Although obsessive-compulsive disorder (OCD) is a chronic and oftentimes debilitating disorder, the specific impact of this illness on the psychosocial functioning of affected youngsters has not been systematically described. A total of 151 clinic-referred youngsters (mean age 11.8 years, 57% male, 83% Caucasian) with primary Diagnostic and Statistical Manual of Mental Disorders (fourth edition) OCD and a primary caretaker completed a checklist designed to assess the impact of OCD on school, social, and family functioning. The two most common OCD-related problems were concentrating on schoolwork and doing homework. Consistent with the heterogeneous nature of OCD, subjects exhibited a broad range of specific impairments. However, almost 90% of youngsters reported at least one significant OCD-related dysfunction, and close to half reported significant OCD-related problems at school, home, and socially. Parents were more likely to report significant impairments in home and school functioning than children. However, few systematic gender or age effects were noted. Impairment ratings were significantly correlated with clinician-generated measures of OCD severity. These results provide the most specific description to date of the adverse impact of OCD on child psychosocial functioning. Given the adverse developmental consequences of psychosocial dysfunction, treatment studies need to carefully track and address OCD-specific functional impairments in affected youngsters.

Objective-To examine attention bias towards threat faces in a large sample of anxiety-disordered youths using a well-established visual probe task.Method-Study participants included 101 children and adolescents (ages 7-18 years) with generalized anxiety disorder, social phobia and/or separation anxiety disorder enrolled in a multisite anxiety treatment study. Non-anxious youths (n = 51; ages 9 -18 years) were recruited separately. Participants were administered a computerized visual probe task that presents pairs of faces portraying threat (angry), positive (happy) and neutral expressions. They pressed a response-key to indicate the spatial location of a probe that replaced one of the faces on each trial. Attention bias scores were calculated from response times to probes for each emotional face type.Results-Compared to healthy youths, anxious participants demonstrated a greater attention bias towards threat faces. This threat bias in anxious patients did not significantly vary across the anxiety disorders. There was no group difference in attention bias towards happy faces.Conclusions-These results suggest that pediatric anxiety disorders are associated with an attention bias towards threat. Future research might examine the manner in which cognitive bias in anxious youth changes with treatment.

Evaluated the concurrent validity of the Anxiety Disorders Interview Schedule for the Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV], American Psychiatric Association, 1994): Child and Parents Versions (ADIS for DSM-IV-C/P; Silverman & Albano, 1996) social phobia, separation anxiety disorder (SAD), generalized anxiety disorder (GAD), and panic disorder diagnoses. Children referred to an outpatient anxiety disorder clinic (N = 186; ages 8 to 17), and their parents completed the Multidimensional Anxiety Scale for Children (MASC; March, 1998) and the ADIS-C/P interview. There was no convergence between MASC scores and ADIS-C/P GAD diagnoses. However, there was strong correspondence between ADIS-C/P social phobia, SAD, and panic disorder diagnoses and the empirically derived MASC factor scores corresponding to these disorders. These results provide support for the concurrent validity of the anxiety disorders section of the ADIS-C/P.

Evaluated the concurrent validity of the Anxiety Disorders Interview Schedule for the Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV], American Psychiatric Association, 1994): Child and Parents Versions (ADIS for DSM-IV-C/P; Silverman & Albano, 1996) social phobia, separation anxiety disorder (SAD), generalized anxiety disorder (GAD), and panic disorder diagnoses. Children referred to an outpatient anxiety disorder clinic (N = 186; ages 8 to 17), and their parents completed the Multidimensional Anxiety Scale for Children (MASC; March, 1998) and the ADIS-C/P interview. There was no convergence between MASC scores and ADIS-C/P GAD diagnoses. However, there was strong correspondence between ADIS-C/P social phobia, SAD, and panic disorder diagnoses and the empirically derived MASC factor scores corresponding to these disorders. These results provide support for the concurrent validity of the anxiety disorders section of the ADIS-C/P.

Objective Pediatric obsessive-compulsive disorder (OCD) is a chronic, impairing condition associated with high levels of family accommodation (i.e., participation in symptoms). Understanding of factors that may engender accommodation of pediatric OCD is limited. This study conducted exploratory analyses of parent-, child-, and family-level correlates of family accommodation, considering both behavioral and affective components of the response. Method The sample included 65 youth (mean age = 12.3 years; 62% male) with OCD and their parents who completed a standardized assessment battery comprised of both clinical and self-report measures (e.g., CY-BOCS, Brief Symptom Inventory). Results Family accommodation was common, with the provision of reassurance and participation in rituals the most frequent practices (respectively occurring on a daily basis among 56% and 46% of parents). Total scores on the Family Accommodation Scale were not associated with child OCD symptom severity; however, parental involvement in rituals was associated with higher levels of child OCD severity and parental psychopathology, and with lower levels of family organization. Comorbid externalizing symptomatology and family conflict were associated with parent report of worse consequences when not accommodating. Conclusions Although these findings must be interpreted in light of potential Type I error, they suggest that accommodation is the norm in pediatric OCD. Family-focused interventions must consider the parent, child, and family-level variables associated with this familial response when teaching disengagement strategies.

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Although anxiety disorders are prevalent among children and adolescents, with a chronic and often disabling course, there is a paucity of research examining the specific ways in which anxiety interferes with various domains of functioning in childhood. The purpose of the current investigation was to examine the initial reliability and construct validity of the Child Anxiety Impact Scale-Parent version (CAIS-P). The CAIS-P is a parent-report measure consisting of School, Social, and Home/Family subscales. In a clinical sample (N = 92), the internal reliability and the convergent and divergent validity were evaluated. Internal consistency was good for the total score as well as each subscale (Cronbach's alpha ranged from 0.73-0.87). The CAIS-P total score demonstrated good construct validity, showing predicted significant correlations with the Child Behavior Checklist Internalizing Scale and the Child Depression Inventory but not the Externalizing Scale of the Child Behavior Checklist. The Social subscale of the CAIS-P was also significantly correlated with measures of social anxiety. The results provide initial support that the CAIS-P is a reliable and valid measure for the assessment of the impact of anxiety on child and adolescent functioning.

Objective To examine the efficacy of exposure-based CBT plus a structured family intervention (FCBT) versus psychoeducation plus relaxation training (PRT) for reducing symptom severity, functional impairment, and family accommodation in youths with OCD. Methods Seventy-one 8–17 year old youngsters (mean 12.2 years, range 8–17, 37% male, 78% Caucasian) with primary OCD were randomized (70:30) to 12 sessions over 14 weeks of FCBT or PRT. Blind raters assessed outcomes with responders followed for six months to assess treatment durability. Results FCBT led to significantly higher response rates than PRT in ITT (57.1% vs 27.3%) and completer analyses (68.3% vs.35.3%). Using HLM, FCBT was associated with significantly greater change in OCD severity and child-reported functional impairment than PRT and marginally greater change in parent-reported accommodation of symptoms. These findings were confirmed in some, but not all, secondary analyses. Clinical remission rates were 42.5% for FCBT vs. 17.6% for PRT. Reduction in family accommodation temporally preceded improvement in OCD for both groups and child functional status for FCBT only. Treatment gains were maintained at 6-months. Conclusions FCBT is effective for reducing OCD severity and impairment. Importantly, treatment also reduced parent-reported involvement in symptoms with reduced accommodation preceding reduced symptom severity and functional impairment. Clinical Trials Registry Information Behavior Therapy for Children and Adolescents with Obsessive-Compulsive Disorder (OCD); http://www.clinicaltrials.gov; Unique Identifier: NCT00000386