Cognitive behavioral therapy for pediatric obsessive-compulsive disorder: development of expert-level competence and implications for dissemination.

Pediatric obsessive-compulsive disorder (OCD) is associated with substantial morbidity, comorbidity, family difficulties, and functional impairment. Fortunately, OCD in youth has also been found responsive to cognitive behavioral therapy (CBT) both alone and in combination with medication. This paper highlights key areas a treatment provider must be highly knowledgeable in to be considered an expert in cognitive behavioral therapy (CBT) for pediatric obsessive-compulsive disorder (OCD). We describe the areas of knowledge that must be mastered to gain expertise, as well as the more difficult to quantify personal qualities that may allow a clinician to convey this knowledge in an expert manner. We provide detailed discussions of CBT theory, assessment strategies, implications of the treatment outcome literature for clinical decision-making, and how best to navigate CBT. We also discuss what the expert needs to accomplish by engaging youth and families throughout the evaluation and treatment process.

Habit reversal training in trichotillomania: guide for the clinician.

Trichotillomania (hair-pulling disorder) involves repetitive hair pulling that can cause significant distress and impairment in functioning. Both children and adults suffer from the disorder. Habit reversal training (HRT) is the trichotillomania treatment with the most empirical support. HRT begins with developing an in-depth understanding of the client's unique pulling behaviors. The major components of HRT can then be carried out in a way that targets the client's specific needs. These include awareness training and self-monitoring, stimulus control and competing response procedures. Within each of these components the client learns to recognize his or her pulling urges, avoid situations in which pulling is more likely and adopt behaviors that can be used instead of pulling. Future work will involve evaluating the efficacy of adding therapy models such as mindfulness meditation in order to further enhance the effectiveness of HRT, and studying the long-term efficacy of HRT for children and adults.

Bridging the research-to-practice gap in autism intervention: an application of diffusion of innovation theory.

There is growing evidence that efficacious interventions for autism are rarely adopted or successfully implemented in public mental health and education systems. We propose applying diffusion of innovation theory to further our understanding of why this is the case. We pose a practical set of questions that administrators face as they decide about the use of interventions. Using literature from autism intervention and dissemination science, we describe reasons why efficacious interventions for autism are rarely adopted, implemented, and maintained in community settings, all revolving around the perceived fit between the intervention and the needs and capacities of the setting. Finally, we suggest strategies for intervention development that may increase the probability that these interventions will be used in real-world settings.