The content of the obsessions and compulsions varies among individuals with obsessive-compulsive disorder (OCD); however, there are five themes that are commonly experienced across both children and adults: contamination, symmetry/ordering, forbidden or taboo thoughts, harm, and hoarding. Notably, OCD becomes more gender balanced into adolescence and adulthood. Comorbid diagnoses are common among youth with OCD. Common comorbid disorders include anxiety disorders, tic disorders, attention deficit hyperactivity disorder (ADHD), and major depressive disorder. The etiology of OCD is multidetermined with behavioral, cognitive, genetic, and biological factors being implicated. This chapter describes three successful cognitive behavioral therapy (CBT) interventions: CBT with exposure and response prevention (ERP), family-based CBT with ERP, and cognitive therapy interventions that can be used in conjunction with ERP. Treatment guidelines for pediatric OCD suggest the most efficacious treatment is CBT with ERP, either alone or in combination with pharmaco-therapy for the most severe cases.
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- Go to chapter: Evidence-Based Interventions for Obsessive-Compulsive Disorder in Children and Adolescents
This book deals with evidence-based mental health and learning interventions for children and adolescents, and provides guidance on implementation in practice. It is a compendium of proven treatment strategies for resolving more than 40 of the most pressing and prevalent issues facing young people, and provides immediate guidance and uniform step-by-step instructions for resolving issues ranging from psychopathological disorders to academic problems, and is of relevance for both school-based and clinically-based practice. Issues covered include crisis interventions and response, social and emotional issues, academic/learning issues, psychopathological disorders, neuropsychological disorders, and the behavioral management of childhood health issues. The book covers several fields of study including applied settings, school crises, natural disasters, school violence, suicidal behavior, childhood grief, reading disabilities, math disabilities, written-language disorders, homework compliance, anger and aggression, bullying, and attention deficit hyperactivity disorder (ADHD). Each chapter follows a consistent format including a brief description of the problem and associated characteristics, etiology and contributing factors, and three evidence-based, step-by-step sets of instructions for implementation. Additionally, each chapter provides several websites offering further information about the topic.
- Go to article: Psychosocial Treatment to Improve Resilience and Reduce Impairment in Youth With Tics: An Intervention Case Series of Eight Youth
Psychosocial Treatment to Improve Resilience and Reduce Impairment in Youth With Tics: An Intervention Case Series of Eight Youth
Background: Many youth with tic disorders experience distress about having tics and how others may perceive them. Such symptoms are often more impairing and distressing than the tics themselves and negatively impact self-concept, psychosocial functioning, and quality of life. Objective: Although there exist pharmacological and behavioral treatments that target the frequency and severity of tics, no intervention has been developed specifically to help youth with tics cope with their condition and limit associated functional impairment and distress. With this in mind, we report an intervention case series of eight youth (ages 8–16 years) supporting the initial efficacy of a cognitive-behavioral therapy program entitled “Living with Tics” that promotes coping and resiliency among youth with tics. Method: Eight youth with a principal diagnosis of a tic disorder (i.e., Tourette syndrome [N = 6]; Chronic Tic Disorder [N = 2]) and associated psychosocial impairment participated. Assessments were conducted at screening, pretreatment, and posttreatment by trained raters. Treatment consisted of 10 weekly individual psychotherapy session focused on improving coping with having tics. Results: Six of eight youth were considered treatment responders. On average, participants exhibited meaningful reductions in tic-related impairment, anxiety, and overall tic severity as well as improvements in self-concept and quality of life. Conclusions: These data provide preliminary evidence for conducting a larger controlled trial to examine the utility of the Living with Tics psychosocial intervention for promoting adaptive functioning among youth with tics.
- Go to article: Tailoring the Unified Protocol for Adolescents for a Stepped-Care Approach: Case Exemplars
Emotional disorders, including anxiety, depressive, and obsessive-compulsive spectrum disorders are prevalent and impairing for youth. Dissemination efforts have been implemented to address these disorders in youth, but these are limited by cost and barriers to accessing mental health services. Stepped care is a method of treatment delivery meant to be cost-effective and less time intensive than administering a full treatment manual. Much, if not all of the research, assessing the efficacy of stepped care delivery has utilized disorder-specific treatment manuals. However, transdiagnostic stepped care approaches may prove more efficacious given that youth commonly present to treatment with more than one disorder and that such problems are not always comprehensively assessed at intake. This manuscript provides details regarding the implementation of a transdiagnostic stepped-care delivery (UPA-SC) using three case examples. Youth evidenced significant improvement in anxiety, depression, and quality of life. Future work to investigate the efficacy of UPA-SC in a larger, more heterogeneous sample of youth may be warranted.
- Go to article: Orthorexia Nervosa in China: An Exploration of Phenomenology and Clinical Correlates Among University Students
Orthorexia Nervosa in China: An Exploration of Phenomenology and Clinical Correlates Among University Students
Orthorexia nervosa, characterized by pathological preoccupation with healthy eating and food purity, is conceptualized as being linked to cultural concepts of health pervasive in contemporary Western societies. However, little is known about the phenomenology and clinical correlates of orthorexia nervosa in non-Western cultures. The current study examined symptoms of orthorexia nervosa, obsessive-compulsive disorder, depression, anxiety, and fear of negative evaluation among 418 Chinese university students. A minority of participants endorsed frequent or impairing orthorexia nervosa symptoms, and females reported slightly higher severity of orthorexia nervosa symptoms than males. Orthorexia nervosa symptom severity was moderately associated with obsessive-compulsive and anxiety symptoms, and weakly associated with depressive symptoms and fear of negative evaluation. Although this study generates initial data about orthorexia nervosa among Chinese students, further research is greatly needed to establish the prevalence and clinical characteristics of orthorexia nervosa in Western and Non-Western cultures.
- Go to article: Obsessive-Compulsive Symptoms and Beliefs in Adolescents: A Cross-Sectional Examination of Cognitive Models
Obsessive-Compulsive Symptoms and Beliefs in Adolescents: A Cross-Sectional Examination of Cognitive Models
Cognitive models of obsessive-compulsive disorder (OCD) posit that particular beliefs transform normal intrusions into disturbing obsessions. A wealth of data shows that such beliefs and obsessive-compulsive (OC) symptoms are related in adults. However, there is markedly less information regarding OCD-related beliefs in youth. The purpose of this study was to assess the relation between OCD-related beliefs and OC symptoms in unselected adolescents (ages 13–18 years; N = 159). Findings from questionnaires completed on the Internet were consistent with previous findings in adults. Increased levels of OCD-related beliefs were related to increased levels of OC symptoms. Perfectionism and certainty beliefs had a specific relation with symmetry and ordering symptoms. Contrary to expectation, levels of OCD-related beliefs in this unselected sample were similar to those found in prior studies of youth diagnosed with OCD. Implications, limitations, and future directions for the study of OCD-related beliefs in youth are discussed.
- Go to article: Clinician Perspectives on the Impact of COVID-19 on the Treatment of Adults and Youth with Anxiety
We describe the perceptions of mental health clinicians practicing in the United States about the effects of the COVID-19 pandemic on the presentation and treatment course of active clients with anxiety. Clinician participants reported on client symptomology at the beginning of treatment, just before (prior to March 2020), and at a mid-pandemic timepoint (December 2020/January 2021). An initial sample of 70 clinicians responded to a survey assessing their clients’ overall anxiety severity, anxiety sensitivity, pathological uncertainty, family accommodation, and avoidance levels. Of these, 54 clinician responses were included in study analyses, providing detailed clinical information on 81 clients. Findings suggest that the COVID-19 pandemic was associated with increases in anxiety severity in the majority of clients; overall, clinicians reported that 53% of clients had symptoms worsen due to COVID-19 and that only 16% experienced improvement of symptoms during treatment. Those who had lower levels of avoidance pre-pandemic and those who increased their frequency of treatment were more likely to experience increases in anxiety severity by the mid-pandemic timepoint. Further research is needed to understand the extended effects of the COVID-19 pandemic on anxiety symptomology and treatment.
- Go to article: Challenges for Evidence-Based Care for Children With Developmental Delays in Nicaragua
Evidence of successful models for promoting early childhood development and for effectively addressing developmental delays is available, yet the adoption of evidence-based strategies is limited in low-income countries. Nicaragua, a low-income country on the Central American isthmus, faces policy-, organizational-, and community-level obstacles which prevent families from receiving the benefits of early child development programs as well as other necessary services for children at risk of or with developmental delays. Failing to address developmental delays in a timely manner leads to detrimental social and economic consequences for families and society at large. In this article, we examine existing information on early childhood development in Nicaragua and discuss some programmatic implications for the recognition and early intervention of developmental delays in Nicaragua.