- Email: [email protected]
51.0 Treatment Updates in Pediatric Obsessive-Compulsive Disorder
SYMPOSIA 50.2 – 51.0
Supported by the Research Fund of the University of Antwerp 41/ FA040300/FFB130145 and the Research Foundation—Flanders (FWOAspirant) http://dx.doi.org/10.1016/j.jaac.2016.07.416
50.2 DIGITAL-CONTROLLING BEHAVIORS AMONG EARLY ADOLESCENTS WITH MENTAL ILLNESS SYMPTOMS Christopher Houck, PhD, Rhode Island Hospital, 1 Hoppin St Ste 204, Providence, RI 02903-4141 Objectives: Technology has had a profound impact on the ways in which adolescents communicate. This increase in the frequency of digital communication can also result in opportunities for abuse, particularly in controlling or monitoring behaviors conducted through social networks or digital devices. However, little data on these types of controlling behaviors among early adolescents have been reported. Methods: Adolescents with mental health symptoms who were enrolled in a sexual risk prevention program were assessed in the ninth grade (mean age ¼ 15.08 years, SD ¼ 0.53). A number of respondents (220 of 359) endorsed a dating partner (47 percent male; 37 percent Caucasian; 39 percent Latino). Participants completed questions on laptop computers about whether their partner had engaged in six controlling behaviors related to technology, including requests for passwords, reviewing cell phone call lists, or reading text messages to monitor their partner’s activity. They also completed subscales of the Conflict in Adolescent Dating Relationships Inventory (CADRI) related to threatening behaviors and physical abuse in their relationship. Results: Approximately 40 percent of adolescents reported that their partner had engaged in some kind of digital controlling behavior. The most common forms of digital control exerted were “asked for your personal password to a social networking site so that he/she can check up on you” (28 percent) and “checked through your text messages to see if you have spoken to someone they don’t trust” (23 percent). Thirty percent of adolescents reported that their partner had engaged in more than one of the six behaviors. The total number of digital controlling behaviors reported was correlated significantly with reports of being victimized by partners by threatening behaviors (r ¼ 0.30) and by physical abuse (r ¼ 0.32). Digital controlling behaviors were also significantly related to perpetration of threats (r ¼ 0.28) and physical abuse (r ¼ 0.29). Conclusions: Many ninth graders with mental health symptoms in dating relationships experience controlling behaviors exerted by partners through monitoring of their digital communication. These behaviors are related to both victimization and perpetration of partner violence. Digital communication behaviors may be a marker of unhealthy relationships that can be assessed by providers.
ADOL PRE RF Supported by National Institute of Nursing Research Grant NR011906 http://dx.doi.org/10.1016/j.jaac.2016.07.417
50.3 THE CO-OCCURRENCE OF SEXTING AND CYBER DATING ABUSE
Conclusions: Intervention programs targeting one behavior should concomitantly address the other.
ADOL PRE SEX Supported by NIH National Institute of Child Health & Human Development Grant K23HD059916 and National Institute of Justice (NIJ) award 2012-WG-BX-0005 http://dx.doi.org/10.1016/j.jaac.2016.07.418
50.4 DATING VIOLENCE AND DIGITAL ABUSE AMONG HIGH-RISK ADOLESCENT GIRLS Christie Rizzo, PhD, Applied Psychology, Northeastern University, 360 Huntington Ave, INV 404, Boston, MA 02115; Meredith Joppa, PhD Objectives: Despite a growing recognition that technology-mediated communication is central to the lives of adolescents, little research has been published on the topic of cyber dating abuse. The few studies that exist have focused on community sample groups of youth, rather than high risk sample groups, who frequently present for mental health services. The goals of the study were as follows: 1) to observe the prevalence of cyber dating abuse among a high risk sample group of adolescent girls with histories of physical dating violence (DV); 2) to measure the longitudinal relationships between digital and in-person DV; and 3) to determine the impact of digital abuse on common DV correlates, such as depressive symptoms. Methods: Data are from a randomized controlled trial of a DV prevention program for high risk adolescent girls. All participants (n ¼ 109) had a history of physical dating violence perpetration or victimization, identified through school-based screening procedures using the Conflict in Adolescent Dating Relationships Inventory. Participants were ages 14–17 years (mean ¼ 15.75), and racial/ethnic distribution was 50 percent Hispanic, 35 percent AfricanAmerican, 22 percent White, eight percent American Indian, and three percent Asian. Students (82 percent) qualified for free or reduced-price lunches. Participants completed an audio-assisted survey battery on laptop computers at four time points over nine months. Results: Adolescent girls with a history DV frequently engage in cyber-controlling behaviors (33–66 percent). Cross-lagged analyses indicate reciprocal relations between these variables over time, with digital abuse perpetration predicting subsequent in-person abuse perpetration and vice versa (p < 0.05). Digital abuse, but not in-person abuse, was found to predict subsequent increases in depressive symptomatology from baseline to six months (p < 0.01). These temporal associations were not attributable to intervention condition as this was controlled statistically. Conclusions: Digital and in-person forms of DV were prevalent in this high risk sample and related reciprocally over time. Even among girls with frequent in-person DV experiences, digital abuse contributed significantly to increases in depressive symptomatology. These data suggest that digital dating abuse can have a significant impact on mental health, even among high risk groups, and that providers may want to include assessment of digital abuse in their evaluation procedures.
ADOL AGG Supported by NIMH Grant K23 MH086328 http://dx.doi.org/10.1016/j.jaac.2016.07.419
Jeff R. Temple, PhD, UTMB Health, 301 University Blvd, Galveston, TX 77555-0587 Objectives: Although online dating abuse and teen sexting have received a great deal of media attention and an increasing amount of research prominence, less is known about whether and how these behaviors co-occur. Methods: By use of our ongoing longitudinal sample group (n ¼ 1042; age at recruitment ¼ 15 years; six years of data collected already), we use latent class analysis to examine the following: 1) whether cyber dating abuse and sexting co-occur; and 2) whether youth who engage in both sexting and cyber dating abuse have more mental symptoms (depression, anxiety, hostility) than youth who engage in neither or “only” one type of behavior. Results: Youth involved in sexting and cyber dating abuse tend to stay engaged in these behaviors over time, and they are more susceptible to experiencing poor mental health.
J OURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016
SYMPOSIUM 51 TREATMENT UPDATES IN PEDIATRIC OBSESSIVECOMPULSIVE DISORDER Joseph McGuire, PhD, Semel Institute of Neuroscience and Human Behavior, University of California Los Angeles, 760 Westwood Plz # 48-228B, Los Angeles, CA 90024; John T. Walkup, MD Objectives: This symposium provides treatment updates in pediatric OCD based on empirically supported research.
www.jaacap.org
S339
SYMPOSIA 51.1 – 51.3
Methods: Dr. Joseph McGuire will present data on the mechanisms of fear, learning, and extinction in youth with OCD. Dr. John Piacentini will present data on the neural correlates of OCD symptom dimensions before and after CBT using magnetic resonance spectroscopic imaging (MRSi). Dr. Tord Ivarsson will present data on a large-scale, stepped-care clinical trial that investigated the benefit of a typical course of CBT and examined the impact of continued CBT or sertraline for youth who were partially responsive and/ or nonresponsive to CBT. Dr. Eric A. Storch will present data on a recently completed randomized clinical trial that examined whether CBT augmented with d-cycloserine (DCS) or CBT augmented with placebo had greater effects in reducing OCD symptom severity. Finally, Dr. S. Evelyn Stewart will present data on the feasibility and efficacy of a novel group family approach to CBT. Results: Dr. McGuire’s research suggests that youth with OCD have impaired inhibitory learning and/or contingency awareness during extinction. Dr. Piacentini’s findings provide data to support the glutamatergic hypothesis of OCD and describe specific neural markers that predicted OCD symptom dimension changes. Dr. Ivarsson’s research highlights the therapeutic benefit of CBT for many youths with OCD and suggests that CBT and sertraline are similarly beneficial for youth who do not initially respond to CBT. Dr. Storch’s research suggests that CBT augmented with DCS does not universally outperform CBT augmented with placebo and noted no moderating effect of antidepressant medication for DCS augmentation. Finally, Dr. Stewart’s findings demonstrate the feasibility and broad therapeutic benefit of a group family-based CBT approach and highlights the particular benefit of increasing parental distress tolerance. Conclusions: As these findings carry implications for the treatment of pediatric OCD, Dr. John T. Walkup will discuss these findings and contextualize them within the broader OCD literature.
CBT OCD TREAT http://dx.doi.org/10.1016/j.jaac.2016.07.421
51.1 FEAR EXTINCTION IN PEDIATRIC OBSESSIVECOMPULSIVE DISORDER Joseph McGuire, PhD, Semel Institute of Neuroscience and Human Behavior, University of California Los Angeles, 760 Westwood Plz # 48-228B, Los Angeles, CA 90024; Scott P. Orr, PhD; Daniel A. Geller, MD; Monica S. Wu, MA; Brent J. Small, PhD; Adam B. Lewin, ABPP, PhD; Sabine Wilhelm, PhD; Tanya K. Murphy, MD, MS; Daniel Pine, MD; Eric A. Storch, PhD Objectives: Fear acquisition and extinction are central constructs in the cognitive-behavioral model of OCD, which underlies exposure-based CBT. Youth with OCD may have impairments in fear acquisition and extinction that carry treatment implications. The present study examined these processes using a differential conditioning procedure. Methods: A number of youth (N ¼ 41; 19 OCD, 22 community comparisons) completed a battery of clinical interviews, rating scales, and a differential conditioning task that included habituation, acquisition, and extinction phases. Skin conductance response (SCR) served as the primary dependent measure. Results: During habituation, no difference between groups was observed. During acquisition, differential fear conditioning was observed across participants as proven by larger SCRs to the CS+ compared with CS; there were no between-group differences. Across all of the participants, the number and frequency of OCD symptoms and anxiety severity were associated with greater reactivity to stimuli during acquisition. During extinction, a three-way interaction and follow-up tests revealed that youth with OCD showed a different pattern of SCR extinction compared with the community comparison group. Conclusions: Youth with OCD exhibit a different pattern of fear extinction relative to community comparisons. This may be attributed to impaired inhibitory learning and contingency awareness in extinction. Findings suggest the potential benefit of using inhibitory learning principles in CBT for youth with OCD and/or augmentative retraining interventions before CBT to reduce threat bias and improve contingency detection.
ANX
S340
www.jaacap.org
Supported by NIH Research Supplement Grant R01MH093381-02S1 http://dx.doi.org/10.1016/j.jaac.2016.07.422
51.2 NEURAL CORRELATES OF COGNITIVEBEHAVIORAL THERAPY–RELATED CHANGES IN PEDIATRIC OBSESSIVE-COMPULSIVE DISORDER SYMPTOM DIMENSIONS John Piacentini, PhD, University of California, Los Angeles, 760 Westwood Plz, Los Angeles, CA 90095-8353; Joseph O’Neill, PhD; Susanna Chang; Allison Vreeland, BA; James T. McCracken, MD Objectives: The goal of this session is to examine the neural correlates of empirically derived OCD symptom dimensions at baseline, as well as changes in these symptom dimensions following exposure-based CBT. Methods: Youth (n ¼ 60; ages 8–17 years) with OCD underwent magnetic resonance spectroscopic imaging (MRSi) and were randomized to CBT or waitlist. All youth underwent reimaging at end of condition, with waitlisted youth who received CBT, and after treatment. Youth completed a comprehensive assessment of symptom severity [Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS)], functional status [Child Obsessive-Compulsive Impact Scale-Revised, Child Behavior Checklist (CBCL)], and treatment outcome [CY-BOCS; Clinical Global Impression—Global Improvement (CGI-I)]. OCD symptom dimensions at baseline and after treatment were derived from JAACAP 2008;47:763–772. This procedure yielded separate scores for hoarding, obsessions, contamination/cleaning, and symmetry/ordering factors. Results: Overall, examination of the primary outcome measures (CY-BOCS total score; CGI-I) identified significant relationships between multiple MRSi markers (primarily glutamate) and CBT response. Specific to this presentation, scores for each of the four OCD symptom factors showed a significant (p < 0.001) decrease pre-post-CBT. However, the strongest imaging findings emerged for contamination/cleaning symptoms. More specifically, levels of pretreatment of glutamate predicted worse contamination/cleaning symptoms at posttreatment and, relatedly, a smaller decrease in these symptoms over the period of treatment (p < 0.05). Conclusions: Findings from the larger study provide additional support for the glutamatergic hypothesis of OCD. Although the specificity of our MRSi findings to contamination/cleaning symptoms may be attributed to methodological issues (e.g., sample characteristics, statistical power), they suggest, if replicated, additional heterogeneity in the neural bases of OCD. In a clinical sense, these findings provide a useful framework for future efforts to develop more precise treatment-matching approaches for youth with OCD.
CBT OCD Supported by NIMH Grant R01MH081864 http://dx.doi.org/10.1016/j.jaac.2016.07.423
51.3 THE NORDIC LONG-TERM OBSESSIVECOMPULSIVE DISORDER TREATMENT STUDY: EFFECTIVENESS OF A STEPPED-CARE TREATMENT Tord Ivarsson, PhD, The Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Postboks 4623 Nydalen, Oslo, 405, Norway; Gudmundur A. Skarphedinsson, PhD; Nor Christian Torp, MS; Kitty Dahl, PhD; Per Hove Thomsen, PhD; Bernhard Weidle, PhD; Judtih B. Nissen, PhD; Karin A. Melin, MSC; Katja Anna Hybel, MSC; Robert Valderhaug, PhD; Fabian Lenhard, MSC; Tore Wentzel-Larsen, MS; Scott N. Compton, PhD; Martin Franklin, PhD Objectives: The goals of this session are to evaluate the impact of continued CBT and sertraline (SRT) in partial and nonresponders to an initial full dose of CBT in pediatric OCD and to investigate predictors and moderators of outcome. Methods: Participants with a primary diagnosis of OCD (age 7–17 years) were first treated with manual-based CBT (14 sessions). Eligibility requirements included the following: DSM-IV diagnostic criteria for primary OCD [based on
J OURNAL
OF THE
AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016
Supported by the Research Fund of the University of Antwerp 41/ FA040300/FFB130145 and the Research Foundation—Flanders (FWOAspirant) http://dx.doi.org/10.1016/j.jaac.2016.07.416
50.2 DIGITAL-CONTROLLING BEHAVIORS AMONG EARLY ADOLESCENTS WITH MENTAL ILLNESS SYMPTOMS Christopher Houck, PhD, Rhode Island Hospital, 1 Hoppin St Ste 204, Providence, RI 02903-4141 Objectives: Technology has had a profound impact on the ways in which adolescents communicate. This increase in the frequency of digital communication can also result in opportunities for abuse, particularly in controlling or monitoring behaviors conducted through social networks or digital devices. However, little data on these types of controlling behaviors among early adolescents have been reported. Methods: Adolescents with mental health symptoms who were enrolled in a sexual risk prevention program were assessed in the ninth grade (mean age ¼ 15.08 years, SD ¼ 0.53). A number of respondents (220 of 359) endorsed a dating partner (47 percent male; 37 percent Caucasian; 39 percent Latino). Participants completed questions on laptop computers about whether their partner had engaged in six controlling behaviors related to technology, including requests for passwords, reviewing cell phone call lists, or reading text messages to monitor their partner’s activity. They also completed subscales of the Conflict in Adolescent Dating Relationships Inventory (CADRI) related to threatening behaviors and physical abuse in their relationship. Results: Approximately 40 percent of adolescents reported that their partner had engaged in some kind of digital controlling behavior. The most common forms of digital control exerted were “asked for your personal password to a social networking site so that he/she can check up on you” (28 percent) and “checked through your text messages to see if you have spoken to someone they don’t trust” (23 percent). Thirty percent of adolescents reported that their partner had engaged in more than one of the six behaviors. The total number of digital controlling behaviors reported was correlated significantly with reports of being victimized by partners by threatening behaviors (r ¼ 0.30) and by physical abuse (r ¼ 0.32). Digital controlling behaviors were also significantly related to perpetration of threats (r ¼ 0.28) and physical abuse (r ¼ 0.29). Conclusions: Many ninth graders with mental health symptoms in dating relationships experience controlling behaviors exerted by partners through monitoring of their digital communication. These behaviors are related to both victimization and perpetration of partner violence. Digital communication behaviors may be a marker of unhealthy relationships that can be assessed by providers.
ADOL PRE RF Supported by National Institute of Nursing Research Grant NR011906 http://dx.doi.org/10.1016/j.jaac.2016.07.417
50.3 THE CO-OCCURRENCE OF SEXTING AND CYBER DATING ABUSE
Conclusions: Intervention programs targeting one behavior should concomitantly address the other.
ADOL PRE SEX Supported by NIH National Institute of Child Health & Human Development Grant K23HD059916 and National Institute of Justice (NIJ) award 2012-WG-BX-0005 http://dx.doi.org/10.1016/j.jaac.2016.07.418
50.4 DATING VIOLENCE AND DIGITAL ABUSE AMONG HIGH-RISK ADOLESCENT GIRLS Christie Rizzo, PhD, Applied Psychology, Northeastern University, 360 Huntington Ave, INV 404, Boston, MA 02115; Meredith Joppa, PhD Objectives: Despite a growing recognition that technology-mediated communication is central to the lives of adolescents, little research has been published on the topic of cyber dating abuse. The few studies that exist have focused on community sample groups of youth, rather than high risk sample groups, who frequently present for mental health services. The goals of the study were as follows: 1) to observe the prevalence of cyber dating abuse among a high risk sample group of adolescent girls with histories of physical dating violence (DV); 2) to measure the longitudinal relationships between digital and in-person DV; and 3) to determine the impact of digital abuse on common DV correlates, such as depressive symptoms. Methods: Data are from a randomized controlled trial of a DV prevention program for high risk adolescent girls. All participants (n ¼ 109) had a history of physical dating violence perpetration or victimization, identified through school-based screening procedures using the Conflict in Adolescent Dating Relationships Inventory. Participants were ages 14–17 years (mean ¼ 15.75), and racial/ethnic distribution was 50 percent Hispanic, 35 percent AfricanAmerican, 22 percent White, eight percent American Indian, and three percent Asian. Students (82 percent) qualified for free or reduced-price lunches. Participants completed an audio-assisted survey battery on laptop computers at four time points over nine months. Results: Adolescent girls with a history DV frequently engage in cyber-controlling behaviors (33–66 percent). Cross-lagged analyses indicate reciprocal relations between these variables over time, with digital abuse perpetration predicting subsequent in-person abuse perpetration and vice versa (p < 0.05). Digital abuse, but not in-person abuse, was found to predict subsequent increases in depressive symptomatology from baseline to six months (p < 0.01). These temporal associations were not attributable to intervention condition as this was controlled statistically. Conclusions: Digital and in-person forms of DV were prevalent in this high risk sample and related reciprocally over time. Even among girls with frequent in-person DV experiences, digital abuse contributed significantly to increases in depressive symptomatology. These data suggest that digital dating abuse can have a significant impact on mental health, even among high risk groups, and that providers may want to include assessment of digital abuse in their evaluation procedures.
ADOL AGG Supported by NIMH Grant K23 MH086328 http://dx.doi.org/10.1016/j.jaac.2016.07.419
Jeff R. Temple, PhD, UTMB Health, 301 University Blvd, Galveston, TX 77555-0587 Objectives: Although online dating abuse and teen sexting have received a great deal of media attention and an increasing amount of research prominence, less is known about whether and how these behaviors co-occur. Methods: By use of our ongoing longitudinal sample group (n ¼ 1042; age at recruitment ¼ 15 years; six years of data collected already), we use latent class analysis to examine the following: 1) whether cyber dating abuse and sexting co-occur; and 2) whether youth who engage in both sexting and cyber dating abuse have more mental symptoms (depression, anxiety, hostility) than youth who engage in neither or “only” one type of behavior. Results: Youth involved in sexting and cyber dating abuse tend to stay engaged in these behaviors over time, and they are more susceptible to experiencing poor mental health.
J OURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016
SYMPOSIUM 51 TREATMENT UPDATES IN PEDIATRIC OBSESSIVECOMPULSIVE DISORDER Joseph McGuire, PhD, Semel Institute of Neuroscience and Human Behavior, University of California Los Angeles, 760 Westwood Plz # 48-228B, Los Angeles, CA 90024; John T. Walkup, MD Objectives: This symposium provides treatment updates in pediatric OCD based on empirically supported research.
www.jaacap.org
S339
SYMPOSIA 51.1 – 51.3
Methods: Dr. Joseph McGuire will present data on the mechanisms of fear, learning, and extinction in youth with OCD. Dr. John Piacentini will present data on the neural correlates of OCD symptom dimensions before and after CBT using magnetic resonance spectroscopic imaging (MRSi). Dr. Tord Ivarsson will present data on a large-scale, stepped-care clinical trial that investigated the benefit of a typical course of CBT and examined the impact of continued CBT or sertraline for youth who were partially responsive and/ or nonresponsive to CBT. Dr. Eric A. Storch will present data on a recently completed randomized clinical trial that examined whether CBT augmented with d-cycloserine (DCS) or CBT augmented with placebo had greater effects in reducing OCD symptom severity. Finally, Dr. S. Evelyn Stewart will present data on the feasibility and efficacy of a novel group family approach to CBT. Results: Dr. McGuire’s research suggests that youth with OCD have impaired inhibitory learning and/or contingency awareness during extinction. Dr. Piacentini’s findings provide data to support the glutamatergic hypothesis of OCD and describe specific neural markers that predicted OCD symptom dimension changes. Dr. Ivarsson’s research highlights the therapeutic benefit of CBT for many youths with OCD and suggests that CBT and sertraline are similarly beneficial for youth who do not initially respond to CBT. Dr. Storch’s research suggests that CBT augmented with DCS does not universally outperform CBT augmented with placebo and noted no moderating effect of antidepressant medication for DCS augmentation. Finally, Dr. Stewart’s findings demonstrate the feasibility and broad therapeutic benefit of a group family-based CBT approach and highlights the particular benefit of increasing parental distress tolerance. Conclusions: As these findings carry implications for the treatment of pediatric OCD, Dr. John T. Walkup will discuss these findings and contextualize them within the broader OCD literature.
CBT OCD TREAT http://dx.doi.org/10.1016/j.jaac.2016.07.421
51.1 FEAR EXTINCTION IN PEDIATRIC OBSESSIVECOMPULSIVE DISORDER Joseph McGuire, PhD, Semel Institute of Neuroscience and Human Behavior, University of California Los Angeles, 760 Westwood Plz # 48-228B, Los Angeles, CA 90024; Scott P. Orr, PhD; Daniel A. Geller, MD; Monica S. Wu, MA; Brent J. Small, PhD; Adam B. Lewin, ABPP, PhD; Sabine Wilhelm, PhD; Tanya K. Murphy, MD, MS; Daniel Pine, MD; Eric A. Storch, PhD Objectives: Fear acquisition and extinction are central constructs in the cognitive-behavioral model of OCD, which underlies exposure-based CBT. Youth with OCD may have impairments in fear acquisition and extinction that carry treatment implications. The present study examined these processes using a differential conditioning procedure. Methods: A number of youth (N ¼ 41; 19 OCD, 22 community comparisons) completed a battery of clinical interviews, rating scales, and a differential conditioning task that included habituation, acquisition, and extinction phases. Skin conductance response (SCR) served as the primary dependent measure. Results: During habituation, no difference between groups was observed. During acquisition, differential fear conditioning was observed across participants as proven by larger SCRs to the CS+ compared with CS; there were no between-group differences. Across all of the participants, the number and frequency of OCD symptoms and anxiety severity were associated with greater reactivity to stimuli during acquisition. During extinction, a three-way interaction and follow-up tests revealed that youth with OCD showed a different pattern of SCR extinction compared with the community comparison group. Conclusions: Youth with OCD exhibit a different pattern of fear extinction relative to community comparisons. This may be attributed to impaired inhibitory learning and contingency awareness in extinction. Findings suggest the potential benefit of using inhibitory learning principles in CBT for youth with OCD and/or augmentative retraining interventions before CBT to reduce threat bias and improve contingency detection.
ANX
S340
www.jaacap.org
Supported by NIH Research Supplement Grant R01MH093381-02S1 http://dx.doi.org/10.1016/j.jaac.2016.07.422
51.2 NEURAL CORRELATES OF COGNITIVEBEHAVIORAL THERAPY–RELATED CHANGES IN PEDIATRIC OBSESSIVE-COMPULSIVE DISORDER SYMPTOM DIMENSIONS John Piacentini, PhD, University of California, Los Angeles, 760 Westwood Plz, Los Angeles, CA 90095-8353; Joseph O’Neill, PhD; Susanna Chang; Allison Vreeland, BA; James T. McCracken, MD Objectives: The goal of this session is to examine the neural correlates of empirically derived OCD symptom dimensions at baseline, as well as changes in these symptom dimensions following exposure-based CBT. Methods: Youth (n ¼ 60; ages 8–17 years) with OCD underwent magnetic resonance spectroscopic imaging (MRSi) and were randomized to CBT or waitlist. All youth underwent reimaging at end of condition, with waitlisted youth who received CBT, and after treatment. Youth completed a comprehensive assessment of symptom severity [Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS)], functional status [Child Obsessive-Compulsive Impact Scale-Revised, Child Behavior Checklist (CBCL)], and treatment outcome [CY-BOCS; Clinical Global Impression—Global Improvement (CGI-I)]. OCD symptom dimensions at baseline and after treatment were derived from JAACAP 2008;47:763–772. This procedure yielded separate scores for hoarding, obsessions, contamination/cleaning, and symmetry/ordering factors. Results: Overall, examination of the primary outcome measures (CY-BOCS total score; CGI-I) identified significant relationships between multiple MRSi markers (primarily glutamate) and CBT response. Specific to this presentation, scores for each of the four OCD symptom factors showed a significant (p < 0.001) decrease pre-post-CBT. However, the strongest imaging findings emerged for contamination/cleaning symptoms. More specifically, levels of pretreatment of glutamate predicted worse contamination/cleaning symptoms at posttreatment and, relatedly, a smaller decrease in these symptoms over the period of treatment (p < 0.05). Conclusions: Findings from the larger study provide additional support for the glutamatergic hypothesis of OCD. Although the specificity of our MRSi findings to contamination/cleaning symptoms may be attributed to methodological issues (e.g., sample characteristics, statistical power), they suggest, if replicated, additional heterogeneity in the neural bases of OCD. In a clinical sense, these findings provide a useful framework for future efforts to develop more precise treatment-matching approaches for youth with OCD.
CBT OCD Supported by NIMH Grant R01MH081864 http://dx.doi.org/10.1016/j.jaac.2016.07.423
51.3 THE NORDIC LONG-TERM OBSESSIVECOMPULSIVE DISORDER TREATMENT STUDY: EFFECTIVENESS OF A STEPPED-CARE TREATMENT Tord Ivarsson, PhD, The Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Postboks 4623 Nydalen, Oslo, 405, Norway; Gudmundur A. Skarphedinsson, PhD; Nor Christian Torp, MS; Kitty Dahl, PhD; Per Hove Thomsen, PhD; Bernhard Weidle, PhD; Judtih B. Nissen, PhD; Karin A. Melin, MSC; Katja Anna Hybel, MSC; Robert Valderhaug, PhD; Fabian Lenhard, MSC; Tore Wentzel-Larsen, MS; Scott N. Compton, PhD; Martin Franklin, PhD Objectives: The goals of this session are to evaluate the impact of continued CBT and sertraline (SRT) in partial and nonresponders to an initial full dose of CBT in pediatric OCD and to investigate predictors and moderators of outcome. Methods: Participants with a primary diagnosis of OCD (age 7–17 years) were first treated with manual-based CBT (14 sessions). Eligibility requirements included the following: DSM-IV diagnostic criteria for primary OCD [based on
J OURNAL
OF THE
AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016