Search

This trial examined stepped-care cognitive-behavioral treatment (CBT) among 96 autistic youth with co-occurring anxiety. Step 1 included an open trial of parent-led, therapist-guided bibliotherapy. Step 2 was family-based CBT for those who did not respond to Step 1 or maintenance for those who did. Eighteen participants (28%) who completed Step 1 responded. Responders reported significantly lower pre-treatment anxiety, internalizing symptoms, and functional impairment than non-responders. After Steps 1 and 2, 80% of completers (55% intent-to-treat) were responders. Anxiety, impairment, and ASD-related impairments significantly improved. Youth in maintenance experienced faster improvement through post-treatment, though there were no group differences at 3-month-follow-up. A stepped approach may help some individuals in Step 1, particularly those who are less anxious.

Obsessive-compulsive disorder (OCD) is an impairing mental health condition defined by intense distress in the presence of unwanted, recurrent thoughts, images, or impulses which are accompanied by compulsions and avoidance performed to reduce distress. During the COVID-19 pandemic, OCD has continued to be an impairing mental health condition regardless of symptom dimensionality (e.g., contamination, harm, etc.) with varying reports of the overall clinical course. However, changes in the assessment, treatment, and diagnosis of OCD have occurred to personalize care and be aligned with public health guidelines. Exposure and response prevention and pharmacotherapy remain the treatment of choice, even though the setting in which treatment is conducted may have shifted. Telehealth in particular has been a 'game-changer' for clinicians and patients alike. Given the continued health risk posed by the pandemic, treatment personalization should still be made to ensure safety for both patients and providers while balancing efficacy and patient preferences.

Mental healthcare professionals often have limited awareness of different obsessive-compulsive disorder (OCD) symptom presentations, which may contribute to years between OCD symptom onset and treatment initiation. While research has identified high rates of OCD misdiagnosis among clinicians from the United States and Canada, research on OCD symptom awareness among healthcare providers in Latin American (LATAM) regions is limited. In this study, LATAM mental healthcare providers (N = 83) provided diagnostic impressions based on five OCD vignettes: three with symptoms centered on taboo thoughts (sexual, harming others, and religion/scrupulosity) and two about contamination or symmetry obsessions. Rates of incorrect (non-OCD) diagnoses were significantly higher for the taboo thoughts vignettes (sexual, 52.7%; harm/aggression, 42.0%; and religious, 34.7%) vs. contamination obsessions (11.0%) and symmetry obsessions (6.9%). The OCD vignette depicting sexual obsessions was often attributed to a paraphilic disorder (36.5%). Bachelor's level clinicians had significantly lower odds of accurately identifying all three vignettes related to taboo thoughts compared to respondents with a graduate degree. Accurate identification of the three taboo vignettes was also associated with first-line psychological treatment recommendations (i.e., cognitive-behavioral therapy) even when controlling for respondents' theoretical orientation. Exposure was rarely mentioned when clinicians were prompted to provide treatment recommendations for each vignette (8–9% of the time for symmetry and contamination vignettes, 5–7% for taboo though vignettes). Like clinicians in the United States and Canada, mental health professionals in LATAM may misidentify OCD symptom presentations, particularly sexual obsessions, highlighting a need for education and training.

This investigation examined vagal modulation of arousal, as indexed by respiratory sinus arrhythmia (RSA), as a moderator of the covariance between interpretation biases and anxiety disorder symptom severity in a diverse sample of clinically anxious youth. A sample of 105 children with anxiety disorders (Mage = 10.07 years, SD = 1.22; range = 8–12 years; 57.1% female; 61.9% ethnic minority) and their mothers completed a battery of measures assessing interpretation biases and anxiety disorder symptom severity. Children also completed a behaviorally-indexed assessment of interpretation biases and participated in an anxiety-provoking speech task. Physiological assessment of RSA was collected at baseline (i.e., baseline RSA) and during the speech task (i.e., challenge RSA). The interaction between challenge RSA and both self-reported and behaviorally-indexed interpretation biases (adjusting for baseline RSA) was significant (ΔR2 = .05 and .04 respectively) in relation to maternal report of child anxiety symptoms. Specifically, among children with low (vs. high) challenge RSA, greater self-reported interpretation biases were significantly associated with maternal report of more severe child anxiety symptoms, and greater behaviorally-indexed interpretation biases were marginally associated with maternal report of more severe child anxiety. Interactions predicting child self-report of anxiety symptoms were not significant. Greater child interpretation biases coupled with lower challenge RSA were associated with maternal report of more severe child anxiety symptoms. Future work should examine whether interventions targeting RSA weaken the association between interpretation biases and anxiety symptoms in youth.

This investigation examined the synergistic role of parental emotion-focused socialization behaviors and children’s perceptual sensitivity on children’s fear reactivity. A sample of 105 children with anxiety disorders (8–12 years; M = 10.07 years, SD = 1.22; 57% female) and their clinically anxious mothers (M = 39.35 years, SD = 7.05) completed an assessment battery that included a diagnostic interview and questionnaires regarding anxiety symptoms, perceptual sensitivity, and emotion socialization behaviors; children also completed a 5-minute, videotaped speech task, and rated their fear levels before and after the task. Analyses revealed a significant interaction between perceptual sensitivity and emotion-focused strategies predicting fear change scores from pre- to post-speech. Higher perceptual sensitivity was related to greater reductions in fear from pre- to post- speech (adjusting for pre-speech fear level), yet only among anxious children whose mothers reported high use of emotion-focused strategies. Maternal emotion-focused socialization strategies may increase anxious children’s ability to modulate their affective responses during stressful situations.

Parental threatening behaviors have emerged as a subset of negative parental behaviors strongly related to internalizing symptoms among youth, yet the underlying mechanisms in this association have remained unexplored. The current investigation examined the role of difficulties engaging in goal-directed behavior while emotionally distressed in the association between exposure to maternal threatening behaviors and internalizing symptoms among trauma-exposed inpatient psychiatric youth. Participants (N = 50; mean [SD] age, 15.1 [0.51] years; age range, 12-17 years) completed measures of emotion dysregulation, exposure to maternal threatening behaviors, depression, anxiety, and posttraumatic stress disorder symptoms, as well as trauma-related functional impairment. Results revealed that inability to engage in goal-directed behavior while distressed significantly explained associations between exposure to maternal threatening behaviors and each of the three symptom classes, but not the association between exposure to maternal threatening behaviors and trauma-related functional impairment. These novel findings underscore the need for interventions that target the capacity for goal-directed behavior in the context of emotional distress, especially among trauma-exposed youth who have experienced parental threatening behaviors.

Introduction Effortful control—the ability to inhibit impulsive reactions in favor of more adaptive responses—is negatively related to child anxiety severity. One potential explanation is that greater effortful control may “slow down” automatic, threat-laden interpretations, thereby lowering children’s anxiety. The present investigation tested this hypothesis by examining associations between effortful control (and its subcomponents) and anxiety symptom severity, mediated by interpretation biases, in a diverse sample of clinically anxious youth. Method Participants (N = 105; Mage = 10.09 years, SD = 1.22; 56.7% female; 49% ethnic minority) completed a diagnostic interview; self-report measures of temperament, anxiety, and interpretation biases; a performance-based measure of interpretation biases; and a parent–child interaction task for which an index of behavioral anxiety was computed. Results Significant indirect effects were found for effortful control, attentional control, and inhibitory control on child self-reported anxiety severity by way of self-reported (but not behaviorally-indexed) interpretation biases. Models predicting behaviorally-indexed child anxiety severity were not significant. Discussion Greater effortful control may result in enhanced attentional capacities that allow children to assess automatic cognitions more objectively, potentially lowering their anxiety. Future work should evaluate whether targeting malleable temperamental constructs, such as effortful control, leads to clinically meaningful reductions in interpretation biases and child anxiety symptoms.

This commentary outlines assessment and treatment of patients with OCD during the era of COVID-19. The ongoing COVID-19 pandemic has required providers to make important considerations in treatment, including how usual risk is defined, as well as the use of personal protective equipment and telehealth services. These considerations have allowed providers to continue using both reliable and valid assessment procedures, as well as previously established and efficacious interventions. These adjustments create a context in which patient care for OCD remains fundamentally unchanged; however, important considerations should still be made because of the COVID-19 pandemic.