An examination of maternal rearing and the development of inflated responsibility beliefs in paediatric OCD

Abstract

OCD in children and adolescents is a severe and debilitating clinical disorder, typified by time consuming and distressing obsessions and/or compulsions. Unfortunately, the sufferer is often beset by considerable psychosocial impairment, distress and comorbidities. The family of children and adolescents with OCD is especially impacted, with parents often engaging in family accommodation of symptoms, as well as maladaptive rearing strategies. Of note, cognitive behavioural theories of OCD propose that obsessional beliefs about inflated responsibility for preventing harm may have their origins during childhood, as a consequence of such rearing processes. However, research into rearing behaviours in paediatric OCD is limited relative to the broader literature examining rearing processes associated with childhood anxiety disorders. This gap exists despite the significant family dysfunction, heightened parental distress, and aberrant parent-child interactions observed in these families when compared to other clinical comparison groups. The current program of research aimed to address current gaps in the literature and is comprised of three empirical studies. Study one aimed to test current theoretical models of the origins of responsibility beliefs by examining the associations between perceived parental rearing behaviours, inflated responsibility/threat beliefs, and OCD severity and impairment in a sample of children (aged 7 – 12 years; n = 79) and adolescents (aged 13 – 17 years; n = 57) with primary OCD. Results indicated that, across age groups, greater child perceptions of overprotection and anxious rearing were associated with increased inflated responsibility beliefs. For adolescents, an indirect association between anxious rearing and OCD-related impairment via inflated responsibility beliefs was also found. Results support theoretical accounts and highlight the role of specific rearing behaviours associated with inflated responsibility biases and OCD-related impairment. Measurement of parental rearing is often challenging. Currently there are few well-validated concurrent measures of both child and parent perceived rearing behaviours, and none of which have been validated for paediatric OCD specifically. Therefore, study two aimed to examine the factor structure of the EMBU child and parent versions in a sample of children and youth with OCD (n = 176), and their mothers (n = 162). This study also reported on the associations between factors and clinical correlates of OCD. For mothers, a 4-factor model (overprotection, anxious rearing, rejection and emotional warmth) provided the best fit. For children and adolescents however, a higher order model was the best fit, with child perceptions of overprotection and anxious rearing loading onto a broader ‘control’ dimension. Greater mother and child perceived negative rearing behaviours (e.g., rejection) and lower perceived positive behaviours (e.g., emotional warmth) were associated with increased OCD severity, comorbid symptoms (i.e., externalising symptoms, depressive symptoms) and impairment. The EMBU-C/P provides a useful and meaningful measure of multi-informant perceptions of parental rearing within paediatric OCD. Study three aimed to examine differences in observed mother-child behaviours during a problem-solving discussion task, to determine the quality of rearing associated with paediatric OCD. This study advanced previous research by incorporating a large clinical sample and non-clinical comparison group, examined differences across age ranges (children relative to adolescents), explored associations between self-report and observed rearing behaviours, and examined associations between observed rearing with OCD-related symptoms. The large clinical sample was comprised of 111 youth with primary OCD (n = 55, aged 7 – 11 years; n = 56, aged 12 – 17 years), and a non-clinical comparison of 66 children (n = 35, aged 7 – 11 years; n = 31, aged 12 – 17 years). Relative to non-clinical mothers, mothers of children with OCD were observed to be more aversive in the OCD dyads irrespective of child age. Furthermore, mothers of adolescents with OCD were observed to be significantly less autonomy granting than mothers of adolescents with no clinical diagnoses, whereas mothers of children with OCD enhanced their child’s responsibility for problem solution more so than comparisons. Both child and parent observed behaviours (e.g., autonomy granting, warmth, aversiveness, confidence, reassurance giving) were associated with a number of clinical variables (e.g., impairment, severity, family accommodation). This thesis provides a clearer understanding of the nature of maternal rearing in paediatric OCD, and its’ associations with key clinical variables such as inflated responsibility beliefs, comorbid symptoms, and OCD symptomatology. Findings are discussed in relation to the complexity of assessing rearing in OCD, and in providing possible avenues for enhancing current best-practice treatments of paediatric OCD. Namely, via addressing parental rearing behaviours (i.e., overprotection, anxious rearing, autonomy granting) and improving parent-child interactions within the home. Furthermore, based upon the current findings, it appears useful to focus on changing mothers’ expectations regarding child responsibility for coping with problems within the realms of what is developmentally appropriate for their developmental stage. That is, to avoid placing enhanced responsibility on younger children too early, yet, to ensure parents flexibly adapt their expectations for an adolescent’s increasing independence and allow older offspring greater autonomy and opportunity to develop coping skills. A greater understanding of the developmental-familial context within which paediatric OCD occurs is important in future endeavours targeted at prevention and intervention.