Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 45
Filtrar
1.
Artigo em Inglês | MEDLINE | ID: mdl-33301814

RESUMO

OBJECTIVE: (1) To describe rates of long-term service use among subjects previously enrolled in a landmark study of youth anxiety disorder treatment and followed into early adulthood; (2) to examine predictors of long-term service use and (3) to examine the relationship between anxiety diagnosis and service use over time. METHOD: The Child/Adolescent Anxiety Multi-modal Extended Long-term Study (CAMELS) prospectively assessed youth treated through the Child/Adolescent Anxiety Multimodal Study (CAMS) at ages 7 to 17 years into early adulthood. 319 youth (mean age =17.7; 55.2% female) previously randomized to cognitive-behavioral therapy (CBT), sertraline (SRT), combination (COMB) or placebo (PBO) for the treatment of anxiety participated; 318 had service use data. Four annual clinic assessments were conducted along with telephone check-ins every six months. RESULTS: Overall, 65.1% of participants endorsed receiving some form of anxiety treatment over the course of the follow-up period, with more subjects reporting medication use than psychotherapy. 35.2% reported consistent use of services over the course of the study. Overall, service use declined over time in subjects with less severe anxiety but remained more steady in those with recurrent/chronic symptoms. Levels of life stress and depressive symptoms were associated with amount of service use over time whereas treatment-related variables (type of initial intervention, acute response, remission) were not. A subset of youth remained chronically anxious despite consistent service use. CONCLUSION: Findings point to the need to develop models of care that approach anxiety disorders as chronic health conditions in need of active long-term management.

2.
J Psychiatr Res ; 2020 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-33172654

RESUMO

Body-focused repetitive behavior disorders (BFRBs) include Trichotillomania (TTM; Hair pulling disorder) and Excoriation (Skin Picking) Disorder (SPD). These conditions are prevalent, highly heterogeneous, under-researched, and under-treated. In order for progress to be made in optimally classifying and treating these conditions, it is necessary to identify meaningful subtypes. 279 adults (100 with TTM, 81 with SPD, 40 with both TTM and SPD, and 58 controls) were recruited for an international, multi-center between-group comparison using mixture modeling, with stringent correction for multiple comparisons. The main outcome measure was to examine distinct subtypes (aka latent classes) across all study participants using item-level data from gold-standard instruments assessing detailed clinical measures. Mixture models identified 3 subtypes of TTM (entropy 0.98) and 2 subtypes of SPD (entropy 0.99) independent of the control group. Significant differences between these classes were identified on measures of disability, automatic and focused symptoms, perfectionism, trait impulsiveness, and inattention and hyperactivity. These data indicate the existence of three separate subtypes of TTM, and two separate subtypes of SPD, which are distinct from controls. The identified clinical differences between these latent classes may be useful to tailor future treatments by focusing on particular traits. Future work should examine whether these latent subtypes relate to treatment outcomes, or particular psychobiological findings using neuroimaging techniques.

3.
J Am Acad Child Adolesc Psychiatry ; 59(7): 785-787, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32618273

RESUMO

We write with great concern in response to the recent systematic review and meta-analysis of cognitive-behavioral therapy (CBT) in pediatric obsessive-compulsive disorder (OCD) by Uhre et al.1 Although the authors' results consistently support the clinical efficacy of CBT for pediatric OCD, we expect that, much like ourselves, readers will be confused by the discordant and inappropriate conclusions that they put forward. These conclusions stem from the authors' application and interpretation of their particular qualitative methods, which could lead important stakeholders (eg, parents, patients, clinicians, and payers) to wrongly discount clear evidence for what is known to be the best evidence-based therapy for pediatric OCD.

4.
Artigo em Inglês | MEDLINE | ID: mdl-32500537

RESUMO

BACKGROUND: Anxiety disorders first emerge during the critical developmental periods of childhood and adolescence. This review synthesizes recent findings on the prevalence, risk factors, and course of the anxiety disorders; and their neurobiology and treatment. METHODS: For this review, searches were conducted using PubMed, PsycINFO, and clinicaltrials.gov. Findings related to the epidemiology, neurobiology, risk factors, and treatment of pediatric anxiety disorders were then summarized. FINDINGS: Anxiety disorders are high prevalence, and early-onset conditions associated with multiple risk factors including early inhibited temperament, environment stress, and structural and functional abnormalities in the prefrontal-amygdala circuitry as well as the default mode and salience networks. The anxiety disorders are effectively treated with cognitive behavioral therapy (CBT), selective serotonin reuptake inhibitors (SSRIs), and serotonin-norepinephrine reuptake inhibitors (SNRIs). CONCLUSIONS: Anxiety disorders are high prevalence, early-onset conditions associated with a distinct neurobiological fingerprint, and are consistently responsive to treatment. Questions remain regarding who is at risk of developing anxiety disorders as well as the way in which neurobiology predicts treatment response.

5.
J Affect Disord ; 273: 552-561, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32560953

RESUMO

BACKGROUND: Trichotillomania (TTM) is a chronic and impairing psychiatric disorder with suspected dysfunctional cortico-striato-thalamo-cortical (CSTC) circuit activity reflecting excitatory/inhibitory signaling imbalance. TTM neurochemistry is understudied, with no prior research using magnetic resonance spectroscopy (MRS). This pilot investigation examined associations between TTM diagnosis, symptom severity, and response to behavioral treatment with MRS neurometabolites glutamate (Glu) and γ-aminobutyric acid (GABA) in CSTC structures. METHODS: Proton echo-planar spectroscopic imaging (PEPSI) MRS was acquired from bilateral pregenual anterior cingulate cortex (pACC), caudate, putamen, globus pallidus, thalamus, and proximal white matter in 10 unmedicated girls with TTM, ages 9-17 years, before and after treatment, and from 13 age- and sex-matched healthy controls. RESULTS: Nine of 10 TTM patients were treatment responders. Pretreatment mean Glu and GABA did not differ significantly between participants and controls. Pretreatment TTM symptoms were correlated with Glu in (left + right) pACC (r = 0.88, p = 0.02) and thalamus (r = 0.82, p = 0.012), and were negatively correlated with pACC GABA (r = -0.84, p = 0.034). Mean GABA in putamen increased 69% (baseline to post-treatment) (p = 0.027). Higher pretreatment Glu in caudate, putamen, globus pallidus, and thalamus predicted greater symptom decreases with treatment (all r < -0.6, p < 0.05); higher caudate GABA predicted less treatment-related symptom decline (r = 0.86, p = 0.014). LIMITATIONS: Small sample, GABA quantified with spectral fitting rather than editing. CONCLUSION: Consistent with other neuroimaging, MRS reveals discrete CSTC chemical changes with effective behavior therapy, and possibly with TTM etiology. TTM symptoms relate to excess excitatory versus inhibitory signaling in pACC and thalamus; symptom improvement may reflect reduced excitatory drive of the CSTC direct-pathway activity.

6.
J Anxiety Disord ; 73: 102229, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32361032

RESUMO

OBJECTIVE: This study examined predictors and moderators of treatment outcome in a randomized controlled trial (RCT) comparing two active interventions for pediatric obsessive compulsive disorder that differed with respect to the focus and format of family intervention. We had a particular interest in the role of race/ethnicity in shaping outcomes given our relatively diverse sample composition and the limited prior work in this area. METHOD: A total of 62 youths (Mean age = 12.71 years; 57 % male; 34 % non-white) were assigned to either a standard cognitive behavioral therapy (CBT) family intervention (ST) or to a tailored intervention designed for cases of OCD complicated by poor family functioning (Enhanced Family Therapy; ET). Treatment in both arms involved 12 sessions of exposure therapy; the family interventions differed. Predictor and moderator variables were chosen based on the extant literature. RESULTS: Minority status did not predict outcome, suggesting that overall, white and non-white youth had comparable treatment response. Race/ethnicity did, however, moderate response with non-white youth faring better in the ET arm of the study. In particular, minority youth in ET had, on average, post-treatment CYBOCS scores consistent with clinical remission whereas their ST counterparts were left with symptoms considered moderately severe. There were no predictors of treatment outcome. CONCLUSIONS: Minority status predicts poorer response to standard CBT across disorders, suggesting the need for possible treatment adaptations. The present findings highlight one avenue for matching patients to treatments that might optimize outcomes and underscore the value of family involvement in OCD treatment.

7.
Autism ; 24(4): 983-994, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32168988

RESUMO

LAY ABSTRACT: Youth with autism spectrum disorder often exhibit symptoms of obsessive-compulsive disorder; however, it can be difficult for parents and clinicians to tell the difference between the restricted and repetitive behaviors often seen in autism spectrum disorder and symptoms of obsessive-compulsive disorder. This difficulty in distinguishing symptoms may arise from the fact that these symptoms appear the same to observers but are typically differentiated based on whether the motivation for the behavior is to reduce stress (restricted and repetitive behaviors) or whether the behavior itself is stressful (obsessive-compulsive disorder). It is important to know the difference between these two symptoms as it may impact the treatment prescribed. The goal of this study was to better determine the difference between restricted and repetitive behaviors and symptoms of obsessive-compulsive disorder in youth with autism spectrum disorder. It was found that although parents and clinicians had trouble differentiating between the two, the children were able to provide insight as to their own motivations for behavior, and thus whether they were restricted and repetitive behaviors or symptoms of obsessive-compulsive disorder. It was also found that children may actually have subjective negative experiences when engaging in restricted and repetitive behaviors, which complicates their classification. These results provide guidance for better understanding, distinguishing, and ultimately treating obsessive-compulsive disorder behavior in youth with autism spectrum disorder.

9.
J Abnorm Child Psychol ; 48(1): 79-89, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31313062

RESUMO

This study examined the relationship between caregivers' and youths' treatment expectations and characteristics of exposure tasks (quantity, mastery, compliance) in cognitive-behavioral therapy (CBT) for childhood anxiety. Additionally, compliance with exposure tasks was tested as a mediator of the relationship between treatment expectations and symptom improvement. Data were from youth (N = 279; 7-17 years old) enrolled in the Child/Adolescent Anxiety Multimodal Study (CAMS) and randomized to cognitive-behavioral therapy (CBT) or the combination of CBT and sertraline for the treatment of separation anxiety disorder, generalized anxiety disorder, and social phobia. Caregivers and youth independently reported treatment expectations prior to randomization, anxiety was assessed pre- and post-treatment by independent evaluators blind to treatment condition, and exposure characteristics were recorded by the cognitive-behavioral therapists following each session. For both caregivers and youths, more positive expectations that anxiety would improve with treatment were associated with greater compliance with exposure tasks, and compliance mediated the relationship between treatment expectations and change in anxiety symptoms following treatment. Additionally, more positive parent treatment expectations were related to a greater number and percentage of sessions with exposure. More positive youth treatment expectations were associated with greater mastery during sessions focused on exposure. Findings underscore the importance of addressing parents' and youths' treatment expectations at the outset of therapy to facilitate engagement in exposure and maximize therapeutic gains.

10.
J Abnorm Child Psychol ; 48(1): 67-77, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31506757

RESUMO

The current study examined prospective bidirectional links between dysregulated sleep, and anxiety and depression severity across 4 years, among youth with a history of anxiety disorder. Participants were 319 youth (age 11-26 years), who previously participated in a large multisite randomized controlled trial for the treatment of pediatric anxiety disorders, Child/Adolescent Anxiety Multimodal Study (CAMS), and subsequently enrolled in a naturalistic follow-up, Child/Adolescent Anxiety Multimodal Extended Long-term Study (CAMELS), an average of 6.5 years later. They participated in four annual visits that included self-report items of dysregulated sleep and semi-structured multi-informant interviews of anxiety and depression. Dysregulated sleep was bidirectionally associated with clinician-rated anxiety and depression symptom severity across adolescence and young adulthood. However, these bidirectional relationships were attributable to youth mean levels of dysregulated sleep, and anxiety and depression severity over the 4 years. Elevations in dysregulated sleep at each visit, relative to mean levels, did not predict worse anxiety or depression severity 1 year later. Likewise visit-specific elevations in anxiety and depression severity, as opposed to average levels, did not predict higher levels of dysregulated sleep at the next visit. Having higher levels of dysregulated sleep or more severe internalizing problems across the four-year period, as opposed to reporting a relative increase in symptom severity at a particular visit, posed greater risk for poor mental health. Interventions should continue to assess and treat persistent sleep problems alongside anxiety and depression.

11.
Biol Psychiatry ; 2020 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-33451676

RESUMO

Avoidant behavior is a defining feature of pediatric anxiety disorders. Although prior research has examined it from the perspective of early information processing events, there has been relatively less consideration of the processes by which anxious youth make avoidant decisions and how these choices are reinforced over time. Studies of risk taking are valuable in this regard because they consider how individuals identify the pros and cons of their choices, how they weigh potential gains and losses and estimate their respective probabilities, and how they tolerate the uncertainty intrinsic to any decision. In this review, we place risk taking within existing models of information processing in pediatric anxiety disorders and highlight the particular value of this construct for informing models of developmental psychopathology and individual differences in outcome over time. We review existing behavioral and neurobiological studies of risk taking in anxious youth and conclude by identifying directions for future research.

12.
Psychiatry Res ; 298: 113653, 2020 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-33621723

RESUMO

BACKGROUND: Little is known about the neural underpinnings of pediatric trichotillomania (TTM). We examined error-related negativity (ERN)-amplitude and theta-EEG power differences among youth with TTM, OCD, and healthy controls (HC). METHODS: Forty channel EEG was recorded from 63 pediatric participants (22 with TTM, 22 with OCD, and 19 HC) during the Eriksen Flanker Task. EEG data from inhibitory control were used to derive estimates of ERN amplitude and event-related spectral power associated with motor inhibition. RESULTS: TTM and HC were similar in brain activity patterns in frontal and central regions and TTM and OCD were similar in the parietal region. Frontal ERN-amplitude was significantly larger in OCD relative to TTM and HC, who did not differ from each other. The TTM group had higher theta power compared to OCD in frontal and central regions, and higher theta than both comparison groups in right motor cortex and superior parietal regions. Within TTM, flanker task performance was correlated with EEG activity in frontal, central, and motor cortices whereas global functioning and impairment were associated with EEG power in bilateral motor and parietal cortices. CONCLUSIONS: Findings are discussed in terms of shared and unique neural mechanisms in TTM and OCD and treatment implications.

13.
Psychiatry Res ; 281: 112578, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31586836

RESUMO

Pediatric trichotillomania (TTM) is an understudied condition that can be highly impairing; little is known about family environmental features that shape its development and course. We examined family functioning among age and gender-matched groups of youth with primary TTM (n = 30; mean age = 12.87), obsessive compulsive disorder (OCD; n = 30; mean age = 12.70), and no psychiatric history (healthy controls; HC; n = 30; mean age = 12.46). An additional group of n = 25 TTM cases was employed to examine relationships between TTM severity and family functioning. All youth completed standardized diagnostic assessment, including the Family Environment Scale (FES) and Children's Report of Parenting Behavior Inventory (CRPBI). Family functioning was more impaired among both TTM and OCD cases relative to controls, as evidenced by higher levels of child-reported FES conflict and lower cohesion, expressiveness, and organization. Less consistent findings emerged on parent report, with cohesion, but not conflict, distinguishing the HC and clinical groups. In keeping with prior research, parents of TTM-affected youth also reported lower expressiveness and cohesion than parents in the OCD group. There was limited evidence for links between hair-pulling severity and family impairment and no links to parenting behavior. Findings are discussed in terms of implications for family focused treatment.


Assuntos
Conflito Familiar/psicologia , Relações Familiares/psicologia , Transtorno Obsessivo-Compulsivo/psicologia , Poder Familiar/psicologia , Tricotilomania/psicologia , Adolescente , Criança , Estudos Transversais , Feminino , Voluntários Saudáveis , Humanos , Relações Interpessoais , Masculino , Transtorno Obsessivo-Compulsivo/epidemiologia , Tricotilomania/epidemiologia
14.
Psychiatry Res ; 276: 115-123, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31075706

RESUMO

Pediatric obsessive-compulsive disorder (OCD) co-occurs frequently with other mental health conditions, adding to the burden of disease and complexity of treatment. Cognitive behavioral therapy (CBT) is efficacious for both OCD and two of its most common comorbid conditions, anxiety and depression. Therefore, treating OCD may yield secondary benefits for anxiety and depressive symptomatology. This study examined whether anxiety and/or depression symptoms declined over the course of OCD treatment and, if so, whether improvements were secondary to reductions in OCD severity, impairment, and/or global treatment response. The sample consisted of 137 youths who received 12 sessions of manualized CBT and were assessed by independent evaluators. Mixed models analysis indicated that youth-reported anxiety and depression symptoms decreased in a linear fashion over the course of CBT, however these changes were not linked to specific improvements in OCD severity or impairment but to global ratings of treatment response. Results indicate that for youth with OCD, CBT may offer benefit for secondary anxiety and depression symptoms distinct from changes in primary symptoms. Understanding the mechanisms underlying carryover in CBT techniques is important for furthering transdiagnostic and/or treatment-sequencing strategies to address co-occurring anxiety and depression symptoms in pediatric OCD.


Assuntos
Ansiedade/terapia , Terapia Cognitivo-Comportamental/métodos , Depressão/terapia , Transtornos do Neurodesenvolvimento/terapia , Transtorno Obsessivo-Compulsivo/terapia , Adolescente , Ansiedade/diagnóstico , Ansiedade/psicologia , Criança , Terapia Cognitivo-Comportamental/tendências , Depressão/diagnóstico , Depressão/psicologia , Feminino , Humanos , Masculino , Transtornos do Neurodesenvolvimento/diagnóstico , Transtornos do Neurodesenvolvimento/psicologia , Transtorno Obsessivo-Compulsivo/diagnóstico , Transtorno Obsessivo-Compulsivo/psicologia , Resultado do Tratamento
15.
Compr Psychiatry ; 86: 47-53, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30077806

RESUMO

BACKGROUND: Childhood obsessive-compulsive disorder (OCD) is a heterogeneous psychiatric condition, with varied symptom presentations that have been differentially associated with clinical characteristics and treatment response. One OCD symptom cluster of particular interest is religious symptoms, including fears of offending religious figures/objects; patients affected by these symptoms have been characterized as having greater overall OCD severity and poorer treatment response. However, the extant literature primarily examines this symptom subtype within adults, leaving a gap in our understanding of this subtype in youth. METHOD: Consequently, this study examined whether presence of religious symptoms in OCD-affected children and adolescents (N = 215) was associated with greater clinical impairments across OCD symptoms and severity, insight, other psychiatric comorbidity, family variables, or worse treatment response. RESULTS: Results found that youth with religious OCD symptoms presented with higher OCD symptom severity and exhibited more symptoms in the aggressive, sexual, somatic, and checking symptom cluster, as well as the symmetry, ordering, counting, and repeating cluster. Religious OCD symptoms were also significantly associated with poorer insight and higher family expressiveness. No differences in treatment response were observed in youths with versus without religious OCD symptoms. CONCLUSION: Ultimately, youths with religious OCD symptoms only differed from their OCD-affected counterparts without religious symptoms on a minority of clinical variables; this suggests they may be more comparable to youths without religious OCD symptoms than would be expected based on the adult OCD literature and highlights the importance of examining these symptoms within a pediatric OCD sample.


Assuntos
Relações Familiares/psicologia , Transtorno Obsessivo-Compulsivo/psicologia , Transtorno Obsessivo-Compulsivo/terapia , Religião e Psicologia , Adolescente , Agressão/psicologia , Criança , Comorbidade , Medo/psicologia , Feminino , Humanos , Masculino , Transtorno Obsessivo-Compulsivo/diagnóstico , Religião , Síndrome , Resultado do Tratamento
16.
J Am Acad Child Adolesc Psychiatry ; 56(12): 1034-1042.e1, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29173737

RESUMO

OBJECTIVE: Although evidence-based treatments for pediatric obsessive-compulsive disorder (OCD) exist, many youth fail to respond, and interventions tailored to the needs of specific subsets of patients are lacking. This study examines the efficacy of a family intervention module designed for cases of OCD complicated by poor family functioning. METHOD: Participants were 62 youngsters aged 8 to 17 years (mean age = 12.71 years; 57% male; 65% white) with a primary diagnosis of OCD and at least 2 indicators of poor family functioning. They were randomized to receive 12 sessions of individual child cognitive-behavioral therapy (CBT) plus weekly parent psychoeducation and session review (standard treatment [ST]) or the same 12 child sessions plus 6 sessions of family therapy aimed at improving OCD-related emotion regulation and problem solving (positive family interaction therapy [PFIT]). Blinded raters evaluated outcomes and tracked responders to 3-month follow-up. RESULTS: Compared to ST, PFIT demonstrated better overall response rates on the Clinician Global Impression-Improvement scale (CGI-I; 68% versus 40%, p = .03, φ = 0.28) and rates of remission (58% PFIT versus 27% ST, p = .01, φ = 0.32). PFIT also produced significantly greater reductions in functional impairment, symptom accommodation, and family conflict, and improvements in family cohesion. As expected, these shifts in family functioning constitute an important treatment mechanism, with changes in accommodation mediating treatment response. CONCLUSION: PFIT is efficacious for reducing OCD symptom severity and impairment and for improving family functioning. Findings are discussed in terms of personalized medicine and mechanisms of change in pediatric OCD treatment. Clinical trial registration information-Family Focused Treatment of Pediatric Obsessive Compulsive Disorder; http://clinicaltrials.gov/; NCT01409642.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Terapia Familiar/métodos , Transtorno Obsessivo-Compulsivo/terapia , Pais/educação , Adolescente , Criança , Terapia Combinada , Relações Familiares , Feminino , Seguimentos , Humanos , Masculino , Transtorno Obsessivo-Compulsivo/diagnóstico , Escalas de Graduação Psiquiátrica , Método Simples-Cego , Resultado do Tratamento
17.
J Am Acad Child Adolesc Psychiatry ; 56(12): 1043-1052, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29173738

RESUMO

OBJECTIVE: Exposure tasks are recognized widely as a key component of cognitive-behavioral therapy (CBT) for child and adolescent anxiety. However, little research has examined specific exposure characteristics that predict outcomes for youth with anxiety and that may guide its application in therapy. METHOD: This study draws on a sample of 279 children and adolescents (48.4% male; 79.6% white) with a principal anxiety disorder who received 14 sessions of CBT, either alone or in combination with medication, through the Child/adolescent Anxiety Multimodal treatment Study (CAMS). The present study examines therapist-reported quantity, difficulty level, compliance, and mastery of exposure tasks as they related to CBT response (i.e., Clinical Global Impressions-Improvement ratings). Secondary treatment outcomes included reduction in anxiety symptom severity on the Pediatric Anxiety Rating Scale, global impairment measured via the Children's Global Assessment Scale, and parent-report of anxiety-specific functional impairment on the Child Anxiety Impairment Scale. RESULTS: Regression analyses indicated a dose-response relationship between therapist-reported quantity of exposure and independent evaluations of treatment outcome, with more time devoted to exposure linked to better outcomes. Similarly, greater time spent on more difficult (rather than mild or moderate) exposure tasks predicted better outcomes, as did therapist ratings of child compliance and mastery. CONCLUSION: The present findings highlight the importance of challenging children and adolescents with difficult exposure tasks and of collaborating to ensure compliance and mastery.


Assuntos
Transtornos de Ansiedade/terapia , Terapia Cognitivo-Comportamental/métodos , Adolescente , Ansiolíticos/uso terapêutico , Transtornos de Ansiedade/psicologia , Criança , Terapia Combinada , Feminino , Humanos , Masculino , Sertralina/uso terapêutico , Resultado do Tratamento
18.
J Am Acad Child Adolesc Psychiatry ; 56(8): 696-702, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28735699

RESUMO

OBJECTIVE: To determine optimal percent reduction and raw score cutoffs on the parent- and child-report Screen for Child Anxiety Related Emotional Disorders (SCARED) for predicting treatment response and remission among youth with anxiety disorders. METHOD: Data were obtained from youth (N = 438; 7-17 years old) who completed treatment in the Child/Adolescent Anxiety Multimodal treatment Study, a multisite, randomized clinical trial that examined the relative efficacy of medication (sertraline), cognitive-behavioral therapy (Coping Cat), their combination, and pill placebo for the treatment of separation anxiety disorder, generalized anxiety disorder, and social phobia. The parent- and youth-report SCARED were administered at pre- and posttreatment. Quality receiver operating characteristic methods evaluated the performance of various SCARED percent reduction and absolute cutoff scores in predicting treatment response and remission, as defined by posttreatment ratings on the Clinical Global Impression scales and the Anxiety Disorders Interview Schedule. RESULTS: Reductions of 55% on the SCARED-Parent and 50% on the SCARED-Youth optimally predicted treatment response. Posttreatment absolute raw scores of 10 (SCARED-Parent) and 12 (SCARED-Youth) optimally predicted remission in the total sample, although separate SCARED-Parent cutoffs for children (12-13) and adolescents (9) showed greatest quality of efficiency. Each cutoff significantly predicted response and remission at 6-month follow-up. CONCLUSION: Results serve as guidelines for operationalizing treatment response and remission on the SCARED, which could help clinicians systematically monitor treatment outcomes of youth with anxiety disorders in a cost- and time-efficient manner. Clinical trial registration information-Child and Adolescent Anxiety Disorders (CAMS); http://clinicaltrials.gov/; NCT00052078.


Assuntos
Transtornos de Ansiedade/terapia , Terapia Cognitivo-Comportamental/métodos , Avaliação de Resultados em Cuidados de Saúde/métodos , Inibidores de Captação de Serotonina/farmacologia , Adolescente , Transtornos de Ansiedade/tratamento farmacológico , Ansiedade de Separação/terapia , Criança , Quimioterapia Combinada , Feminino , Humanos , Masculino , Fobia Social/terapia , Indução de Remissão , Sertralina/farmacologia
19.
J Psychiatr Res ; 93: 72-78, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28601668

RESUMO

OBJECTIVE: To date, few studies of childhood obsessive compulsive disorder (OCD) have been adequately powered to examine patterns and predictors of comorbidity, despite the frequency with which it occurs. We address this gap, drawing on a large sample of youth with OCD who were systematically assessed through research and clinical programs in a university-based specialty program for children and adolescents with OCD. We examine patterns of comorbidity across different epochs of development and predict specific classes of OCD (comorbidity internalizing/externalizing/both) from key demographic and clinical variables that may be useful in guiding individualized treatment. METHOD: A total of 322 youths (mean age = 12.28, 53% male) were assessed using the Anxiety Disorders Interview Schedule (ADIS; Silverman and Albano, 1996), the Children's Yale Brown Obsessive Compulsive Scale (CYBOCS; Scahill et al., 1997) and other standardized measures. RESULTS: Consistent with prior research, 50% of youth met criteria for a co-occurring anxiety or depressive disorder. Rates of externalizing disorders were lower (16%). Developmental differences emerged such that older youth met criteria for a higher number of co-occurring disorders. As expected, adolescents in particular were more likely to have a co-occurring internalizing disorder compared to early or pre-adolescent peers. Surprisingly, they were also more likely to have a comorbid externalizing disorder. Developmental trends were particularly striking with respect to depression, with adolescents with OCD demonstrating a six-fold greater likelihood of co-occurring depressive disorder compared to younger counterparts. DISCUSSION: Clinical implications are discussed with eye toward tailoring interventions, particularly during the transition to adolescence when youth are at heightened risk for depression.


Assuntos
Ansiedade/epidemiologia , Deficiências do Desenvolvimento/epidemiologia , Transtorno Obsessivo-Compulsivo/epidemiologia , Adolescente , Criança , Comorbidade , Feminino , Humanos , Masculino , Valor Preditivo dos Testes , Escalas de Graduação Psiquiátrica
20.
J Abnorm Child Psychol ; 45(3): 457-470, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-27796692

RESUMO

Although parental attention-deficit/hyperactivity disorder (ADHD) is a risk factor for multiple negative youth outcomes, it is unknown how change in parental ADHD symptoms over time affects change in child ADHD symptoms; moreover, mediators of these predictions are largely unknown. Parents of 230 5-10 year-old children (68 % male) with (n = 120) and without ADHD (n = 110) were followed prospectively for 6-7 years across three separate waves. Parents self-reported their ADHD and depression symptoms and similarly rated offspring ADHD, oppositional defiant disorder (ODD), and conduct disorder (CD) symptoms; youth self-reported their substance use. Temporally-ordered mediators consisted of parental expressed emotion (EE), derived from the Five Minute Speech Sample, and self-reported positive and negative parenting behavior. Controlling for key demographics and parental depression symptoms, increasing parental ADHD symptoms were a time-varying predictor of worsening youth ADHD and ODD, although it was unrelated to change in CD and alcohol/substance use. Next, although EE facets (i.e., criticism, emotional over-involvement) did not mediate these predictions, negative parenting behavior significantly mediated predictions of youth ADHD (and marginally in predictions of ODD) from parental ADHD symptoms. These quasi-experimental findings suggest that parental ADHD symptoms are a potential unique causal risk factor for offspring ADHD and ODD; also, preventing negative parenting behavior secondary to parental ADHD symptoms is critical to improve trajectories of youth ADHD and ODD. We consider parental ADHD symptoms and family factors underlying emergent externalizing problems utilizing a developmental psychopathology framework, including implications for intervention and prevention.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/fisiopatologia , Filho de Pais Incapacitados/psicologia , Transtorno da Conduta/fisiopatologia , Emoções Manifestas/fisiologia , Poder Familiar/psicologia , Pais/psicologia , Comportamento Problema/psicologia , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Masculino
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA