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ObjectiveThe current study utilized a single case series, non-concurrent multiple baseline design to examine the efficacy of training parents via telehealth videoconferencing in exposure and response prevention (ERP) for home delivery of the treatment for their children and adolescents with obsessive compulsive disorder (OCD).MethodThere were nine participants aged 8 to 14 years who had received a primary diagnosis of OCD. The design involved a series of AB replications, whereby following pre-treatment assessments participants were randomly assigned to either a 2-week (n = 4) or 3-week (n = 5) baseline condition with weekly monitoring of their child’s OCD symptoms. Following baseline, parents participated four weekly telehealth parent-training modules in delivering FAST (Families Accessing Skills Training) cognitive behavior therapy (CBT) with ERP (CBT-ERP) to children with OCD via videoconferencing with the clinician. Primary outcome measures were OCD symptom severity, diagnostic severity, and global functioning, which were assessed post-treatment and at 2 month follow-up.ResultsThe stability of the baseline period from pre-treatment to week 2 (for the 2-week condition) or to week 3 (for the 3-week condition) was established as there were no significant differences across baseline scores for parent target obsessions or parent target compulsions ratings. Significant improvements on the primary outcomes of clinician assessed symptom severity, diagnostic ratings, and global functioning were observed from baseline to post-treatment, and continued to 2 months follow-up.ConclusionThese data suggest that brief, parent training in FAST CBT-ERP via telehealth provides an overall effective intervention that is likely to be of most benefit to children and youth who are mild to moderate in severity.

Food neophobia (FN) describes problematic fear-based avoidance/restriction of novel foods. Using the novel parent-reported Measure of Food Neophobia (MFN), the authors examined FN symptoms and impairment in 305 Salvadorian children and explored clinical correlates. Factor analysis supported the MFN's designed structure to inquire about FN symptoms and FN impairment. At least one FN symptom was observed in 91% of the sample; however, only 9% were rated as having moderate or greater impairment. Demographic variables were not associated with FN; however, FN was positively correlated with internalizing, externalizing, inattention, health anxiety, and obsessive-compulsive symptoms. Inattention symptoms and health anxiety emerged as significant predictors of FN symptoms, while FN symptoms were the only significant predictor of FN impairment. The present study supports the MFN and provides information about FN in a general population, including the prevalence of clinically significant symptoms and association with psychological domains. Continued investigation of FN is still needed.

Comorbidities are seen with obsessive-compulsive disorder (OCD) across the lifespan. Neurodevelopmental comorbidities are common in young children, followed by mood, anxiety, and obsessive-compulsive related disorders (OCRDs) in children, adolescents and adults, and neurological and degenerative disorders in the elderly. Understanding comorbidity prevalence and patterns has clinical and research implications. We conducted a systematic review and meta-analysis on comorbidities in OCD across the lifespan, with the objective to, first, estimate age-wise pattern and prevalence of comorbidities with OCD and, second, to examine associations of demographic (age at assessment, gender distribution) and clinical characteristics (age of onset, illness severity) with comorbidities. Four electronic databases (PubMed, EMBASE, SCOPUS, and PsycINFO) were searched using predefined search terms for articles published between 1979 and 2020. Eligible studies, across age, reported original findings on comorbidities and had an OCD sample size of ≥100. We excluded studies that did not use standardised diagnostic assessments, or that excluded patients on the basis of comorbidity. We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The review protocol has been registered on the International Prospective Register of Systematic Reviews. A comorbidity rate of 69% was found in a pooled sample of more than 15,000 individuals. Mood disorders (major depressive disorder), anxiety disorders (generalised anxiety disorder), neurodevelopmental disorders (NDDs) and OCRDs were the commonest comorbidities. Anxiety disorders prevailed in children, mood disorders in adults, whereas NDDs were similarly prevalent. Higher comorbidity with any psychiatric illness, NDDs, and severe mental disorders was seen in males, vs. females. Illness severity was inversely associated with rates for panic disorder, tic disorders, OCRDs, obsessive compulsive personality disorder, and anorexia nervosa. This systematic review and meta-analysis provides base rates for comorbidities in OCD across the lifespan. This has implications for comprehensive clinical evaluation and management planning. The high variability in comorbidity rates suggests the need for quality, multi-centric, large studies, using prospective designs.Systematic Review Registration: Unique Identifier: CRD42020215904.

Purpose Coercive and disruptive behaviors (CDBs) are commonplace in pediatric obsessive-compulsive disorder (OCD) and are associated with increased disorder impact and reduced treatment response. Prior research suggests that CDBs mediate the cross-sectional relationship between family accommodation and OCD symptom severity; however, the impact of reducing CDBs on other treatment outcomes has yet to be studied. Methods Participants comprised 49 OCD-affected youth (42.9% male, Mage at baseline = 13.7) and their parent(s) who completed a 12-week, group family-based cognitive-behavioral treatment at an OCD specialty clinic. Outcomes included parent-report measures of CDBs, family accommodation, symptom severity, and both child- and family-level impairment. Descriptive, correlation, and regression analyses were followed by tests of indirect effects (mediation). Results Changes in all outcome variables had moderate to strong correlations with each other. As hypothesized, CDB decreases predicted positive changes in OCD severity as well as in child and family impairment. Further, whereas improvement in OCD severity predicted changes in child and family impairment, improvements in family accommodation were not directly predictive of any outcomes. Consistent with hypotheses, changes in CDBs mediated relationships between changes in accommodation and child- and family-level impairment, as well as relationships between changes in OCD severity and both levels of impairment. Additional exploratory analyses found that changes in symptom severity significantly mediated relationships between changes in CDBs and both levels of impairments. Conclusions Findings suggest that attention to reducing CDBs is warranted in the treatment of pediatric OCD, and that accommodation reductions lead to meaningful improvements in child and family functioning only when CDBs and/or symptoms are also reduced. Future family-based treatments may benefit from inclusion of components specifically targeting CDBs that occur within the context of accommodating OCD symptoms.

Background Influences of race and ethnicity have received limited attention in pediatric obsessive-compulsive disorder (OCD), despite noted importance in other psychiatric diseases. We sought to compare racially defined groups presenting to a North American tertiary care pediatric OCD subspecialty clinic. Methods Clinician-rated and parent/child-reported information was extracted from a research data registry comprising OCD-affected youth assessed between 2011 and 2018. The study population was aggregated into racial groups, defined as Caucasian, Asian, and "other." Country of origin and spoken language were used as ethnicity proxies. Obsessivecompulsive disorder phenotype, clinical course, and family environment were compared, with inclusion of mixed Asian-Caucasians in post-hoc analyses. Results Asian youth reported significantly later ages of OCD symptom onset, clinical diagnosis, and treatment compared with Caucasian youth and were significantly less likely to have participated in OCD-specific treatment, despite similar clinician recommendation rates. Obsessivecompulsive disorder severity and comorbidities did not differ across groups. Asian parents reported significantly higher levels of family blame and conflict than Caucasian parents, but similar prevalence of OCD family history. Conclusions Clinically relevant differences were identified between Asians and Caucasians, highlighting the need for individualized care that respects the influences of ethnicity and race in pediatric OCD. Replication and future study of additional racial groups is warranted.

Background Body-Focused Repetitive Behaviors (BFRBs), including skin-picking, hair-pulling, and nail-biting, commonly occur in youth, even at elevated/problematic levels, and are associated with a number of other psychiatric symptoms. The present study examined the internal consistency of a brief screening tool for BFRBs as well as the prevalence, severity, and correlates of BFRBs in a sample of youth with a primary anxiety or obsessive-compulsive disorder (OCD). Methods Ninety-three youth-parent dyads presenting for treatment for anxiety or OCD completed study measures including the Repetitive Body Focused Behavior Scale — Parent (RBFBS), which includes subscales for skin-picking, hair-pulling, and nail-biting, as well as a number of additional clinician-, parent-, and child-rated scales. Results The RBFBS demonstrated good to excellent internal consistency. BFRBs were endorsed in 55% of youths, with elevated levels in 27%. Skin-picking was the most common BFRB (38%), followed by nail-biting (34%) and hair-pulling (4%). Youth with BFRBs, as compared to those without, were rated as more avoidant by their parents. Among those with BFRBs, more avoidant tendencies, anxiety sensitivity, and child-rated panic, separation, and generalized anxiety symptoms were associated with elevated BFRB severity. BFRBs were equally common but more likely to be elevated among youth with a primary anxiety, than OCD, diagnosis. Discussion Results provide initial support for the RBFBS as a brief screening tool for the three common BFRBs. In addition, the results suggest avoidant tendencies and physical manifestations of distress may be particularly relevant to the escalation of BFRB symptoms in youth.

Hoarding symptoms frequently emerge in early adulthood and can result in considerable impairments. Hoarding is related to many other psychological symptoms; however, greater study of hoarding within its context as an obsessive compulsive spectrum disorder, as well the role of attention-deficit/hyperactivity symptoms amongst these disorders, warrants investigation. As such, this study explored the extent and nature of hoarding symptoms, as well as their relationship with other psychopathology, in a college sample. Participants were 578 undergraduate students who completed a series of measures assessing the presence and severity of hoarding, anxiety, depression, stress, obsessive-compulsive, body dysmorphic, trichotillomania, skin picking, and attention-deficit hyperactivity symptoms. Independent samples t -tests did not detect significant differences in frequency of hoarding symptoms among men versus women, or those living alone versus with others; however, hoarding symptoms were significantly more common in individuals with a self-reported family history of hoarding. Correlational analyses found positive relationships between hoarding and all other symptom areas. Results from path analyses suggest that contrary to prior investigations, ADHD symptoms were not uniquely related to hoarding relative to anxiety and other obsessive-compulsive-spectrum pathology. This research may aid in developing a more thorough clinical profile of hoarding symptoms, potentially leading to more effective treatment strategies.

Background Youth with autism spectrum disorder (ASD) are frequently victimized. Acts of peer victimization of youth with ASD can lead to the development of detrimental and maladaptive behavioral problems. The purpose of this study is to examine the relationship between peer victimization and the psychological characteristics of youth with ASD. Method Study participants were 81 school-aged youth with ASD between the ages of 9 and 17 years and had an intelligence quotient (IQ) ≥ 70 and their parents. Participants completed questionnaires examining the frequency of peer victimization and clinical characteristics of the youth. Results Victimization had a significant positive relationship with child’s loneliness and anxiety and depressive symptoms, and a significant negative relationship with social skills. The relationship between victimization and these symptoms did not significantly vary as a function of social support. The relationship between victimization and social avoidance was not mediated by a fear of negative evaluation. Conclusions These results may assist in identifying risk factors for peer victimization in youth with ASD and may help to shape treatment protocols by targeting the associated factors of peer victimization (e.g., anxiety and depressive symptoms, social skill deficits).

Anxiety is a common and impairing condition in youth with autism spectrum disorders (ASD). Evidence supports the use of cognitive behavioral therapy for treating anxiety in this population; however, available treatment protocols may be difficult to implement outside of research settings. The present study examined the efficacy of family-based exposure-focused treatment (FET) compared to a treatment as usual (TAU) control in 32 youth aged 6–17 years with ASD and co-occurring anxiety. Fourteen youth were randomized to FET, which included 12 face-to-face weekly therapy sessions lasing 45–55 min, while 18 youth completed the TAU control where engagement in psychotherapy or pharmacotherapy was at the discretion of the families. Results strongly supported FET with a 79% (versus 0% in TAU) response rate, 86% (versus 0% in TAU) remission in primary anxiety diagnosis, and large between-group effects on clinician-rated anxiety severity and most parent-rated domains of anxiety-related impairment. Among treatment responders, 2-month follow-up supported maintenance of gains. Overall, the study supported FET as a relatively brief intervention for the treatment of anxiety in youth with ASD, although further research is needed to replicate these findings and compare FET outcomes to more comprehensive interventions.

Cognitive-behavioral therapy (CBT) for pediatric obsessivecompulsive disorder (OCD) is effective, although many individuals report they need continued support after completing treatment.Six monthly drop-in booster sessions were offered to 94 youth with OCD and their parents who previously had completed a 12-week group family-based CBT program (GF-CBT). This report describes program utilization rates and participant satisfaction levels.Twenty-three percent (n = 22) of invited youths with OCD attended ≥1 booster session; 63% of attendees participated in1 session. The mean number of attended sessions was 2.84 (standard deviation = 1.74). No significant group differences between booster attendees and non-attendees were found in terms of age, sex, ethnicity, parental education, or symptom severity at baseline or end of GF-CBT. Booster session attendees were more likely to have comorbidities than non-attendees (82% vs 58%; P = .045). Most participants were recent treatment completers (59%). Based on participant feedback, booster sessions were valuable, with perceived benefits related to peer interaction and support, skills review, and homework development.Cognitive-behavioral therapy booster sessions for pediatric OCD seem to be an acceptable approach that a significant percentage of recent treatment completers would utilize. Further research is needed to examine program efficacy and to draw conclusions about key program features.

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.

Objective Parental reactions to, involvement with, and impairment from, pediatric OCD are highly relevant to the disorder's manifestation and treatment. Method Examining a host of family OCD-specific (e.g., severity, accommodation, functioning) and non-OCD-specific (e.g., family dynamics, parent capacity, parent psychopathology) variables in a sample of 243 family triads (youth, mothers, fathers) of OCD-affected youth (5–19 years old; 57% female), dependent mixture modeling was utilized to identify latent family presentation profiles. Relationship between profiles and response to group family-based cognitive behavioral therapy (CBT) was explored in a sub-sample (n = 123). Results Results supported a four-profile solution: A) Low Impact (n = 28; 12%) characterized by low OCD-specific and non-specific impacts; B) Relational Impact (n = 68; 28%) characterized by notable disruptions in family dynamics; C) OCD Impact (n = 65; 27%) characterized by high OCD-specific impacts; and D) Dual Impact (n = 82; 34%) characterized by high OCD-specific impacts and disruptions in family dynamics. All four profiles demonstrated improvement with family-based CBT and response did not significantly differ across groups. Conclusions Four distinct profiles of OCD-affected families were identified. These profiles highlight differential OCD impact, family responses, and disruption. In the future, they may prove useful in informing treatment direction.

Emetophobia is an under-researched disorder characterized by a specific fear of vomiting. There is a paucity of research on this impairing condition, with extant examinations being largely limited to adult samples and online communities. The present study examined the incidence, phenomenology, and correlates of emetophobia in 305 Salvadorian youths. Caregivers completed a battery of questionnaires regarding the youth's symptoms of emetophobia, internalizing/externalizing symptoms, health anxiety, and obsessive-compulsive symptoms. Approximately 7.5 % of the sample was elevated on emetophobia symptoms, and higher levels of emetophobia symptoms were correlated with higher levels of internalizing, externalizing, health anxiety, and obsessive-compulsive symptoms, and lower levels of adaptive functioning. Youths meeting the cutoff for elevated emetophobia symptoms versus those who did not demonstrated significantly higher levels of externalizing behaviors, as well as general obsessive-compulsive symptoms, especially doubting/checking and neutralizing behaviors. These findings are hoped to help improve the conceptualization and treatment of this poorly understood disorder.

Insight in obsessive-compulsive disorder (OCD) refers to patients' recognition that their obsessions and compulsions are symptoms rather than necessary or natural thoughts and behaviors.1 It has been estimated that 20% to 45% of youth with OCD exhibit poor or absent insight.2-4 Identified correlates of poor insight include younger age,2,3,5,6 increased OCD severity,2,4,7 impairment,4,7,8 and family accommodation2,4; lower intellectual and adaptive functioning3; and greater depressive symptoms.2,3 Poorer insight has also been associated with reduced response across treatment groups (ie, selective serotonin reuptake inhibitor [SSRI], cognitive behavioral therapy [CBT], combined SSRI plus CBT, or pill placebo).9.

Obsessive-compulsive disorder (OCD) is a prevalent and debilitating illness that often begins in childhood and has a significant impact on the functioning of youth and their families. Given that schooling represents a considerable portion of youth's lives and is a key contributor to their development, identifying impacts of OCD on school performance is important.The present study evaluated academic skill differences in OCD-affected youth age 7 to 18 (n = 25) compared with matched healthy controls (HCs; n = 25), as captured via standardized testing. Analysis of variance was used to examine group effects on the outcome variables.In comparison with HCs, OCD-affected youth presented with significantly poorer performance in math calculation (P = .029), although mean scores fell in the normative range. Thirty-six percent of the OCD group were in the Below Average range, compared with 12% of the HCs (P = .047). There were no significant between-group differences in word reading or spelling. Academic skills were not associated with symptom severity.Findings suggest that underperformance in math may be present in a higher-than-expected proportion of OCD-affected youth. Further studies of academic skills are warranted to replicate the current findings and to examine roles of academic enhancers in this vulnerable population.

Following an appropriate course of evidence-based treatment for tics, whether psychosocial or pharmaceutical in nature, clinicians face difficult decisions about next steps. Therefore this chapter focuses on the challenges that relate to end of the treatment decisions. First, an overview is provided regarding information important to this process. Second, guidance is provided on end-of-treatment decisions as they relate to youth who have not demonstrated an adequate treatment response and/or those who continue to have impairing symptoms despite initial response. This includes discussions around strategy variation, identifying, and addressing factors associated with poor adherence, medication side effects, problematic comorbid symptoms, severity of tics, alternative conceptualizations, and alternative treatment options. Third, relapse prevention strategies are presented including how they relate to maintaining behavior management gains, medication management postresponse, and maintaining quality-of-life gains. Finally, conclusions and areas of continued research are presented.

Tic disorders commonly occur among youth and are characterized by the presence of sudden and repetitive body movements and/or vocalizations. Tics range in location (e.g., face, legs) and complexity (e.g., eye blinks, humming, multistep movements, phrases). Typically, tics onset early in childhood (i.e., ages 5–8), peak in severity and prevalence in preadolescence (i.e., ages 10–12), and begin to decline during adolescence. Only a small percentage of youth (around 20%) continue to have moderate or severe tics in adulthood.

Body-focused repetitive behaviors (BFRBs; e.g., hair pulling, skin picking, and nail biting) can cause significant physical and psychological distress. However, data examining BFRBs in non-clinical youth is limited. This study examined parent-reports of the incidence and clinical correlates of BFRBs in 315 Salvadorian children (4–17 years). Forty-six percent had at least one BFRB; nail biting was commonly reported (34.6%), followed by skin picking (24.8%), and hair pulling (10.5%). Of those endorsing BFRBs, 13.7% reported elevated distress and/or interference due to these behaviors, including approximately one-third of skin pickers and hair pullers (8.3% and 2.9% of the total sample) and one-fifth of nail biters (7.3% of the total sample). Skin pickers and hair pullers, but not nail biters, had higher levels of internalizing and externalizing behaviors, poorer adaptive functioning, and more difficulties with inattention, compared to those who reported no BFRBs. Skin picking symptom severity was positively correlated with externalizing and internalizing behaviors. Nail biting symptom severity was associated with increased internalizing symptoms, while severity of hair pulling was not significantly associated with behavioral and emotional functioning. These data suggest that BFRBs are commonplace and may be associated with behavioral and emotional functioning.

The present study examined perceptions of mental health care amongst a group of parents presenting to a children’s museum in El Salvador. A total sample of 311 guardians completed a set of questionnaires focused on suitability of treatment approaches, barriers to obtaining care, and mental health attitudes. Results suggested positive mental health attitudes (i.e., low stigma, positive help-seeking attitudes and intentions), high approval for self-reliant methods of treating mental health problems (e.g., pull oneself together, physical exercise, and relaxation), and perception of barriers to treatment as, on average, likely to be a moderate problem in attempts to obtain care. Psychotherapy was also rated favorably; however, use of psychiatric medication was rated largely unfavorable along with other ingestive strategies (e.g., drinking alcohol, taking alternative medicine). Approval of psychotherapy was associated with past obtainment of such services, lower levels of stigma, and more positive help-seeking attitudes. Overall, individuals in El Salvador appear open to mental health treatment for their children, but may prefer self-reliant methods of solving mental health problems or believe obtaining care will be too difficult. Continued understanding of perceptions of mental health care treatment may aid in improving the quality of mental health care treatment available and obtained for individuals in El Salvador and other nations.

Few randomized controlled trials (RCTs) exist examining the efficacy of behavior therapy (BT) or serotonin reuptake inhibitors (SRIs) for the treatment of trichotillomania (TTM), with no examination of treatment moderators. The present meta-analysis synthesized the treatment effect sizes (ES) of BT and SRI relative to comparison conditions, and examined moderators of treatment. A comprehensive literature search identified 11 RCTs that met inclusion criteria. Clinical characteristics (e.g., age, comorbidity, therapeutic contact hours), outcome measures, treatment subtypes (e.g., SRI subtype, BT subtype), and ES data were extracted. The standardized mean difference of change in hair pulling severity was the outcome measure. A random effects meta-analysis found a large pooled ES for BT (ES = 1.41, p < 0.001). BT trials with greater therapeutic contact hours exhibited larger ES (p = 0.009). Additionally, BT trials that used mood enhanced therapeutic techniques exhibited greater ES relative to trials including only traditional BT components (p = 0.004). For SRI trials, a random effects meta-analysis identified a moderate pooled ES (ES = 0.41, p = 0.02). Although clomipramine exhibited larger ES relative to selective serotonin reuptake inhibitors, the difference was not statistically significant. Publication bias was not identified for either treatment. BT yields large treatment effects for TTM, with further examination needed to disentangle confounded treatment moderators. SRI trials exhibited a moderate pooled ES, with no treatment moderators identified. Sensitivity analyses highlighted the need for further RCTs of SRIs, especially among youth with TTM.

The present study explored the concept of tolerance for child distress in 46 children (ages 5–8), along with their mothers and fathers, who received family-based CBT for OCD. The study sought to describe baseline tolerance, changes in tolerance with treatment, and the predictive impact of tolerance on symptom improvement. Tolerance was rated by clinicians on a single item and the CY-BOCS was used to measure OCD severity. Descriptive results suggested that all participants had some difficulty tolerating the child’s distress at baseline while paired t-tests indicated large improvements were made over treatment (d = 1.2 – 2.0). Fathers’ initial tolerance was significantly related to symptom improvement in a multivariate regression as were fathers’ and children’s changes in distress tolerance over the course of treatment. Overall, results provide support for examining tolerance of child distress including its predictive impact and potential as a supplemental intervention target.

This open, uncontrolled study examined the efficacy of a group family-based cognitive behavioral therapy (GF-CBT) protocol in treating pediatric obsessive-compulsive disorder (OCD) and explored predictors of symptom improvement. Eighty-five OCD-affected youth aged 8-18 years (M = 13.9 years, SD = 2.49; 46% male) and their parent(s) participated in a weekly, 12-session GF-CBT program. Data from multiple perspectives were gathered at the beginning and end of treatment, as well as at one-month follow-up. A broad range of assessment measures were utilized to capture clinically-relevant domains and a number of potential predictor variables were explored. Paired t-tests indicated that treatment was associated with significant reductions in clinician- and parent-rated OCD severity (d = 1.47, 1.32), youth and parent-rated functional impairment (d = 0.87, 0.67), coercive/disruptive behaviors (d = 0.75), and family accommodation (d = 1.02), as well as improvements in youth-, mother-, and father-rated family functioning (d = 1.05, 0.50, 0.88). Paired t-tests also indicated that youth remained improved at one-month follow-up. Step-wise regression identified greater homework success as a significant predictor of symptom improvement. This study provides evidence that GF-CBT significantly improves a wide range of domains for youth/families that extends beyond OCD symptom severity and supports homework as a core treatment component.

Cognitive-behavioral therapy for anxiety in youth with an autism spectrum disorder appears efficacious; however, maintenance of treatment gains has not yet been studied. Using a sample of 32 youth who had benefited at least minimally from a past trial of cognitive-behavioral therapy for anxiety in autism spectrum disorder, this study assessed anxiety symptoms in youth 10–26 months following treatment completion. Compared to baseline, follow-up scores were associated with large effects for treatment. Relative to post-treatment, a small effect for return in symptoms was present and significantly fewer individuals were rated as responders at follow-up. Future studies should investigate factors associated with poor treatment maintenance and modifications or additions to treatment that may help maintain treatment gains.

Empirical support exists for behaviorally oriented psychosocial interventions to reduce functional impairment related to autism spectrum disorder (ASD) symptoms in young children, but little research exists examining the effectiveness of such treatments when applied to preschool-aged children with comorbid anxiety symptoms. With this in mind, the authors report on the case of “Marcus,” a 4-year-old boy with autistic disorder and impairing comorbid anxiety. Marcus participated in 8 weekly sessions of family-based cognitive-behavioral therapy, addressing his fear-based avoidance of social interactions and sensory stimuli, using an anxiety treatment protocol for youth with ASD modified to account for his young age. This protocol consisted of modular components addressing affective education, exposure, cognitive restructuring, and social coaching. At post-treatment assessment, Marcus exhibited markedly decreased impairment, as evidenced by parent responses to clinical interview and rating scales. In addition, Marcus displayed improvement in severity of anxiety symptoms as illustrated by a decrease in his scores on the Pediatric Anxiety Rating Scale from 17 at baseline to 8 at post-treatment. Therapeutic gains were maintained at 4-month follow-up. Implications and clinical considerations are discussed.

Treatment worries, which surround requirements and results of obtaining treatment, may represent an important construct; however, previous measures were limited by their specificity, format, and lack of parent report. Therefore the present study examined the initial outcomes and psychometrics of corresponding measures of treatment worries in youth (Treatment Worries Questionnaire - Child; TWQ-C) and their parents (Treatment Worries Questionnaire - Parent; TWQ-P). Participants were 94 youth (7-17-years old) and parent dyads presenting for treatment of an anxiety disorder. Dyads completed the TWQ-C and TWQ-P along with additional measures prior to initiating treatment. Treatment worries were endorsed in the mild-moderate range by youth and the TWQ-C demonstrated good-excellent internal consistency, a three-factor structure, and consistent convergent and divergent relationships. Treatment worries were endorsed in the low-mild range by parents and the TWQ-P demonstrated fair-good internal consistency, a four-factor structure, and consistent divergent relationships, but variable (by factor) convergent relationships. The results provide information on treatment worries and support the use of the TWQ-C and TWQ-P as broad assessments of the concept. Low endorsement of worries among parents likely relates to the treatment-seeking nature of the sample. Future investigations using the TWQ-C and TWQ-P in a variety of samples is warranted.

The Pediatric Obsessive-Compulsive Disorder Treatment Study II (POTS II) investigated the benefit of serotonin reuptake inhibitor (SRI) augmentation with cognitive behavioral therapy (CBT). Primary outcomes focused on OCD symptom change and indicated benefit associated with a full course of CBT. Given that the majority of youth with OCD suffer from significant comorbid symptoms and impaired quality of life, the current study examined POTS II data for effects on secondary outcomes. Participants were 124 youth ages 7–17 years with a primary diagnosis of OCD who were partial responders to an adequate SRI trial. Participants were randomized to medication management, medication management plus instructions in cognitive behavioral therapy (CBT), or medication management plus full CBT. Acute effects on non-OCD anxiety, depression, inattention, hyperactivity, and quality of life were examined across treatment conditions. Improvement across treatment was observed for non-OCD anxiety, inattention, hyperactivity, and quality of life. Changes were generally significantly greater in the group receiving full CBT. Child-rated depression was not found to change. OCD-focused treatment lead to improvement in other areas of psychopathology and functioning. For youth who are partial responders to SRI monotherapy, augmentation with full CBT may yield the greatest benefit on these secondary outcomes. Clinical trials registration Treatment of Pediatric OCD for SRI Partial Responders, Clinicaltrials.gov Identifier: NCT00074815, http://clinicaltrials.gov/show/NCT00074815 .

SUMMARY: Chronic tic disorders (CTDs) are a category of movement disorders, including Tourette's syndrome, that typically onset in youth and can be associated with a wide range of topography, complexity, severity and co-occurring conditions. We present an overview of evidence-based recommendations on the assessment and management of CTD for healthcare professionals. In particular, the following article focuses on the assessment and differential diagnosis of CTDs from other movement or psychiatric conditions, pharmacological and behavioral treatments of CTDs, as well as considerations and recommendations for treatment decisions for CTDs.

Clinically significant anxiety affects many youth with autism spectrum disorders (ASD) and is associated with a number of functional consequences. Building from treatment approaches of anxiety in typically developing populations, pharmacological and psychotherapeutic approaches to treating anxiety in ASD are being increasingly examined. Despite being commonly prescribed, there is limited empirical support beyond open trials and case series at present for the use of antidepressants or anxiolytics in the treatment of anxiety for youth with ASD. A modest body of evidence exists supporting the application of a modified form of cognitive-behavioral therapy, with associated reductions in anxiety and some core autism improvements. Further research, refinement and replication is needed to establish the efficacy of treatment approaches for anxiety in youth with ASD, what treatment component(s) are most appropriate for which patients, what factors may play an integral role in treatment outcomes, and whether treatments result in durable and generalizable gains.

Family accommodation in obsessive-compulsive disorder (OCD) is characterized by myriad behaviors, such as modifying family routines, facilitating avoidance, and engaging in compulsions to reduce obsessional distress. It has been linked to various deleterious outcomes including increased functional impairment and poorer treatment response for OCD. Although extant literature suggests a linear relationship between family accommodation and OCD symptom severity, the magnitude and statistical significance of this association has been inconsistent across studies, indicating that moderators may be influencing this relationship. The present study examined this relationship using meta-analytic techniques, and investigated sample-dependent (age, gender, comorbid anxiety/mood disorders) and methodological (administration method and number of items used in family accommodation measure, informant type, sample size, publication year) moderators. Forty-one studies were included in the present meta-analysis, and the overall effect size (ES) for the correlation between family accommodation and OCD symptom severity was moderate (r=.42). Moderator analyses revealed that the number of items on the family accommodation scale moderated the ES. No other sample-dependent or methodological characteristics emerged as moderators. In addition to being the first systematic examination of family accommodation moderators, these results highlight the moderate relationship between family accommodation and OCD severity that is influenced by measurement scales. Findings may be used to guide clinical care and inform future investigations by providing a more nuanced understanding of family accommodation in OCD.

Objective While individual trials suggest benefit of interventions for excoriation (skin-picking) disorder (ExD), limited systematic evaluation of treatments, or their collective benefit, exists. Methods The present study examined the current state of treatments for ExD in a systematic review and meta-analysis and explored potential treatment moderators. Twelve trials were identified for review, including five with a control condition. Of these, nine were eligible to be included in the meta-analysis (three with a control). Results A fixed-effects meta-analysis found a large overall treatment effect size ( g =1.13), comprised of large effects for behavioral treatments ( g =1.19), lamotrigine ( g =0.98) and selective serotonin reuptake inhibitors ( g =1.09). Clinician-rated measures did not significantly differ from self-rated measures; however, larger effects were observed on self-rated measures of severity, as compared to impairment [Q(1)=4.63, P =.03]. Treatment type, trial length and trial methodological quality were not significant moderators. For controlled trials, the comparative efficacy of treatments for ExD was in the moderate range ( g =0.47). Conclusion Findings suggest that treatment for ExD has benefit; however, the meta-analysis did not provide strong evidence to support any specific treatment or to suggest its unique clinical benefit over control conditions. Overall, there is a lack of study on treatments for ExD and additional randomized controlled trials with inclusion of multiple informants in assessment is needed.

Although there are efficacious, evidence-based treatments for anxiety disorders, youth often experience delays in seeking therapy. Myriad reasons may contribute to this lag in treatment initiation, with some youth possessing concerns about therapy. Treatment concerns are broadly characterized by worries/ambivalence about seeking treatment, including concerns about the negative reactions, consequences, and inconvenience of treatment. As no studies exist for youth with anxiety disorders, this study examined the phenomenology of treatment concerns in 119 treatment-seeking, anxious youth and utilized a structural equation model to examine the relationship between child anxiety, depressive symptoms, treatment concerns, and anxiety-related functional impairment. Over 90 % of the children positively endorsed some type of treatment-related fear, with the most frequently expressed concern being that therapy would take too much time (50.4 %). Based on the model, both child anxiety and depressive symptoms predicted functional impairment, and treatment concerns mediated the relationship between child anxiety and functional impairment.

This study reports an open trial of family-based cognitive-behavioral therapy (CBT) in children and adolescents with obsessive-compulsive disorder (OCD) exhibiting an onset pattern consistent with pediatric acute-onset neuropsychiatric syndrome (PANS).Eleven primarily Caucasian youth with PANS-related OCD (range=4-14 years; 6 boys) who were incomplete responders to antibiotic treatment, received family-based CBT delivered either face-to-face or via web camera.All participants completing treatment (8 of 8) were considered improved at posttreatment, and average obsessive-compulsive symptom severity was reduced by 49%. Significant reductions in obsessive-compulsive symptom severity and in clinician- and parent-rated OCD-related impairment were noted. Reductions in parent- and child-rated anxiety, child-rated OCD-related impairment, and comorbid neuropsychiatric symptoms were not statistically significant.Gains were maintained at follow-up, with 100% (6 of 6) of those assessed remaining improved. Implications for treatment and further research are discussed.

Cognitive-behavioral therapy (CBT) has been developed and modified to treat anxiety symptoms in youth with high-functioning autism spectrum disorders (ASD) but has yielded varying findings. The present report is a systematic review and meta-analysis examining the efficacy of CBT for anxiety among youth with ASD. A systematic search identified 14 studies involving 511 youth with high-functioning ASD. A random effects meta-analysis yielded a statistically significant pooled treatment effect size (g) estimate for CBT (g = −0.71, p

Few studies have examined the phenomenology of obsessive–compulsive disorder (OCD) in younger children. A sample of 292 treatment seeking youth with a primary diagnosis of OCD was divided into the young child (3–9 years old) and older child (10–18 years old) groups. Overall OCD severity did not differ between groups. However, older youth demonstrated stronger intensity of obsessive and compulsive symptoms, while younger children were rated as having less resistance and control of compulsions. Older youth exhibited increased occurrence of comorbid depression, and an increased occurrence of sexual, magical thinking, and somatic obsessions, as well as, checking, counting and magical thinking compulsions. Conversely, the group of younger children exhibited significantly poorer insight, increased incidence of hoarding compulsions, higher rates of comorbid attention deficit/hyperactivity disorder, disruptive behavior, and parent-rated anxiety, and more frequently exhibited hoarding compulsions. These differences suggest domains to consider when screening for OCD among younger/older pediatric cohorts.