation, and NIH. He was a consultant for Brainsway and Biohaven Pharmaceuticals in the past 12 months. He owns stock less than $5000 in NView. He receives book royalties from Elsevier, Wiley, Oxford, American Psychological Association, Guildford, Springer, Routledge, and Jessica Kingsley. Dr. Guzick reports research funding from the Ream Foundation. Aron Tendler is a consultant chief medical officer for BrainsWay, the manufacturers of Deep TMS, and has a financial interest in BrainsWay, Alpha Tau Medical and a commercial TMS center. HE has received research support in the last twelve months from Liva Nova, Biohaven and BrainsWay. The other authors have no disclosures. The authors declare no competing interests., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: Misophonia is characterized by intense emotional reactions to specific sounds or visual stimuli and typically onsets during childhood. An obstacle for research and clinical practice is that no comprehensively evaluated measures for pediatric misophonia exist., Methods: In a sample of 102 youth meeting the proposed diagnostic criteria of misophonia, we evaluated the child and parent-proxy versions of the self-reported Misophonia Assessment Questionnaire (MAQ; assessing broad aspects of misophonia) and the child version of the Amsterdam Misophonia Scale (A-MISO-S; assessing misophonia severity). Confirmatory and exploratory factor analysis were used to examine factor structures of the measures. Further, child-parent agreement on the MAQ and associations between both measures and misophonia-related impairment, quality of life, and misophonia-related school interference were examined to evaluate aspects of convergent validity., Results: For both youth- and parent-ratings, four MAQ factors emerged: pessimism, distress, interference, and non-recognition. A-MISO-S showed a unidimensional structure, but the item 'effort to resist' did not load significantly onto the unidimensional factor. Good child-parent agreement on the MAQ scales were found and both MAQ and A-MISO-S were moderately to strongly associated with misophonia-related impairment, quality of life (inverse association), and misophonia-related school interference., Limitations: MAQ and A-MISO-S assess sensitivity to auditory but not visual stimuli, the sample size was modest, and repeated assessments were not conducted., Conclusions: The combination of MAQ and A-MISO-S shows promise as a multidimensional assessment approach for pediatric misophonia. Future evaluations should include known-groups validity, screening performance, and sensitivity to change in symptom severity., Competing Interests: Declaration of competing interest None, (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: There is little information on the clinical presentation, functional impact, and psychiatric characteristics of misophonia in youth, an increasingly recognized syndrome characterized by high emotional reactivity to certain sounds and associated visual stimuli., Method: One-hundred-two youth (8-17 years-old) with misophonia and their parents were recruited and compared with 94 youth with anxiety disorders. Participants completed validated assessments of misophonia severity, quality of life, as well as psychiatric symptoms and diagnoses., Results: The most common misophonia triggers included eating (96 %), breathing (84 %), throat sounds (66 %), and tapping (54 %). Annoyance/irritation, verbal aggression, avoidance behavior, and family impact were nearly universal. Misophonia severity was associated with internalizing symptoms, child-reported externalizing behaviors, and poorer quality of life. High rates of comorbidity with internalizing and neurodevelopmental disorders were found. Quality of life and externalizing behaviors were not significantly different between misophonia and anxiety samples; internalizing symptoms and autism characteristics were significantly higher among youth with anxiety disorders., Limitations: This self-selected sample was characterized by limited multicultural diversity., Conclusions: This study presents misophonia as a highly impairing psychiatric syndrome. Future interdisciplinary work should clarify the mechanisms of misophonia, establish evidence-based treatments, and extend these findings to randomly sampled and more culturally diverse populations., Competing Interests: Conflict of interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Drs. Guzick, Storch, Lewin, and Lijffijt receive grant support from the Ream Foundation. Dr. Guzick also receives grant funding from the Texas Higher Education Coordinating Board unrelated to this study. Dr. Lijffijt has served as principal investigator for studies funded by NeuroRx and VistaGen Therapeutics. Dr. Goodman has received donated devices from Medtronic and is a consultant for Biohaven Pharmaceuticals. Dr. Lewin has unrelated grant support from the Centers for Disease Control and Prevention and Tourette Association of America. He receives editorial and/or publishing honorarium from Springer and Elsevier. He is on the Scientific Advisory Board for the International OCD Foundation and is a Tourette Centers of Excellence Director. He may receive travel compensation for service to the American Psychological Commission on Accreditation or Board of Directors for the American Board of Clinical Child and Adolescent Psychiatry. Dr. Storch discloses the following relationships: consultant for Biohaven Pharmaceuticals; Book royalties from Elsevier, Springer, American Psychological Association, Wiley, Oxford, Kingsley, and Guilford; Stock valued at less than $5000 from NView; Research support from NIH, IOCDF, Ream Foundation, and Texas Higher Education Coordinating Board., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Objective: Misophonia is a complex disorder characterized by a heightened reaction to certain sounds and associated stimuli. While there is no uniformly accepted treatment to date, different intervention approaches are being investigated. Individual's perceptions of different misophonia treatment methods may affect compliance and satisfaction with treatment options. We sought to gather data on patient perceptions of currently available misophonia treatments., Methods: Using an online survey, we collected data about treatment preferences, treatment usage, and diagnosis history from parents of children with misophonia (N = 141) and adults with misophonia (N = 252)., Results: Most respondents were not satisfied with misophonia treatments that they or their children had previously received. Audiologic interventions including active and passive noise cancelling and lifestyle modifications were rated as most appropriate for treatment of misophonia by both parent and adult respondents., Limitations: Because of the descriptive nature of this study, we chose to use a completer-only approach to ensure the data reflect the true responses of participants, though this did result in a meaningful proportion of missing data. Participants were selected through convenience sampling and responses were self-reported. Individuals with more severe misophonia symptoms may be more likely to participate and complete a research survey., Conclusions: Most interventions are considered inappropriate by parents of youth with misophonia and by adults with misophonia. This should be interpreted in the light of a general lack of misophonia-specific interventions. Findings suggest dissatisfaction with currently available treatments and an opportunity for development of effective treatment strategies corresponding to participants' preferences. Deeper understanding of treatment preferences has the potential to guide future treatment development., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Until recently, psychotherapies, including exposure and response prevention (ERP) for obsessive-compulsive disorder (OCD), have primarily been delivered in-person. The COVID-19 pandemic required OCD providers delivering ERP to quickly transition to telehealth services. While evidence supports telehealth ERP delivery, limited research has examined OCD provider perceptions about patient characteristics that are most appropriate for this modality, as well as provider abilities to identify and address factors interfering with effective telehealth ERP. In the present study, OCD therapists (N = 113) rated the feasibility of delivering telehealth ERP relative to in-person for different (1) patient age-groups, (2) levels of OCD severity, and (3) provider ability to identify and address factors interfering with ERP during in-person and telehealth ERP (e.g., cognitive avoidance, reassurance seeking, etc.). Providers reported significantly greater feasibility of delivering telehealth ERP to individuals ages 13-to-65-years relative to other age groups assessed. Greater perceived feasibility for telehealth relative to in-person ERP was reported for lower versus higher symptom severity levels. Lastly, providers felt better able to identify and address problematic factors in-person. These findings suggest that providers should practice appropriate caution when offering telehealth ERP for certain patients with OCD. Future research may examine how to address these potential limitations of telehealth ERP delivery., (Copyright © 2022. Published by Elsevier B.V.)

Background: The COVID-19 pandemic has led to increased stress, anxiety, and depression in children. A six-session, parent-led, transdiagnostic, cognitive-behavioral teletherapy program was adapted from an established protocol to help youth aged between 5 and 13 years manage emotional problems during the pandemic., Methods: One-hundred twenty-nine parents of youth struggling with emotional problems during the COVID-19 pandemic participated in the program. Parents reported on their children's psychosocial functioning before and after treatment using validated assessments. They also reported on treatment satisfaction. Clinician-rated global improvement was assessed at each session to determine clinically significant treatment response., Results: Significant improvements in parent proxy-reported anxiety (d = 0.56), depression (d = 0.69), stress (d = 0.61), anger (d = 0.69), family relationships (d = 0.32), and COVID-19-related distress (d = 1.08) were found, with 62% of participants who completed the program being classified as treatment responders. Parents reported high levels of satisfaction with the program., Limitations: This study was limited by use of primarily parent-report assessments and a lack of a control group., Conclusions: Brief, parent-led, transdiagnostic cognitive-behavioral teletherapy appeared to be an effective way to help youth cope with the pandemic and may be a scalable framework in response to large-scale mental health crises., (Copyright © 2022 Elsevier B.V. All rights reserved.)

The COVID-19 pandemic has created novel mental health challenges for those with pre-existing problems including obsessive-compulsive disorder (OCD). Our study reports on clinician perceptions regarding the effect of the COVID-19 pandemic on patients with OCD receiving exposure and response prevention treatment (ERP) prior to and during the pandemic. Participating clinicians completed a survey which included questions adapted from National Institute of Mental Health-Global Obsessive-Compulsive Scale (NIMH-GOCS) and Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Clinicians rated clinical features at treatment initiation, just prior to the pandemic, and mid-pandemic (July/August, 2020). Findings suggest that the COVID-19 pandemic was associated with attenuation of ERP progress from expected rates in most patients during first several months of the pandemic; clinicians estimated that 38% of their patients had symptoms worsen during the pandemic and 47% estimated that symptoms remained unchanged despite participating in ERP. Those who endured financial distress or were medically at-risk for severe COVID-19 disease had worse ERP course. Adults also had a worse ERP course during than pandemic than youth. Further research is needed to better understand the effect of the COVID-19 pandemic on OCD symptomatology and treatment trajectory post-pandemic., (Copyright © 2020. Published by Elsevier B.V.)

Selective serotonin reuptake inhibitors (SSRIs) are an efficacious and effective treatment for pediatric obsessive-compulsive disorder (OCD) but have received scrutiny due to a potential side effect constellation called activation syndrome. While recent research introduced a subjective measure of activation syndrome, objective measures have not been tested. This pilot study, using data from a larger randomized-controlled trial, investigated the potential of actigraphy to provide an objective measure of activation symptoms in 44 youths with OCD beginning an SSRI medication regimen. Data were collected over the first four weeks of a multi-site, parallel, double-blind, randomized, placebo controlled psychopharmacological treatment study and statistical modeling was utilized to test how activation syndrome severity predicts daily and nightly activity levels. Results indicated that youths with higher activation symptoms had lower daytime activity levels when treatment averages were analyzed; in contrast youths who experienced onset of activation symptoms one week were more likely to have higher day-time and night-time activity ratings that week. Results support actigraphy as a potential objective measure of activation symptoms. Subsequent studies are needed to confirm these findings and test clinical applications for use by clinicians to monitor activation syndrome during SSRI treatment. National Institutes of Health (5UO1 MH078594-01); NCT00382291., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)