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  • Avoidance, Insight, Impairment Recognition Concordance, and Cognitive-Behavioral Therapy Outcomes in Pediatric Obsessive-Compulsive Disorder

    Author(s)
    Selles, RR
    Højgaard, DRMA
    Ivarsson, T
    Thomsen, PH
    McBride, NM
    Storch, EA
    Geller, D
    Wilhelm, S
    Farrell, LJ
    Waters, AM
    Mathieu, S
    Stewart, SE
    Griffith University Author(s)
    Farrell, Lara J.
    Waters, Allison M.
    Year published
    2019
    Metadata
    Show full item record
    Abstract
    Objective: Insight and avoidance are commonly discussed factors in obsessive-compulsive disorder (OCD) that have demonstrated associations with increased severity as well as reduced treatment response in adults, but these factors have not been sufficiently examined in pediatric OCD. This study examined the impacts of avoidance, insight, and impairment recognition concordance on cognitive-behavioral therapy (CBT) outcomes as well as impacts of CBT on insight and avoidance in a large sample of youths affected by OCD. Method: Data from 573 OCD-affected youths enrolled in CBT trials were aggregated. Children’s Yale-Brown ...
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    Objective: Insight and avoidance are commonly discussed factors in obsessive-compulsive disorder (OCD) that have demonstrated associations with increased severity as well as reduced treatment response in adults, but these factors have not been sufficiently examined in pediatric OCD. This study examined the impacts of avoidance, insight, and impairment recognition concordance on cognitive-behavioral therapy (CBT) outcomes as well as impacts of CBT on insight and avoidance in a large sample of youths affected by OCD. Method: Data from 573 OCD-affected youths enrolled in CBT trials were aggregated. Children’s Yale-Brown Obsessive-Compulsive Scale items measured treatment response, insight, and avoidance. Standardized differences between child and parent ratings of impairment were used to calculate impairment recognition concordance. Binary logistic regression was used to identify variables associated with treatment response. Results: Greater avoidance, limited child recognition of impairment, older age, and lower baseline severity predicted reduced likelihood of treatment response, but insight did not. Both insight and avoidance improved significantly following CBT. Response rates were lower when posttreatment insight and avoidance were worse. Conclusion: Contrasting with prevailing belief, poor insight does not appear to limit CBT response potential in pediatric OCD. Avoidance and impairment recognition are understudied CBT response predictors and warrant further consideration in pediatric OCD. Clinicians should attend to these factors to optimize outcomes for children affected by this common, debilitating illness.
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    Journal Title
    Journal of the American Academy of Child and Adolescent Psychiatry
    DOI
    https://doi.org/10.1016/j.jaac.2019.05.030
    Note
    This publication has been entered into Griffith Research Online as an Advanced Online Version.
    Subject
    Biomedical and clinical sciences
    Psychology
    Cognitive and computational psychology
    exposure and response prevention
    mega-analysis
    predictors
    symptom recognition
    treatment response
    Publication URI
    http://hdl.handle.net/10072/391256
    Collection
    • Journal articles

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