Quality of life and burden in caregivers of youth with obsessive-compulsive disorder presenting for intensive treatment.

BACKGROUND: Pediatric obsessive-compulsive disorder (OCD) is associated with deleterious familial effects; caregivers are often enmeshed in the disorder and can experience considerable burden and decreased quality of life (QoL). Consequently, this study examined burden and QoL in caregivers of youth with OCD enrolled in an intensive outpatient or partial hospitalization program. METHOD: The relationships between caregiver QoL and burden and the following variables were investigated: OCD symptom severity, functioning (youth functional impairment, general family functioning), family (family accommodation, parental relationship satisfaction, positive aspects of caregiving), and comorbid psychopathology (caregiver anxiety and depressive symptoms, youth internalizing and externalizing behaviors). Seventy-two child and caregiver dyads completed clinician- and self-rated questionnaires. RESULTS: Components of caregiver QoL correlated with caregiver-rated functional impairment, family accommodation, youth externalizing behaviors, and caregiver psychopathology. Aspects of caregiver burden correlated with child OCD symptom severity, functional impairment related to OCD, as well as caregiver and child comorbid psychopathology. Caregiver depressive symptoms predicted caregiver QoL, and caregiver depressive symptoms and child externalizing symptoms both predicted caregiver burden. Caregiver burden did not mediate the relationship between obsessive-compulsive symptom severity and caregiver QoL. CONCLUSION: Ultimately, elucidating factors associated with increased caregiver burden and poorer QoL is pertinent for identifying at-risk families and developing targeted interventions.

Black and White Parents' Willingness to Seek Help for Children's Internalizing and Externalizing Symptoms.

OBJECTIVE: Understanding social and environmental factors that contribute to parental help-seeking intentions is an important step in addressing service underutilization for children in need of treatment. This study examined factors that contribute to parents' intentions to seek formal and informal help for child psychopathology (anxiety and attention-deficit/hyperactivity disorder [ADHD]). METHOD: A total of 251 parents (N = 128 mothers, N = 123 fathers; 49% Black, 51% White) read 3 vignettes describing children with anxiety, ADHD, and no diagnosis. Measures of problem recognition, perceived barriers, and formal (pediatricians, psychologists, teachers) and informal (religious leaders, family/friends, self-help) help seeking were completed. Four separate hierarchical logistic regression models were used to examine parental help-seeking likelihood from formal and informal sources for internalizing and externalizing symptoms. Predictors were socioeconomic status, parent race, age, and sex, parent problem recognition (via study vignettes), and perceived barriers to mental health service utilization. RESULT: Mothers were more likely than fathers to seek help from pediatricians, psychologists, teachers, and religious leaders for child anxiety and pediatricians, religious leaders, and self-help resources for child ADHD. Black parents were more likely to seek help from religious leaders and White parents were more likely to use self-help resources. Problem recognition was associated with greater intentions to seek help from almost all formal and informal sources (except from friends/family). CONCLUSION: Understanding factors that contribute to parental help seeking for child psychopathology is critical for increasing service utilization and reducing the negative effects of mental health problems. This study highlights the importance of decreasing help-seeking barriers and increasing problem recognition to improve health equity.

FEAR CONDITIONING AND EXTINCTION IN YOUTH WITH OBSESSIVE-COMPULSIVE DISORDER.

BACKGROUND: Fear acquisition and extinction are central constructs in the cognitive-behavioral model of obsessive-compulsive disorder (OCD), which underlies exposure-based cognitive-behavioral therapy (CBT). Youth with OCD may have impairments in fear acquisition and extinction that carry treatment implications. We examined these processes using a differential conditioning procedure. METHODS: Forty-one youth (19 OCD, 22 community comparisons) completed a battery of clinical interviews, rating scales, and a differential conditioning task that included habituation, acquisition, and extinction phases. Skin conductance response (SCR) served as the primary dependent measure. RESULTS: During habituation, no difference between groups was observed. During acquisition, differential fear conditioning was observed across participants as evidenced by larger SCRs to the CS+ compared to CS-; there were no between-group differences. Across participants, the number and frequency of OCD symptoms and anxiety severity was associated with greater reactivity to stimuli during acquisition. During extinction, a three-way interaction and follow-up tests revealed that youth with OCD showed a different pattern of SCR extinction compared to the community comparison group. CONCLUSIONS: Youth with OCD exhibit a different pattern of fear extinction relative to community comparisons. This may be attributed to impaired inhibitory learning and contingency awareness in extinction. Findings suggest the potential benefit of utilizing inhibitory-learning principles in CBT for youth with OCD, and/or augmentative retraining interventions prior to CBT to reduce threat bias and improve contingency detection.

Child problem recognition and help-seeking intentions among black and white parents.

Parents play a central role in utilization of mental health services by their children. This study explored the relationship between parents' recognition of child mental health problems and their decisions to seek help. Participants included 251 parents (49% Black, 51% White; 49% fathers, 51% mothers) recruited from community settings. Parents ranged in age from 20 to 66 years old with at least one child between ages 2 and 21. Parents read three vignettes that described a child with an anxiety disorder, ADHD, and no clinically significant diagnosis. Parents completed measures of problem recognition, perception of need, willingness to seek help, and beliefs about causes of mental illness. Findings from Generalized Estimating Equations revealed that parents were more likely to report intentions to seek help when they recognized a problem (odds ratio [OR] = 41.35, p < .001), 95% confidence interval (CI) [14.81, 115.49]; when it was an externalizing problem (OR = 1.85, p < .05), 95% CI [1.14, 3.02]; and when parents were older (OR = 1.04, p < .05), 95% CI [1.01, 1.08]. Predictors of parental problem recognition included perceived need, prior experience with mental illness, and belief in trauma as a cause of mental illness. Predictors of help-seeking intentions included problem recognition, perceived need, externalizing problem type, and being female. Given the relationship between parental problem recognition and willingness to seek help, findings suggest that efforts to address disparities in mental health utilization could focus on problem-specific, gender-sensitive, mutable factors such as helping parents value help-seeking for internalizing as well as externalizing problems.

Parental Descriptions of Childhood Avoidance Symptoms after Trauma.

Recognizing and diagnosing the avoidance symptom cluster of posttraumatic stress disorder (PTSD) in young children has been challenging. This study examines caregivers' descriptions of young children's avoidance reactions. By describing parents' examples of childhood avoidance, clinicians, researchers, and educators may be able to provide more specific psychoeducation which may improve identification of avoidance behaviors in young children. Caregivers (N=73) of young children (age 3-7 years) participated in a semi-structured diagnostic clinical interview prior to enrolling in a clinical trial for childhood trauma. The assessment regarding the caregiver's description of the child's avoidance was audio recorded and transcribed for a thematic analysis. Most caregivers reported that the child experienced avoidance. Avoidance of conversation and places were the most reported type of child avoidance. Other types of avoidance included avoiding people, things, interpersonal situations, and activities. Some caregivers thought that their child avoided thoughts and feelings, but other caregivers were unsure if their child was avoiding these types of private experiences. Caregiver avoidance and non-avoidance also emerged as a main theme. Diagnosis for PTSD in young children relies on accurate symptom identification. Current results provide insight into how caregivers describe avoidant reactions in their children which may help professionals with accurate diagnoses, as well as help caregivers become better reporters themselves.

Parenting, coparenting, and adolescent adjustment in African American single-mother families: An actor-partner interdependence mediation model.

This study examined family processes on the adjustment of adolescents from single-mother households using a dyadic approach. Participants included 107 noncohabiting Black parental dyads of adolescents aged 12 to 18 years. Each parent completed measures of positive parenting, parent-child relationship quality, parental depressive symptoms, coparenting relationship quality, and adolescent adjustment. Data were analyzed using the actor-partner interdependence model (APIM) and extended mediational model (APIMeM) within a structural equation modeling framework. APIM demonstrated significant actor effects from parent-child relationship quality and parental depressive symptoms to both adolescent externalizing and internalizing problems as well as significant partner effects from parent-child relationship quality to adolescent externalizing problems for both mothers and fathers. Additionally, APIMeM revealed significant indirect actor and partner effects from parent-child relationship quality to externalizing behavior through one's own and one's coparent's coparenting relationship quality for both parents. Indirect actor effects were also observed from positive parenting to externalizing behavior through one's own perception of coparenting relationship quality for both parents. Both APIM and APIMeM models found a significant gender difference for the direct effect from positive parenting to externalizing problems. Specifically, the association was negative for mothers in both models; whereas it was nonsignificant (APIM) and positive (APIMeM) for fathers. This study highlights the unique contributions of mother's and father's parent and coparent factors on one's own, and one's coparent's, perception of adolescent adjustment. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Fathers' role in the etiology, prevention and treatment of child anxiety: a review and new model.

Fathers have been neglected in investigations of the development, prevention, and treatment of anxiety and anxiety disorders in children and adolescents. This review provides a historical background of what is known about fathers' roles in the etiology of anxiety problems and provides evidence from bottom-up, top-down, and cross-sectional correlation studies of the connections between fathers' and their children's anxiety. Treatment and prevention programs are discussed in terms of the limited findings regarding fathers' involvement in treatment for children's and adolescents' anxiety problems. Finally, a model is presented to show the unique ways in which mothers and fathers are involved in the development of anxiety disorders in their children. Future directions for research in this area are highlighted.

Fathers' ratings in the assessment of their child's anxiety symptoms: a comparison to mothers' ratings and their associations with paternal symptomatology.

We examined the comparability between mothers' and fathers' ratings in the assessment of their child's anxiety symptoms. The sample consisted of 78 youth (6 to 17 years) and their mothers and fathers who presented to a childhood anxiety disorders specialty research clinic. Using intraclass correlation coefficients, mother?father agreement of their child's anxiety symptoms was found to be moderate. Mean differences between mothers' and fathers' ratings of their child's anxiety were not significantly different. Both maternal and paternal self-ratings of psychopathology predicted respective ratings of their child's anxiety. Although either mothers or fathers can provide useful information, use of multiple informants is encouraged, especially when parental psychopathology is present. Additional implications and suggestions for future research are discussed.

The Treatment Worries Questionnaire: Conjoined measures for evaluating worries about psychosocial treatment in youth and their parents.

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 role of anxiety sensitivity in the relationship between posttraumatic stress symptoms and negative outcomes in trauma-exposed adults.

BACKGROUND: The development of posttraumatic stress symptoms (PTSs) following a trauma is related to impairment, diminished quality of life, and physical health issues. Yet it is not clear why some trauma-exposed individuals experience negative outcomes while others do not. The purpose of this study was to determine the role of several influential factors related to PTS severity and negative outcomes. METHODS: One hundred and twenty-two trauma-exposed adults were administered the following self-report measures: the Posttraumatic Stress Disorder Checklist-Civilian, the Trauma History Questionnaire-Short, the Anxiety Sensitivity Index-3, Depression and Anxiety Stress Scale 21, Sheehan Disability Scale, World Health Organization Quality of Life-BREF, and an abbreviated Patient Health Questionnaire. PRIMARY RESULTS: PTS severity was positively correlated with depressive symptom severity (r = 0.54, p < 0.001), chronicity of the most distressing trauma (r = 0.21, p = 0.017), and number of traumas (r = 0.22, p = 0.012). Main effects were found for PTS severity (ß = -0.38, p < 0.01) and anxiety sensitivity (AS; ß = -0.39, p < 0.01) on quality of life. No interaction was found between PTS severity and AS with any negative outcome. PTS severity mediated the relationship between AS and physical health issues (0.05; 95% CI: 0.02-0.08). CONCLUSION: This study helps clarify the role of various factors in the relationship between trauma and negative outcomes. Clinical and research implications are discussed.

A meta-analysis of family accommodation and OCD symptom severity.

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.

Psychometric properties of the Family Accommodation Scale for Obsessive-Compulsive Disorder-Patient Version.

In obsessive-compulsive disorder (OCD), family accommodation is a frequently occurring phenomenon that has been linked to attenuated treatment response, increased obsessive-compulsive symptom severity, and lower levels of functioning. No patient-report version of family accommodation exists, with available measures relying on relatives as informants. However, adult patients with OCD often present to clinical services alone, frequently making it impractical to obtain information from these informants. Consequently, a standardized patient-reported measure of family accommodation proves salient in clinical practice. The present study examined the psychometric properties of the Family Accommodation Scale for Obsessive-Compulsive Disorder-Patient Version (FAS-PV). Sixty-one adults with OCD were administered clinician-rated measures of OCD symptom severity and self-report questionnaires examining functional impairment, family functioning, and emotional/behavioral difficulties. Fifty-four relatives completed self-report measures assessing family accommodation and family functioning. The majority of the adult OCD participants (89%) endorsed at least 1 type of accommodating behavior in the previous week. The FAS-PV total score demonstrated good internal consistency and test-retest reliability. Convergent validity was evidenced by strong associations with scores on another measure of family accommodation, OCD symptom severity, OCD-related family functioning, anxiety, and functional impairment. Divergent validity was supported through nonsignificant correlations with depressive symptoms and impulsivity. The FAS-PV did not significantly differ from the relative-reported measure of family accommodation in terms of the internal consistency or mean of the total scores. Ultimately, the FAS-PV scores demonstrated sound psychometric properties and validity in assessing family accommodation from the patient's perspective, encouraging its use in research and clinical practice.

Still looking for Poppa.

In 1992, V. Phares published an article titled "Where's Poppa?: The Relative Lack of Attention to the Role of Fathers in Child and Adolescent Psychopathology". Since that time, there have been modest gains in the research literature on clinical child issues, but there remains a wide gap between the inclusion of mothers and fathers in clinical child and family research. To provide an update of this issue for the field of developmental psychopathology, the authors of this comment conducted an updated review and analysis of the research on fathers and developmental psychopathology. These current data were compared with the data from the Phares and Compas (1992) study. It was found that there continues to be a dearth of research on fathers and developmental psychopathology.

Coping with parental loss because of termination of parental rights.

This article addresses the process by which children and adolescents cope with severe acute stress of parental loss from causes other than divorce or death. Participants were 60 children and adolescents from a residential treatment facility. Most had experienced neglect, physical abuse, and sexual abuse, and their parents had their parential rights terminated. Measures of symptomatology indicated that children reported low levels of depressive symptoms, whereas caregivers reported the children were experiencing significant psychological problems. Children used avoidant coping strategies more often than emotion-focused coping strategies, which, in turn, were used more than problem-focused coping strategies. Results are discussed in terms of helping children cope with parental loss.

Cognitive-behavioral therapy for anxiety in youth with an autism spectrum disorder: A follow-up study.

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.

Cross-informant ratings of social competence in children and adolescents.

The cross-informant ratings of social competence displayed by children and adolescents were investigated in a meta-analytic study. Effect sizes from 74 studies containing the ratings of the social competence of children and adolescents from at least two different informants were included in this meta-analysis. Results indicated that studies investigating the correspondence of the child or adolescent's own report with the report of parent, teacher, or peer informants had average effect sizes that were small in magnitude. The average effect sizes of other types of cross-informant pairs (e.g., parent-teacher) were moderate in magnitude, with teachers and peers demonstrating the greatest correspondence. Potential moderators (e.g., the type of measure completed by the informants, the age and gender of the target child or adolescent, and the location of the assessment) were also examined. These results demonstrate the importance of selecting carefully informants when evaluating the social competence of children and adolescents.

Inter-rater Reliability of the Anxiety Disorders Interview Schedule for DSM-IV in High-Functioning Youth with Autism Spectrum Disorder.

The present study examined inter-rater agreement on the Anxiety Disorder Interview Schedule DSM-IV Child and Parent Interview (ADIS-IV-C/P) in high-functioning youth with autism spectrum disorder and if age and ASD diagnosis moderated agreement. Diagnoses established for 70 7 to 16-year-old youth with ASD during a live administration of the ADIS-IV-C/P were compared to diagnoses identified by a second rater after listening to audiotaped recordings of the interviews. Clinician-to-clinician agreement on individual parent and child reports was excellent (k=1.00). Inter-rater agreement on principal diagnoses (k=0.91), individual anxiety diagnoses (k=0.85-0.97), and other comorbid diagnoses (i.e., major depressive disorder, dysthymia, oppositional defiant disorder) (k=0.89-1.00) were excellent; agreement did not differ as a function of ASD diagnosis or age. Results suggest good to excellent inter-rater agreement for disorders assessed by the ADIS-IV-C/P.

Psychometric properties of the Connor-Davidson Resilience Scale 10 among low-income, African American men.

The Connor-Davidson Resilience Scale 10 (CD-RISC 10; Campbell-Sills & Stein, 2007) is a self-report measure of resilience that has been found to provide reliable and valid scores among U.S. and international samples, although its psychometric properties have not been validated among African Americans. This study used confirmatory factor analysis (CFA) and structural equation modeling to examine the psychometric properties of the CD-RISC 10 among a community sample of 127 low-income, African American men. Participants completed measures of resilience, spirituality, and psychological distress. CFA results supported the unidimensional factor structure of the CD-RISC 10. The CD-RISC 10 scores also evidenced construct validity by being related to theoretically relevant constructs (i.e., spirituality and psychological distress). Satisfactory internal consistency score reliability was demonstrated. These results support the validity of the CD-RISC 10 scores in a sample of low-income, African American men.

Coping Styles of Female Adolescent Cancer Patients with Potential Fertility Loss.

PURPOSE: The purpose of this qualitative study was to assess the coping styles of female adolescent cancer patients regarding potential loss of fertility. Expectations and desires for the future, coping styles in typical adolescence, and coping styles when faced with potential loss of fertility due to cancer treatment are discussed. METHODS: Female adolescents diagnosed with cancer aged 12-18 years at study (N=14) were administered a 10-item values clarification tool to pilot test the readability and relevance of the items on reproductive concerns, followed by a cognitive debriefing interview asking participants how they would respond to each item. These qualitative responses were assessed for coping style type using the constant comparative approach. RESULTS: All adolescent participants reported having a strong desire for biological children in the future. Reactions to questions regarding the loss of fertility fell into two categories of coping styles: emotion-focused coping or problem-focused (engagement) coping. Within emotion-focused coping, there were three distinct styles: externalizing attribution style, internalizing attribution style, and repressive adaptation. Problem-focused coping adolescents displayed optimism. CONCLUSION: Successful interventions aimed at promoting adaptive coping styles should seek to uncover adolescents' values about future parenthood and reproduction. Development of an age-appropriate assessment to stimulate dialogue regarding fertility and initiate an adolescent's cognitive processing of potential fertility loss is warranted.

Dysregulation in pediatric obsessive compulsive disorder.

Although obsessive compulsive disorder (OCD) and common co-occurring conditions share deficits in self-regulatory abilities, there has been minimal examination of impaired self-regulation (dysregulation) in youth with OCD. This study examined the association of dysregulation with symptom severity, impairment, and treatment outcome in pediatric OCD. Clinicians assessed obsessive-compulsive severity, family accommodation and global severity in 144 youth with OCD. Youth completed self-report severity ratings of anxiety and depressive symptoms. Parents completed the Child Behavior Checklist (CBCL), and both children and parents completed parallel ratings of obsessive-compulsive impairment. Ninety-seven youth received cognitive behavioral therapy (CBT) and were re-assessed after treatment. Dysregulation was assessed using the CBCL-Dysregulation Profile. Before treatment, dysregulated youth exhibited greater obsessive-compulsive symptom severity, depressive mood, family accommodation, and impairment than non-dysregulated youth. The magnitude of dysregulation directly predicted child-rated impairment, parent-rated impairment, and family accommodation, beyond obsessive-compulsive severity. The magnitude of pretreatment dysregulation predicted treatment discontinuation but not treatment response. Obsessive-compulsive symptom severity and dysregulation level significantly decreased after CBT. Dysregulated youth with OCD presented as more clinically severe than their non-dysregulated counterparts, and may require more individualized interventions to reduce dysregulated behavior to prevent CBT attrition. For treatment completers, CBT was associated with a decrease in dysregulation level.