Defining cognitive-behavior therapy response and remission in pediatric OCD: a signal detection analysis of the Children’s Yale-Brown Obsessive Compulsive Scale

Skarphéðinsson, Guðmundur; Nadai, Alessandro S. De; Storch, Eric A.; Lewin, Adam B.; Ivarsson, Tord

doi:10.1007/s00787-016-0863-0

Cited by 30 publications

(24 citation statements)

References 53 publications

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“…The CY-BOCS is a clinician-administered interview that assesses OCD symptom severity over the past week. The CY-BOCS total score has demonstrated good reliability, validity, and treatment sensitivity (Scahill, et al, 1997;Skarphedinsson, et al, 2017;Storch, et al, 2010). For this evaluation, conservative benchmarks were used to categorize treatment response (≥35% reduction in total score) and clinical remission (≥55% reduction in total score, or total score cutoff ≤11; Skarphedinsson, et al, 2017).…”

Section: Methodsmentioning

confidence: 99%

“…The CGI-Severity is clinician-rated scale that provides a global rating of OCD severity, which ranges from "not at all ill" (0) to "extremely ill" (6). Consistent with similar evaluations (Skarphedinsson, et al, 2017;Storch, et al, 2010), scores of "no illness" or "slight illness" were used to designate clinical remission.…”

Section: Methodsmentioning

confidence: 99%

“…This measure is typically administered to both youth and parents together. Research suggests that a 25-35% reduction on the CY-BOCS total score is associated with a positive treatment response, with a 45-55% reduction on the CY-BOCS total score (or total score cutoff ≤11-14) associated with clinical remission (Skarphedinsson, De Nadai, Storch, Lewin, & Ivarsson, 2017;Storch, Lewin, De Nadai, & Murphy, 2010). Although offering quantitative benchmarks for categorizing treatment response and clinical remission, administration of the CY-BOCS in clinical practice is challenging due to the time-intensive nature of the measure (~30 minutes), required training for administration, and non-linear nature of the scale.…”

Section: Introductionmentioning

confidence: 99%

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Defining Treatment Outcomes in Pediatric Obsessive-Compulsive Disorder Using a Self-Report Scale

et al. 2019

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This study examined benchmarks of treatment response and clinical remission on the Obsessive Compulsive Inventory-Child Version (OCI-CV) for youth with obsessive-compulsive disorder (OCD). Participants were 91 youth who enrolled in a randomized controlled trial that examined the benefit of augmenting cognitive behavior therapy (CBT) with either d-cycloserine or placebo. Youth completed the OCI-CV at baseline, Week 4 (prior to initiating exposure therapy), and posttreatment. Receiver operator curve (ROC) analyses examined optimal benchmarks for treatment response and clinical remission as identified by independent evaluators at the post-treatment assessment using the Clinical Global Impression (CGI) scales of Improvement (CGI-Improvement), Severity (CGI-Severity), and Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS). Optimal benchmarks for treatment response were a 20-25% reduction in the OCI-CV total score. Meanwhile, optimal benchmarks for remission were a 55-65% reduction in the OCI-CV total score and a post-treatment total score ≤6-8. OCI-CV benchmarks exhibited moderate agreement with the CY-BOCS for treatment response and clinical remission. Meanwhile, fair agreement was observed for response and remission with CGI scales. A lower pre-treatment OCI-CV total score was associated with less agreement between classification approaches. Findings provide benchmarks for classifying treatment response and clinical remission in an efficient manner. Given the moderate agreement between the CY-BOCS and OCI-CV benchmarks, the OCI-CV may serve as a useful alternative when clinician-rated scales cannot be administered due to limited resources (e.g., time, training). Thus, evidence-based measurement can be incorporated to monitor therapeutic response and remission in clinical practice.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Defining Treatment Outcomes in Pediatric Obsessive-Compulsive Disorder Using a Self-Report Scale

et al. 2019

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“…Signal detection analysis used to compare judgments of remission at various discrimination thresholds on symptom measures using the YBOCS, showed that a posttreatment YBOCS score of ≤14 was the best predictor of symptom remission defined as having mild or no symptoms on the CGI-S, while a posttreatment YBOCS score of ≤12 was associated with a combination of minimal OCD severity and life satisfaction and adaptive functioning in adults measured by the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) and the Social Adjustment Scale ( Farris et al, 2013 ). A raw YBOCS total score of 11 was also found to be predictive of symptomatic remission in pediatric OCD patients ( Skarphedinsson et al, 2017 ).…”

Section: Recovery: Application Of the Concept To Ocdmentioning

confidence: 99%

From Treatment Response to Recovery: A Realistic Goal in OCD

Burchi

Hollander

Pallanti

2018

International Journal of Neuropsychopharmacology

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Despite longitudinal studies reporting symptomatic remission rates ranging from 32% to 70%, Obsessive-Compulsive Disorder is considered a persistent and very disabling disorder. However, these studies suggest that recovery can be a realistic goal for a subgroup of the Obsessive-Compulsive Disorder population and that a clear definition of recovery is timely in Obsessive-Compulsive Disorder. The aim of this paper is to discuss the dimensions of and propose an operational definition of recovery in Obsessive-Compulsive Disorder. Considering the impact generated by the definition of recovery for other mental disorders, this article discusses how this concept may shape the future of research and clinical practice in Obsessive-Compulsive Disorder. Ultimately, the hope is that the management of Obsessive-Compulsive Disorder may parallel, and expand upon, some of the current approaches implemented in the care of schizophrenia, so that early diagnosis, stepped-care techniques, and a personalized approach can be used to create recovery-oriented treatment programs and influence policy making for Obsessive-Compulsive Disorder.

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“…To track the course of change, it is desirable to assess participants at one or more points during the course of treatment. In the current ECAP, this point is highlighted by Skarphedinsson et al [9], who used the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) to assess Nordic children before, during, and after cognitive-behavioral therapy for obsessive-compulsive disorders. CY-BOCS scores obtained from independent evaluators were plotted against Clinical Global Impression ratings by clinicians to identify optimal cutoff scores for defining favorable treatment responses and remission of OCD disorders.…”

Section: Research Applicationsmentioning

confidence: 99%

The need for evidence-based intake, progress, and outcomes assessment

Achenbach

2016

Eur Child Adolesc Psychiatry

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standardized data on problems and strengths manifested by the child and parents. Parallel self-report and collateralreport instruments for developmentally appropriate assessment of child and parent functioning can give clinicians a comprehensive picture of areas in which children and parents may need help [3]. To qualify as evidence-based, assessment instruments should be supported by published standardization, reliability, validity, and normative data [4]. Multi-informant dimensional assessment of children and their parentsAssessment instruments that are scored on developmentally normed dimensional scales document the problems and strengths that can then be compared with subsequent reassessments to measure the progress and outcomes of treatment. If clinicians deem it appropriate, they can show parents bar graphs of dimensional scales that are scored from ratings of their child's functioning, their partner's functioning, and their own functioning. Bar graphs of data from multiple informants can help parents understand how views of their child's functioning and of their own functioning may differ. For example, a child's teachers may report more attention problems than reported by the child or parents. On the other hand, a child may report more depression than reported by the child's parents or teachers. One parent may report that the other parent displays much more aggressive behavior than that parent reports. Graphs of normed dimensional scores derived from each informant's reports provide clinicians and parents with concrete pictures of problems for which help may be needed. Graphs also reveal differences between informants' reports that can help parents understand variations in how their child functions in different contexts and in how their child is seen by different informants.Mental health clinicians are under increasing pressure to provide evidence for the effectiveness of their services. Many kinds of treatment are being promoted as "evidence based," with randomized controlled trials (RCTs) serving as gold standards for evidence-based treatments. Despite the importance of RCTs for evaluating treatments, it has been found that therapeutic benefits achieved in RCTs often shrink markedly when the treatments are applied to children in community mental health services [1,2].One possible reason for the shrinkage of benefits is that children seen in community services are not recruited for having the specific problems targeted by particular evidence-based treatments. A second possible reason for shrinkage is that community clinicians are not trained to provide all the relevant evidence-based treatments. And a third possible reason is that parents in community services may not collaborate as effectively as parents participating in RCTs. Whether to treat, what to treat, whom to treat?To benefit from RCT findings, clinicians need to have a clear basis for determining whether particular children need treatment. If treatment is indicated, clinicians also need a clear basis for determining what should be treated and w...

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Defining cognitive-behavior therapy response and remission in pediatric OCD: a signal detection analysis of the Children’s Yale-Brown Obsessive Compulsive Scale

Cited by 30 publications

References 53 publications

Defining Treatment Outcomes in Pediatric Obsessive-Compulsive Disorder Using a Self-Report Scale

Defining Treatment Outcomes in Pediatric Obsessive-Compulsive Disorder Using a Self-Report Scale

From Treatment Response to Recovery: A Realistic Goal in OCD

The need for evidence-based intake, progress, and outcomes assessment

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