Treatment of obsessive-compulsive disorder in very young children

There is an increasing awareness that very young children can present with obsessive-compulsive disorder (OCD); however, there is limited evidence for the efficacy of treatment in this age group. Early intervention may have the potential to alter the negative trajectory associated with pediatric OCD and may avoid longstanding dysfunction and impairment resulting in academic, social, and family functioning. Pharmacotherapy generally has poor acceptability among parents of young children, and there is evidence of increased risk of adverse side effect in very young children. There is emerging support for family-based cognitive behavioral therapy and exposure and response prevention as a first-line treatment for preschool OCD. In this chapter, we review the phenomenology, assessment, and treatment of OCD in very young children, as well as the complexities involved with differential diagnosis and developmentally sensitive treatment in this age group. The assessment, case conceptualization, and treatment of a 4-year-old boy are presented to illustrate the complexities of working with preschoolers and their families.14 page(s

Differences in anxiety and depression symptoms : comparison between older and younger clinical samples

BACKGROUND: Anxiety and depression symptoms change over the lifespan and older adults use different terms to describe their mental health, contributing to under identification of anxiety and depression in older adults. To date, research has not examined these differences in younger and older samples with comorbid anxiety and depression. METHODS: One hundred and seven treatment-seeking participants (47 older, 60% female, and 60 younger, 50% female) with anxiety and mood disorders completed the Anxiety Disorders Interview Schedule and a symptom checklist to examine differences in symptom severity, symptom profiles and terms used to describe anxiety and mood. RESULTS: The findings indicated several key differences between the presentation and description of anxiety and depression in younger and older adults. Older adults with Social Phobia reported fearing a narrower range of social situations and less distress and interference. Older adults with Generalized Anxiety Disorder (GAD) reported less worry about interpersonal relationships and work/school than younger adults, however, there were no differences between age groups for behavioral symptoms endorsed. Further older adults reported phobia of lifts/small spaces more frequently than younger adults. Depressed older depressed adults also reported more anhedonia compared to younger adults, but no differences in terms of reported sadness were found. Finally, older and younger adults differed in their descriptions of symptoms with older adults describing anxiety as feeling stressed and tense, while younger adults described anxiety as feeling anxious, worried or nervous. CONCLUSIONS: Clinicians need to assess symptoms broadly to avoid missing the presence of anxiety and mood disorders especially in older adults.10 page(s

Refining clinical judgment of treatment response and symptom remission identification in childhood anxiety using a signal detection analysis on the pediatric anxiety rating scale

Objective: The purpose of this study was to determine guidelines for delineating treatment response and symptom remission for children with anxiety disorder based on the five item and Pediatric Anxiety Rating Scale (PARS5), and replicate guidelines using the six item PARS (PARS6). Methods: Participants were 73 children 7-13 years of age with a primary anxiety disorder who received computer-assisted cognitive behavioral therapy for anxiety. Signal detection analyses utilizing receiver operating curve procedures were used to determine optimal guidelines for defining treatment response and symptom remission for youth with anxiety disorders on the PARS5 and PARS6. The percent reduction in anxiety severity was used to predict treatment responder status. The percent reduction in symptoms and posttreatment raw score were used to predict remission status. Results: Optimal prediction of treatment response based on gold standard criteria was achieved at 15-20% reduction in symptoms on the PARS5 (with 20% reduction achieving marginally higher accuracy), and 20% reduction on the PARS6. A 25% reduction in symptoms on the PARS5 or a posttreatment raw score cutoff of 9 optimally predicted remission status. For the PARS6, a cutoff of 35% reduction or a posttreatment score of 11, was considered optimal for determining remission in clinical settings, whereas a 30% reduction or score of 12 was considered optimal for research settings. Conclusions: With different scoring options available for the PARS, these results provide guidelines for determining response and remission based on the PARS5 and PARS6 scores. Guidelines have implications for use in clinical trials, as well as for assessment of change in clinical practice.10 page(s

Refining Clinical Judgment of Treatment Response and Symptom Remission Identification in Childhood Anxiety Using a Signal Detection Analysis on the Pediatric Anxiety Rating Scale

Objective: The purpose of this study was to determine guidelines for delineating treatment response and symptom remission for children with anxiety disorder based on the five item and Pediatric Anxiety Rating Scale (PARS5), and replicate guidelines using the six item PARS (PARS6). Methods: Participants were 73 children 7–13 years of age with a primary anxiety disorder who received computer-assisted cognitive behavioral therapy for anxiety. Signal detection analyses utilizing receiver operating curve procedures were used to determine optimal guidelines for defining treatment response and symptom remission for youth with anxiety disorders on the PARS5 and PARS6. The percent reduction in anxiety severity was used to predict treatment responder status. The percent reduction in symptoms and posttreatment raw score were used to predict remission status. Results: Optimal prediction of treatment response based on gold standard criteria was achieved at 15–20% reduction in symptoms on the PARS5 (with 20% reduction achieving marginally higher accuracy), and 20% reduction on the PARS6. A 25% reduction in symptoms on the PARS5 or a posttreatment raw score cutoff of 9 optimally predicted remission status. For the PARS6, a cutoff of 35% reduction or a posttreatment score of 11, was considered optimal for determining remission in clinical settings, whereas a 30% reduction or score of 12 was considered optimal for research settings. Conclusions: With different scoring options available for the PARS, these results provide guidelines for determining response and remission based on the PARS5 and PARS6 scores. Guidelines have implications for use in clinical trials, as well as for assessment of change in clinical practice

The Impact of comorbidity profiles on clinical and psychosocial functioning in childhood anxiety disorders

Despite the high rates of comorbidity in pediatric anxiety disorder samples, there are few studies that systematically examine differences in clinical and psychosocial functioning between different comorbidity profiles. Those that have, typically combine youth with comorbid conduct problem and those with comorbid ADHD, despite likely differences in the etiology and course of these conditions. This study compared the profile of children with a primary anxiety disorder without comorbidity to those with different comorbidity profiles in a treatment-seeking sample of 111 children recruited from community mental health settings. Anxiety severity and depressive symptomatology did not vary by comorbidity profile. Anxious children without comorbidity had lower levels of attention problems, rule breaking, aggressive and externalizing behaviors compared to the comorbid ADHD and comorbid conduct problems groups, as well as lower levels of functional impairment and social problems. There were some differences in clinical phenomenology and psychosocial functioning between the comorbid ADHD and comorbid conduct problems groups, with the conduct problems group having higher levels of rule breaking, aggressive and externalizing behaviors, as well as higher levels of functional impairment, providing preliminary evidence of separate clinical profiles.8 page(s

Defining treatment response and symptom remission for anxiety disorders in pediatric autism spectrum disorders using the pediatric anxiety rating scale

This study examined optimal guidelines to assess treatment response and remission for anxiety in youth with autism spectrum disorders (ASD) using the Pediatric Anxiety Rating Scale (PARS). Data was collected for 108 children aged 7–16 years with comorbid anxiety and ASD before and after receiving cognitive behavior therapy. Optimal cut-offs on the PARS were assessed using signal detection analyses using receiver operating characteristic methods. Maximum agreement with response criteria was achieved at 15 % reduction in symptoms on the PARS. Maximum agreement with remission criteria was achieved at 40 % reduction in symptoms, or at a score of 10 or below at post-treatment. Results have implications for standardizing criteria used in research trials and clinical practice. Erratum can be found in Journal of Autism and Developmental Disorders, 45(10), pp 3243-3243.11 page(s