The Relationship Between Adverse Childhood Experiences, Symptom Severity, Negative Thinking, Comorbidity, and Treatment Response in Youth with Obsessive-Compulsive Disorder.

Although youth and adults with obsessive-compulsive disorder (OCD) endorse elevated incidence of exposure to traumatic life events during childhood, the existing literature on adverse childhood experiences (ACEs) and OCD is mixed and studies focusing on pediatric OCD are limited. The present study examines the relationship between ACEs and OCD onset, symptom severity, negative cognitive patterns, comorbidity, and cognitive-behavioral therapy (CBT) response in 142 children and adolescents with OCD. ACEs were ascertained from parent reports. Most parents reported child exposure to ACEs. Out of the parents who reported ACEs, 50% reported ACE exposure prior to OCD diagnosis and 50% reported ACE exposure after OCD diagnosis. No significant associations between ACEs and comorbidity or CBT response were found, suggesting that CBT for pediatric OCD is effective regardless of ACE exposure. Family financial problems were associated with increased obsessive-compulsive symptom severity and negative thinking. Implications for research and practice are discussed.

The Relationship Between Perceptions of Response to Disclosure of Childhood Sexual Abuse and Later Outcomes.

This study assessed whether perceptions of others' reactions to disclosure are related to psychological and physical outcomes among individuals with a history of child sexual abuse. Eighty-six female undergraduates completed a series of questionnaires assessing child sexual abuse, nonsexual trauma, depression, anxiety, posttraumatic stress disorder, somatic symptoms, disclosure, and social reactions to disclosure. Those who reported child sexual abuse endorsed higher levels of psychological and physical symptoms than those who reported a nonsexual traumatic event. Child sexual abuse survivors who reported more hurtful responses to disclosure had higher levels of posttraumatic stress disorder, anxiety, and physical symptoms than nonsexual trauma survivors. These findings suggest that many survivors of CSA may need psychological services, and an important focus of treatment may be assessing and strengthening social support.

Inaccuracy of perceived competence ratings is associated with problem behaviors in 5-year-old children.

The authors examined problem behaviors in preschool children as a function of perceived competence. Prior research has demonstrated a link between inaccuracy of self-perceptions and teacher-reported externalizing behaviors in preschool aged boys. This study extended past research by adding data collected from observed behaviors in a laboratory setting, as well as parent reports of internalizing and externalizing behaviors. Five-year-old children completed the Pictorial Scale of Perceived Competence and Social Acceptance for Young Children (PSPCSA) in the lab, participated in a 10-min puzzle interaction task with their cotwin and mother, and completed a short task assessing cognitive abilities. Children were grouped into 3 self-esteem categories (unrealistically low, realistic, and unrealistically high) based on comparisons of self-reported (PSPCSA) versus actual competencies for maternal acceptance, peer acceptance, and cognitive competence. Results showed that children who overreported their maternal acceptance and peer acceptance had significantly more parent-reported externalizing problems as well as internalizing problems. There were no significant differences in accuracy for cognitive competence. The findings from this study underscore the negative impact of unrealistically high self-appraisal on problem behaviors in young children.

Randomized trial comparing standard versus light intensity parent training for anxious youth.

OBJECTIVE: To examine the efficacy of the parent-led intervention Supportive Parenting for Anxious Childhood Emotions (SPACE) relative to a low-dose version of the protocol among children and adolescents with clinically significant anxiety and/or obsessive-compulsive disorder (OCD). METHOD: 68 youth (7-17) with anxiety/OCD and their parents were randomized to receive 12 weekly telehealth SPACE sessions (SPACE-Standard) or bibliotherapy plus 4 telehealth sessions over 12 weeks (SPACE-light). After screening, assessments were conducted via videoconferencing at baseline, post-treatment, and one-month follow-up. Independent evaluators were blind to treatment condition. RESULTS: Treatment condition did not predict whether a participant responded to the intervention (SPACE-Standard = 70%; SPACE-Light = 68%), nor was treatment condition a predictor of anxiety severity, parent-reported anxiety, or parent-/child-reported functional impairment at post-treatment or one-month follow-up. Youth in SPACE-Light self-reported higher post-treatment anxiety than youth in SPACE-standard, though this was no longer significant at one-month follow-up. Parent-reported family accommodation total change scores were associated with anxiety severity at post-treatment across both arms. CONCLUSION: This is the second randomized controlled trial (RCT) evaluating SPACE and provides further support for the efficacy of this intervention both in standard and low-dose formats. This study provides support for parent-led anxiety treatment targeting family accommodation as a primary mechanism of change and extends evidence of efficacy to a more clinically diverse sample. TRIAL REGISTRATION: ClinicalTrials.gov Registry: NCT04922502.https://classic. CLINICALTRIALS: gov/ct2/show/NCT04922502.

Promoting OCD WEllness and resilience (POWER) study: Rationale, design, and methods.

Obsessive-compulsive disorder (OCD) affects 1-2% of children and is associated with functional impairment and diminished quality of life. Several treatments are efficacious: cognitive behavioral therapy (CBT) with exposure and response prevention, serotonin reuptake inhibitor (SRI) monotherapy, and combined treatment (SRI + CBT). Expert clinician-informed practice parameters suggest that youth with mild to moderate OCD should be treated initially with CBT yet SRIs are frequently employed as the first-line intervention or in combination with psychotherapy in applied practice. Empirical data to guide SRI discontinuation in pediatric OCD are very limited. This study, Promoting OCD Wellness and Resiliency (POWER), aims to address this gap through a two phase, double-blinded, placebo-controlled, randomized controlled non-inferiority trial with the purpose of evaluating whether youth with OCD on an SRI can discontinue their medication after successful CBT augmentation and maintain wellness for a period of 24 weeks during which they receive maintenance CBT that models standard-of-care. In this paper we describe the rationale and methodological design of the POWER study.

The impact of COVID-19 on the treatment of obsessive-compulsive disorder.

The COVID-19 pandemic has led to challenges in providing cognitive-behavioral therapy for patients with obsessive-compulsive disorder (OCD). Despite the presence of the pandemic and the risk of contracting illness, therapists can continue to utilize exposure with response prevention (ERP), which is the gold standard psychotherapy treatment for OCD. Therapists can ethically implement ERP by focusing on core treatment tenets while incorporating guidelines recommended by the Centers for Disease Control and Prevention to mitigate risk for COVID-19 exposure. The pandemic has also provided an opportunity to more widely implement ERP through virtual telehealth appointments, which have notable benefits as well as some drawbacks.

The impact of COVID-19 on the treatment of obsessive-compulsive disorder.

The COVID-19 pandemic has led to challenges in providing cognitive-behavioral therapy for patients with obsessive-compulsive disorder (OCD). Despite the presence of the pandemic and the risk of contracting illness, therapists can continue to utilize exposure with response prevention (ERP), which is the gold standard psychotherapy treatment for OCD. Therapists can ethically implement ERP by focusing on core treatment tenets while incorporating guidelines recommended by the Centers for Disease Control and Prevention to mitigate risk for COVID-19 exposure. The pandemic has also provided an opportunity to more widely implement ERP through virtual telehealth appointments, which have notable benefits as well as some drawbacks.