Study finds family-based exposure therapy effective treatment for young children with OCD

What do you think of this article on kids and OCD? "Bradley Hasbro Children’s Research Center study finds family-based exposure therapy effective treatment for young children with OCD 5/5/2014 • Children five to eight years old with emerging OCD can benefit from therapies used for older children A new study from the Bradley Hasbro Children’s Research Center has found that family-based cognitive behavioral therapy (CBT) is beneficial to young children between the ages of five and eight with Obsessive-Compulsive Disorder (OCD). The study, now published online in JAMA Psychiatry, found developmentally sensitive family-based CBT that included exposure/response prevention (EX/RP) was more effective in reducing OCD symptoms and functional impairment in this age group than a similarly structured relaxation program. Jennifer Freeman, PhD, a staff psychologist at the Bradley Hasbro Children’s Research Center and clinical co-director of the Intensive Program for OCD at Bradley Hospital, led the study. “CBT has been established as an effective form of OCD treatment in older children and adolescents, but its effect on young children has not been thoroughly examined,” said Freeman. “These findings have significant public health implications, as they support the idea that very young children with emerging OCD can benefit from behavioral treatment.” During the 14-week randomized, controlled trial, which was conducted at three academic medical centers over a five-year period, the team studied 127 children between the ages of five and eight with a primary diagnosis of OCD. Each child received either family-based CBT with EX/RP or family-based relaxation therapy. The family-based CBT focused on providing the child and parent “tools” to understand, manage and reduce OCD symptoms. This includes psychoeducation, parenting strategies, and family-based exposure treatment, so children can gradually practice facing feared situations while learning to tolerate anxious feelings. The family-based relaxation therapy focused on learning about feelings and implementing muscle relaxation strategies aimed at lowering the child’s anxiety. At the end of the trial period, 72 percent of children receiving CBT with EX/RP were rated as “much improved” or “very much improved” on the Clinical Global Impression-Improvement scale, versus 41 percent of children receiving the family-based relaxation therapy. According to Freeman, the traditional approach for children this young presenting with OCD symptoms has been to watch and wait. “This study has shown that children with early onset OCD are very much able to benefit from a treatment approach that is uniquely tailored to their developmental needs and family context,” said Freeman. “Family-based EX/RP treatment is effective, tolerable and acceptable to young children and their families.” Freeman hopes that the family-based CBT model will become the first-line choice for young children with OCD in community mental health clinics where they first present for treatment. Earlier intervention may better address the chronic issues many children have with OCD, as well as the impact the debilitating illness can have on their overall development. “We use this family-based CBT model for treating children in this age range in both our Pediatric Anxiety Research Clinic and our Intensive Outpatient Program with much success,” said Freeman. “My hope is that others will utilize this treatment model to the benefit of young children at the onset of their illness.” “The findings from this study support extending downward the age range that can benefit from CBT with EX/RP for pediatric OCD treatment,” said Freeman. “With appropriate parental support, young children with OCD can make significant gains beyond what can be expected from having parents attempt to teach relaxation strategies to their children with OCD.” This study was funded by the National Institute of Mental Health (NIMH) under grant number 1R01MH079217. Freeman’s principal affiliation is the Bradley Hasbro Children’s Research Center, a division of the Lifespan health system in Rhode Island. She is also co-director of the Pediatric Anxiety Research Clinic at the Bradley Hasbro Children’s Research Center and clinical co-director of the Intensive Program for OCD at Bradley Hospital. She is an associate professor (research) at The Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior." For more information on PTSD and other mental health resources, please visit, Aspira Continuing Education Online Courses or our Anxiety Disorders CE Course

Mothers and OCD children trapped in rituals have impaired relationships

News Release: Tuesday, April 10, 2012

A new study from Case Western Reserve University finds mothers tend to be more critical of children with obsessive-compulsive disorder than they are of other children in the family. And, that parental criticism is linked to poorer outcomes for the child after treatment.

Parent criticism has been associated with child anxiety in the past, however, researchers wanted to find out if this is a characteristic of the parent or something specific to the relationship between the anxious child and the parent.

“This suggests that mothers of anxious children are not overly critical parents in general. Instead they seem to be more critical of a child with OCD than they are of other children in the home,” said Amy Przeworski, assistant professor of psychology. She is the lead author of the study, “Maternal and Child Expressed Emotion as Predictors of Treatment Response in Pediatric Obsessive-Compulsive Disorder,” in the recent journal, Child Psychiatry & Human Development.

OCD is found in one in 200 children, according to the American Academy of Child and Adolescent Psychiatry. The psychological disorder overcomes individuals with repetitive thoughts that lead to anxiety, which is then acted out in exacting routines or behaviors that can range from foot tapping to eating rituals to school or bedtime preparations.

This research evolved from other studies that found parental criticism is associated with less success in therapy and a relapse of behavior.

“Parents’ criticism may be a reaction to the child’s anxiety. This research is not blaming the parent for the child’s OCD. But it does suggest that the relationship between parents and children with OCD is important and should be a focus of treatment. This means that parents can help children with OCD to get better.” Przeworski says.

“OCD sneaks up on the kids and parents,” Przeworski says.

The psychology professor, who specializes in anxiety disorders, says some parents become concerned when their children show some early warning signs for OCD:

• Rigidity in a child, with things routinely done or said in exactly the same way or order.
• Asking for reassurance many times in the day.
• Repetition of a task from tapping the foot, checking on the stove, washing hands that the child cannot stop when asked.
• Routines that have prescribed patterns or are excessive lengthy: An example is a two-hour shower or raw and chapped hands that look like the child is wearing red gloves.
• Bedtime or dinner rituals, where there is a prescribed order for eating food, placement of food on the plate, etc.
• Temper tantrums where the child goes beyond being stubborn but has anxiety associated with them.
• Children want symmetry in appearance or things around them.

Parents initially may think it is a phase, a habit or stubbornness. Over time, the behaviors become so exacting that the child and family members have to act in prescribed ways. Parents may end up criticizing the child in an effort to get them to drop obsessive-compulsive behaviors.

The researchers videotaped interviews with 62 mother-child pairs just before the child’s OCD treatment began. Children either had medication, therapy, a combination of the two, or a placebo. The children were between the ages of 7 and 17.

Because most mothers bring their children for treatment appointments, the researchers focused on the mother’s view of their children. Mothers were asked to give a five-minute description of their relationship with the child with OCD and the mother’s relationship with the sibling closest in age to the child with OCD. The researchers asked the children to describe their relationships with their mothers and fathers.

The researchers examined the presence of criticism and emotional over-involvement (over-protection or excessive self-sacrificing) in these descriptions. The tone of the OCD child and parent tended toward criticism, they said. The other sibling received more loving expressions. Parent criticism was associated with poorer child functioning after treatment.

Przeworski said treatment of OCD has good results, but many times parents misjudge these rigid routines as stubbornness or “just going through a phase” until the behavior takes over family life. Then parents realize the behavior requires therapy professional counselor continuing education

Collaborating with Przeworski were: Lori Zoellner from University of Washington; Martin E. Franklin and Edna B. Foa, University of Pennsylvania School of Medicine; and Abbe Garcia and Jennifer Freeman, Brown University. The study was supported with funds from the National Institute of Mental Health.


Posted by: Susan Griffith, April 10, 2012 01:19 PM | News Topics: Official Release