Frustration, Cognition, and Psychophysiology in Dysregulated Children: A Research Domain Criteria Approach.

OBJECTIVE: Dysregulated children experience significant impairment in regulating their affect, behavior, and cognitions and are at risk for numerous adverse sequelae. The unclear phenomenology of their symptoms presents a barrier to evidence-based diagnosis and treatment. METHOD: The cognitive, behavioral, and psychophysiological mechanisms of dysregulation were examined in a mixed clinical and community sample of 294 children ages 7-17 using the Research Domain Criteria constructs of cognitive control and frustrative nonreward. RESULTS: Results showed that caregivers of dysregulated children viewed them as having many more problems with everyday executive function than children with moderate or low levels of psychiatric symptoms; however, during standardized assessments of more complex cognitive control tasks, performance of dysregulated children differed only from children with low symptoms on tests of cognitive flexibility. In addition, when frustrated, dysregulated children performed more poorly on the Go/No-Go Task and demonstrated less autonomic flexibility as indexed by low respiratory sinus arrhythmia and pre-ejection period scores. CONCLUSION: The findings of this study suggest that autonomic inflexibility and impaired cognitive function in the context of frustration may be mechanisms underlying childhood dysregulation.

Examination of Outcomes among Sexual Minorities in Treatment for Obsessive-Compulsive and Related Disorders.

The first-line psychological treatment for obsessive-compulsive and related disorders (OCRDs) is exposure and response prevention (ERP). As the first study to examine treatment outcomes for sexual minorities, it is crucial to examine: (1) how treatment-seeking individuals who identify as sexual minorities compare to heterosexual individuals in symptom severity at admission, length of stay in treatment, and (2) whether ERP is equally effective for sexual minorities. The current study explored these questions in an intensive/residential treatment (IRT) program for OCRDs. Adult participants (N = 191) completed self-reported measures of OCD severity, distress tolerance, and depression at program admission, in the first four weeks of treatment, and at discharge. No differences were found between groups for treatment outcome, although slight differences (non-significant) emerged at baseline for OCRD severity, distress tolerance, and depression. Sexual orientation was not predictive of OCRD severity at weeks 1-4, and number of days spent in treatment was not associated with sexual orientation. This is the first study exploring whether sexual orientation is predictive of treatment outcomes for individuals diagnosed with OCRDs. Results suggest that outcomes did not differ and participation in the program resulted in an overall improvement of symptoms regardless of sexual orientation, however several study limitations are discussed. Future studies should replicate these findings, attempt to collect a larger sample, incorporate qualitative feedback from treatment, and examine outcomes in gender minorities.

Reevaluating the psychometric properties of symptom measures within longitudinal contexts: The Yale-Brown Obsessive Compulsive Scale and Dimensional Obsessive-Compulsive Scale.

As research and clinical settings increasingly emphasize questions of change, it is crucial that our mechanistic and outcome variables are established as reliable and valid measures of such change. However, there is often a mismatch between the purposes for which symptom measures were developed and validated versus their application. Traditional psychometric theory has focused largely on between-person change, whereas increasingly research and clinical questions concern within-person change. We examined the psychometric properties of two commonly used measures of obsessive-compulsive symptoms (Yale-Brown Obsessive Compulsive Scale, YBOCS; Dimensional Obsessive-Compulsive Scale, DOCS) within a longitudinal treatment context (N = 570). Regarding reliability, we applied traditional (i.e., internal consistency at each week) and novel methods that allow for examination of the reliability of both within- and between-person change (i.e., variance partitioning based on generalizability theory). We examined longitudinal concurrent validity by correlating per-person slopes of obsessive-compulsive and depression symptom measures obtained via mixed-effects models. Within-person change reliability was acceptable or good for the YBOCS and DOCS total scores (.77, .83), suggesting that these measures are capable of capturing meaningful changes that exist within persons over time, and between-person change reliability was excellent (.99-1.0). Per-person slopes analyses supported the longitudinal concurrent validity of both measures. Our data support the continued use of the YBOCS and DOCS as measures of obsessive-compulsive symptoms for the purpose of many longitudinal research questions. The current study provides a template for reestablishing the psychometric properties of other commonly used measures in the context of longitudinal investigations. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Core Motivations of Childhood Obsessive-Compulsive Disorder: The Role of Harm Avoidance and Incompleteness.

In an effort to improve patient conceptualization and targeted treatment, researchers have sought to accurately classify OCD subtypes. To date, the most common form of OCD classification has used the content of symptom topography as opposed to functional links between symptoms to categorize OCD. The aim of the current study was to explore the associations between these two forms of OCD classification. Participant topographical symptoms were self-reported using the Obsessive-Compulsive Inventory-Child Version (OCI-CV). Clinicians assessed whether participant symptoms were motivated by harm avoidance and/or incompleteness. Structural equation modeling was employed to explore the associations between harm avoidance and incompleteness and symptom dimensions in youth with OCD. Results showed that harm avoidance was significantly associated with doubting/checking, obsessing, and neutralizing symptoms, whereas incompleteness was associated with doubting/checking, ordering, and neutralizing symptoms. Findings are consistent with child and adult literature and highlight the importance of assessing the underlying function of OC behaviors.

Ahead of the Curve: Responses From Patients in Treatment for Obsessive-Compulsive Disorder to Coronavirus Disease 2019.

Alongside concern about the physical health impacts of the coronavirus disease 2019 (COVID-19) crisis, public health officials have also raised concerns about the potential for massive mental health impact. This has led many to wonder, how are individuals with obsessive-compulsive disorder (OCD), and especially those with contamination fears, doing in the era of COVID-19? We present data from eight patients in our residential treatment program for OCD who were admitted prior to any COVID-19 restrictions and continued in treatment at the facility during the pandemic. Much like the general population, our patients varied in the ways they were impacted by COVID-19, yet the majority experienced improvements in OCD symptoms despite the context. This is not to downplay the many ways in which our patients were personally affected by COVID-19. Rather our patients' relatively resilient responses mirror our program's treatment model, which emphasizes exposure and response prevention (ERP) within the complementary framework of acceptance and commitment therapy (ACT). The intention of this article is to challenge the notion that by definition this population will fare worse than the general public or that ERP cannot proceed effectively during this time. In contrast, we underscore that effective OCD treatment can and should continue in the era of COVID-19.

Disgust propensity and sensitivity in childhood anxiety and obsessive-compulsive disorder: Two constructs differentially related to obsessional content.

The role of disgust in anxiety and related disorders has been extensively studied in adults, however its role in childhood psychopathology is in need of further investigation. The adult literature has suggested that two distinct sub-constructs within "disgust proneness" may differentially predict anxiety-related disorders. Namely, disgust propensity (DP) has been defined as the likelihood an individual will experience a disgust reaction, and disgust sensitivity (DS) as the degree to which an individual is distressed by their experience of disgust. The current study aimed to validate the Disgust Propensity and Sensitivity Scale-Revised (DPSS-R) in a sample of youth receiving intensive services for OCD and anxiety, examine the relationship between disgust sub-constructs and obsessional content in a sample of youth with OCD, and examine the relationship between disgust change and symptom severity at discharge. A confirmatory factor analysis supported a two-factor structure of the DPSS-R. DP was found to be uniquely predictive of contamination obsessions, and DS was found to be uniquely predictive of moral obsessions. Lastly, change in DP, but not DS, predicted overall change in OCD symptom severity. The present study provides a valid measure of DS and DP in youth with anxiety and related disorders, and suggests that subconstructs of disgust may serve as distinct risk factors for obsessional content in youth with OCD. Future research should examine the predictive validity of DP and DS longitudinally, as well as examine effective ways to more effectively target DP with exposure therapy.

Measurement and impacts of intersectionality on obsessive-compulsive disorder symptoms across intensive treatment.

Historically, intensive obsessive-compulsive and related disorder (OCRD) treatment settings have been underrepresentative in terms of patient race and ethnicity. The present study piloted a novel technique to measure multiple marginalized identities and assess their impact on obsessive-compulsive disorder (OCD) symptoms and treatment response across intensive residential treatment (IRT). Participants included 715 residents receiving IRT for OCRD. Measures included the Yale-Brown Obsessive-Compulsive Scale, Dimensional Obsessive-Compulsive Scale (DOCS), Obsessive Beliefs Questionnaire-44, and measures of depression and quality of life. In addition, we piloted a marginalized identity score, an additive measure of intersectionality. Most patients endorsed holding primarily privileged identities. Higher marginalized identity score was significantly correlated with higher depression symptom severity and lower quality of life throughout treatment. Both at baseline and discharge, higher marginalized identity score was significantly and positively correlated with greater OCD symptom severity. Higher marginalized identity score was significantly associated with greater severity of DOCS1, DOCS2, DOCS4, and obsessive beliefs across multiple domains. Consistent with previous literature, patients in our IRT setting were not demographically representative of the general population. Individuals with more marginalized identities endorsed higher symptoms of OCD, obsessive beliefs, OCD dimensions, and depression, as well as lower quality of life at admission and discharge. Results support increased consideration of the role marginalization plays in symptom severity, symptom presentation, and treatment response across treatment settings. Further investigation is warranted to better address the multiplicative effects of holding intersecting marginalized identities and how treatment may be adapted to ameliorate these inequities. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Does Motivation Impact OCD Symptom Severity? An Exploration of Longitudinal Effects.

Understanding the role of patient motivation in OCD treatment is of clinical importance given the requisite autonomous role of patients in Exposure and Response Prevention. The present study investigated state- and trait-like relations between three variables: two previously established motivational constructs, readiness to change (RTC) and committed action (CA), derived from the University of Rhode Island Change Assessment, and OCD symptom severity as measured by the self-report Yale-Brown Obsessive Compulsive Scale (Y-BOCS-SR). Utilizing a random-intercept cross-lagged panel model (RI-CLPM) design, we assessed autoregressive, within-time correlations, and cross-lagged effects of RTC, CA, and Y-BOCS-SR scores at admission, month 1 of treatment, and discharge from an intensive/residential treatment program for OCD. Results revealed significant autoregressive (i.e., state-like) effects for CA and Y-BOCS-SR, negative within-time correlations between state CA and Y-BOCS-SR across all time points, a positive within-time correlation between state CA and RTC at admission, and a cross-lagged effect between state Y-BOCS-SR at month 1 of treatment and state RTC at discharge. Results also demonstrated that the stability of the RTC variable was attributable to trait-like factors in the present sample. This study is novel in its use of RI-CLPM in an OCD sample and represents an important addition to the literature on the longitudinal impacts of dynamic constructs of motivation. Our findings may provide future researchers with strategies to supplement ERP with CA-driven motivational interviewing.

Empirically-derived response trajectories of intensive residential treatment in obsessive-compulsive disorder: A growth mixture modeling approach.

BACKGROUND: This study investigated distinct trajectories of treatment response in a naturalistic intensive/residential treatment (IRT) program for adults with severe obsessive-compulsive disorder (OCD). We hypothesized that: (1) distinct trajectories would emerge and (2) demographic variables, psychiatric comorbidity, OCD symptom subtype, level of insight, previous exposure and response prevention (ERP) treatment, and quality of life, would differentially predict assignment to these trajectories. METHODS: Participants included 305 individuals with primary OCD admitted for IRT. RESULTS: Two trajectories emerged over the course of the first eight weeks of treatment, with the vast majority of participants demonstrating treatment response. The first trajectory (96%, n = 292) showed a negative, linear treatment response (a.k.a. "linear responders") and more severe OCD symptoms at admission. The second trajectory (4%, n = 13) had less severe OCD symptoms at admission and did not exhibit a significant overall change in symptoms over the course of treatment. More specifically, this second trajectory or "u-shaped responders" show a non-significant linear response through week four of treatment, followed by slightly increased symptoms in week five. Assignment to these classes was not differentially predicted by hypothesized predictor variables. LIMITATIONS: Our final model had inconsistent fit indices and small class prevalance of the u-shaped responder group; therefore, model selection was based on both fit indices and substantive meaning. CONCLUSIONS: This study emprically derived two distinct trajectories of OCD symptom severity over the course of IRT. These findings have the potential to refine IRT for patients with severe OCD, and to potentially guide future investigation into the optimal delivery of ERP treatment for OCD generally.

Childhood family adversity and adult cortisol response: The role of observed marital conflict behavior.

Childhood family adversity predicts adult interpersonal behavior and physiological responses to interpersonal stress. Additionally, negative marital behaviors (e.g., hostility and distress maintaining attributions) predict maladaptive stress responses and mental health problems, whereas positive marital behaviors (e.g., acceptance and relationship enhancing attributions) predict adaptive physiological and psychological outcomes. The present study examined potential marital behavior mediators and moderators of the link between childhood adversity and cortisol responses to conflict. In a sample of 218 different-sex newlywed couples, we examined (a) actors' marital conflict behaviors as candidate mediators of the link between childhood adversity and cortisol responses to marital conflict discussions, and (b) partners' marital conflict behaviors as candidate moderators of the relation between childhood adversity and cortisol responses to marital discussions. Path analysis using actor-partner interdependence modeling did not confirm mediation. Instead, wives' childhood family adversity directly predicted husbands' attenuated cortisol responses, and wives' negative behavior predicted wives' attenuated cortisol responses. As hypothesized, wives' negative behaviors moderated the association between husbands' childhood family adversity and husbands' cortisol in response to conflict; husbands showed higher cortisol if they had experienced greater family adversity and if their wives displayed more negative behavior. Results suggest that childhood family adversity may carry forward to shape adult cortisol responses to conflict and highlights the importance of wives' negative behavior for both husbands and wives. These findings add to the family psychology literature by further clarifying how the interaction of stressful childhood experiences and conflict behaviors in marriage are associated with adult physiological responses to conflict. (PsycINFO Database Record

Child Temperament, Maternal Parenting Behavior, and Child Social Functioning.

We examined child temperament, maternal parenting, and the effects of their interactions with each other on child social functioning. A total of 355 children aged 5-18 years old (54% male; mean age=10.8) were evaluated. Regression equations were used to test models of the main and interactive effects of temperament and maternal parenting behavior on the Social Problems and Social Competence Subscales of the Child Behavior Checklist (CBCL), a questionnaire assessing internalizing and externalizing behavior problems in children ages 4 to 18. Higher levels of child Novelty Seeking and Harm Avoidance and lower levels of Persistence were significantly associated with poorer social functioning. When accounting for child temperament, neither maternal parenting nor the interaction between maternal parenting and child temperament were significantly associated with social functioning. However, the interaction between maternal positive involvement and harm avoidance trended toward significance, such that at higher levels of harm avoidance, more extreme levels of maternal positive involvement were related to lower levels of social functioning. Further research on the interplay between child temperament and parenting across different stages of development is warranted.

High level of persistence of pediatric bipolar-I disorder from childhood onto adolescent years: a four year prospective longitudinal follow-up study.

OBJECTIVE: To examine the longitudinal course of pediatric bipolar (BP)-I disorder in youth transitioning from childhood into adolescence. METHODS: We conducted a four year prospective follow-up study of 78 youth with BP-I disorder 6-17 years old at ascertainment followed up into adolescent years (13.4 ± 3.9 years). All subjects were comprehensively assessed with structured diagnostic interviews, neuropsychological testing, psychosocial, educational and treatment history assessments. BP disorder was considered persistent if subjects met full criteria for DSM-IV BP-I disorder at follow-up. RESULTS: Of 78 BP-I participating youth subjects, 57 (73.1%), continued to meet full diagnostic criteria for BP-I Disorder. Of those with a non-persistent course, only 6.4% (n = 5) were euthymic (i.e., syndromatic and symptomatic remission) at the 4-year follow-up and were not receiving pharmacotherapy for the disorder. The other non-persistent cases either continued to have subthreshold BP-I disorder (n = 5, 6.4%), met full (n = 3, 3.8%) or subthreshold (n = 1, 1.3%) criteria for major depression, or were euthymic but were treated for the disorder (n = 7, 9.0%). Full persistence was associated with higher rates of major depression and disruptive behavior disorders at the follow-up assessment and higher use of stimulant medicines at the baseline assessment. Non-Peristent BP-I was also characterized by high levels of dysfunction and morbidity. CONCLUSIONS: This four year follow-up shows that the majority of BP-I disorder youth continue to experience persistent disorder into their mid and late adolescent years and its persistence is associated with high levels of morbidity and disability. Persistence of subsyndromal forms of bipolar disorder was also associated with dysfunction and morbidity.