Research paperClinical expression and treatment response among children with comorbid obsessive compulsive disorder and attention-deficit/hyperactivity disorder
Section snippets
Clinical characteristics
Children with ADHD experience significant dysfunction and impairments across multiple domains of life including social, school, and family functioning (Barkley, 2002; DuPaul et al., 2001; Mariani and Barkley, 1997). Given that both OCD and ADHD are individually associated with impairment in functioning, it is not surprising that children with both diagnoses experience significant psychosocial adversity. Children with comorbid OCD and externalising disorders (including ADHD symptomatology),
Family functioning
In childhood, OCD is often associated with profound impairments to family life due to high rates of family accommodation to OCD symptoms, which has been found to be associated with hieghtened parental distress and burden (Lee et al., 2015). Moreover, studies highlight that greater parental distress predicts greater OCD severity and higher functional impairment (Storch et al., 2009), and poorer family functioning (i.e., blame, conflict, low cohesion) predicts poorer response to treatment (Peris
Executive function
Functional imaging studies in adult OCD support theory that the cortico-striato-thalamo-cortical (CSTC) is involved in the pathogenesis and expression of OCD (Saxena and Rauch, 2000), which is proposed to explain the observed associations between OCD and deficits in executive functions (Bannon et al., 2002; Chamberlain et al., 2007; Kuelz et al., 2004). However, findings across the neuropsychological literature in OCD are inconsistent and heterogeneous (Abramovitch et al., 2013; Kuelz et al.,
Treatment response
CBT, including exposure with response prevention (ERP), either alone or in combination with SRI medication, is considered the gold-standard treatment for paediatric OCD (O'Kearney, 2007). However, despite best efforts, a large number of children and adolescents do not achieve complete remission following CBT. Comorbidity has consistently been found to be associated with poorer response to OCD treatment (Stewart et al., 2004; Storch et al., 2008), with several studies demonstrating that comorbid
The present study
The aim of the present study was to examine the clinical expression (i.e., symptoms, comorbidity) and correlates (i.e., family variables, executive functioning) of comorbid OCD and ADHD in a sample of treatment-seeking children and adolescents with a primary diagnosis of OCD and comorbid ADHD (OCD+ADHD group), compared to an age- and gender-matched sample of youth with OCD and other comorbidity, but without ADHD (OCD without ADHD). Based on the literature reviewed, it was hypothesised that (1)
Participants
The participants for the current study included 40 children and adolescents aged 7 to 17 years (M = 12.18, SD = 2.85) with a primary diagnosis of OCD and comorbid ADHD, as well as an age- and gender-matched sample of 40 children and adolescents with OCD without ADHD (M = 12.13, SD = 2.85). Sixty-nine percent of the overall sample were male. The sample was drawn from consecutive referrals into cognitive-behavioural treatment studies being offered at Griffith University, Queensland, Australia.
Discussion
In the current study, we investigated the unique clinical expression and CBT treatment response of youth with comorbid OCD and ADHD relative to children with a diagnosis of OCD but not ADHD. Results of the current study suggest that the comorbid OCD and ADHD is relatively common, affecting between 14 and 20% of treatment seeking youth in the current study. Youth with both disorders may represent a specific subtype of OCD, characterised by high comorbidity and significant OCD-related impairments
Funding
The current research was supported by funding from the Foundation for Children, Financial Markets grant scheme, as well as a National Health and Medical Research Council (NHMRC) project grant (Farrell APP1058025).
Author contributions
LJF designed the study, oversaw data collection, analysis and revising the paper. Author CL and EB assisted with data collection, literature searchers, data analysis and drafting / editing the first drafts of the manuscript. Authors AW and MZG contributed to the final drafting and revising the manuscript and contributed to the methodology and deigns. All authors contributed to and have approved the final manuscript. All authors warrant that the article is the authors' original work, hasn't
Declaration of Competing Interest
None.
Acknowledgements
The current research was supported by funding from the Foundation for Children, Financial Markets grant scheme, as well as a National Health and Medical Research Council (NHMRC) project grant (Farrell APP1058025).
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