An observational study of parent–child behaviours in paediatric OCD: Examining the origins of inflated responsibility

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Highlights

  • Parents in OCD dyads were observed to be significantly more aversive than controls.

  • Children with OCD were observed to be significantly less warm than controls.

  • Children with OCD were observed to be significantly more withdrawn controls.

  • Irrespective of diagnostic group parents enhanced child responsibility for solutions.

Abstract

Inflated responsibility is a well-established belief domain relevant to the development of obsessive–compulsive disorder (OCD), and is proposed to develop during childhood (Salkovskis, P.M., Shafran, R., Rachman, S., & Freeston, M.H. (1999). Multiple pathways to inflated responsibility beliefs in obsessional problems: possible origins and implications for therapy and research. Behaviour Research and Therapy, 37(2), 1055–1072). However, parental enhancement of such beliefs have rarely been examined. This study explored the proposed pathways of development for responsibility biases in paediatric OCD by examining parent–child behaviours during a family discussion task. 24 children with OCD (mean age=12.96), 20 control children (mean age=13.13) and their parents participated in this study. Dyads discussed an ambiguous scenario for five minutes with the goal of finding a solution. Parent behaviours of autonomy granting and overinvolvement, as well as parent–child behaviours of warmth, withdrawal, aversiveness and confidence were independently coded along with parent and child enhancement of responsibility for solving the problem. Parents in OCD dyads were observed to be significantly more aversive than control parents. Children with OCD were significantly less warm and more withdrawn than control children. Irrespective of group membership, parents enhanced their child's responsibility more than their own when generating solutions. These findings add to the literature on parent–child variables that play a role in enhancing OCD related beliefs such as inflated responsibility.

Introduction

Cognitive behavioural theories of Obsessive–Compulsive Disorder (OCD) are widely accepted (Pietrefesa, Schofield, Whiteside, Sochting & Coles, 2010) and provide the basis for cognitive-behavioural therapy (CBT), which is currently the most effective psychological treatment for OCD (Barrett, Farrell, Pina, Peris & Piacentini, 2008). These models propose that biological and environmental factors account for vulnerability; whereas maladaptive beliefs about the experience of intrusive thoughts (i.e., obsessions) lead to the development and maintenance of obsessions, related distress and the urge to neutralize (Rector, Cassin, Richter & Burroughs, 2009). Arguably the most widely studied cognitive theory in OCD research is Salkovskis (1985) model of inflated responsibility. This cognitive model of OCD proposes that distorted cognitive appraisals of risk and responsibility for harm are what differentiate normal intrusive thoughts from those characteristic of OCD (Rachman, 1993, Salkovskis, 1985, Salkovskis, 1989. Salkovskis, 1985, Salkovskis, 1989 proposed that the interpretation of intrusive thoughts as indicating personal responsibility for harm to self or others, leads to increased discomfort and anxiety, increased salience of the intrusive thoughts, and neutralizing behaviours (e.g., “if do not check my sleeping baby all night, she might die, and that would be my fault”). In a study of 59 OCD patients given both the Responsibility Interpretations Questionnaire (RIQ) and the Responsibility Attitudes Scale (RAS; Salkovskis et al., 2000) it was found that compared to 22 anxious controls and 69 non-clinical controls, beliefs concerning responsibility for harm were specific to OCD, regardless of whether the participant reported checking behaviours or not (Cougle, Lee & Salkovskis, 2007). These results have been replicated in other survey based studies with adult participants (e.g. Rhéaume, Freeston, Dugas, Letarte & Ladouceur, 1995; Wilson & Chambless, 1999). Experimental studies in adults have similarly illustrated that high responsibility conditions exacerbate checking behaviours, as compared to participants in reduced responsibility conditions (e.g. Arntz et al., 2007; Ladouceur et al., 1995; Ladouceur, Rhéaume & Aublet, 1997). Given that these biases appear to play central role in mainitinaing OCD symptoms, understanding the development of such biases warrants investigation. Salkovskis, Shafran, Rachman & Freeston (1999) argue that the development of these maladaptive beliefs may originate in early childhood through one or more of five developmental pathways, including: (1) a broad sense of responsibility that is deliberately or implicitly encouraged during childhood; (2) rigid or extreme codes of conduct characterised by authoritarian enforcers, blame, guilt and punishment; (3) sensitivity to responsibility, as a result of being overprotected from it; (4) an incident where one's (in)actions contributed to a serious misfortune to self or others, and; (5) an incident where one's thoughts or (in)actions appeared to cause a serious misfortune.

While cognitive theories have received strong empirical support in the adult literature (see Obsessive Compulsive Cognitions Working Group, 1997; 2001; Rhéaume et al., 1995; Wilson & Chambless, 1999; Cougle et al., 2007), initial investigations in paediatric samples suggest the origin and nature of these cognitive biases is less clear (Lawrence and Williams, 2011, Farrell et al., 2013). The degree to which responsibility develops as a result of specific parenting practices/family environment is not yet known. Several studies show support for inflated responsibility in children and youth. For example, Reeves, Reynolds, Coker & Wilson (2010), manipulated responsibility in a sample of 81 school children (aged 9–12) by asking the children to sort sweets into containers for those sweets containing nuts, those that may contain nuts and those which did not contain nuts. The sweets would then be given to a group of children, one of which had an allergy to nuts. Responsibility was induced by telling the children in the inflated responsibility group that their sorting would not be checked by the researcher, in the moderate responsibility group children were not provided with any information regarding who would be checking or who would be to blame and in the reduced responsibility group children were told the researcher would double-check their sorting and that if anything were to go wrong it would be the fault of the researcher. Children in the inflated responsibility group engaged in more checking and hesitant behaviours during a series of tasks as compared to those in the reduced responsibility group. Furthermore, in a clinical sample of children aged 11–18 years, responsibility scores on the RAS independently predicted the severity of OCD symptoms, and furthermore, children with OCD scored significantly higher than both anxious and non-clinical controls (Libby, Reynolds, Derisley & Clark, 2004). In contrast, Barrett & Healy (2003) found that inflated responsibility occurred in both children with OCD and anxious children, as compared to non-clinical controls, in a younger sample of 7–13 year olds. In another study which experimentally manipulated responsibility in children and adolescents with OCD (n=43, 7–17 years) during behavioural avoidance tasks (BATs), Barrett & Healy did not find an association between the high responsibility BAT and associated anxiety, ritualizing or avoidance behaviours. These studies provide mixed support for the process of inflated responsibility biases in paediatric samples. Consequently, adult cognitive theories, which are currently applied top-down to the treatment of paediatric OCD may not be appropriate, however, limited bottom-up research in clinical paediatric samples currently exists (Turner, 2006). Evidence for the importance of parents and families in understanding the development and maintenance of paediatric OCD symptoms, and moreover, the establishment of maladaptive belief domains, therefore represents an important area of future research. This study extends current research by examining the nature of parent–child interactions, focusing on validated constructs shown to be associated with anxious and OCD samples, during a parent–child problem solving task. Furthermore, this study examines whether parents may “enhance” responsibility for solving problems, therefore examining Salkovskis et al. (1999) proposed pathways to the development of responsibility bias, in particular pathways (1), (2) and (3) as described above. These pathways were specifically tested since they relate to rearing processes, which potentially can be reliably observed and coded during parent–child interaction tasks, as opposed to pathways (4) and (5) which specifically relate to how parents and children may have responded to a past event.

Section snippets

Parenting factors and childhood OCD

An authoritarian familial context of rigid and extreme codes of conduct might be characterised by families which are high on rejection and control (Pathways 1. 2 and 3; Salkovskis et al., 1999); dimensions which have been largely examined in the broader literature on child anxiety disorders, and to a lesser extend childhood OCD (e.g. Barrett, Shortt & Healy, 2002). Research using different methodologies (McLeod et al., 2007, Bögels and Brechman-Toussaint, 2006) has focused on parental rearing

Participants

Two groups of children aged 8–17, along with a parent, were recruited, including 24 children with a primary diagnosis of OCD (mean age=12.96, SD=2.55), and 20 children with no clinical diagnosis (mean age=13.13, SD=2.68). The mean age of the overall combined sample was 13.04 years (SD=2.58) and genders were recruited equally (50% male). Participants with a primary diagnosis of OCD and their mother (n=22) or father (n=2), were recruited through the Griffith University OCD Treatment research

Data analysis

All analyses were carried out using the Statistical Package for Social Sciences (SPSS) computer program, version 22.0. There were two parts to the analyses in order to address the two aims of the study. Prior to the analyses central to the study’s aims and hypotheses, descriptive data across the two groups were compared in order to characterise the sample on self-reported anxiety and depression (parent–child). Across self-report measures there were a few participants on each with missing data

Discussion

The current study examined the nature of parent–child behavioural characteristics during a family discussion task, in order to better understand the familial context of paediatric OCD. On the basis of past research (see McLeod et al. (2007), Farrell et al. (2013), and Barrett et al. (2002)) it was hypothesized that OCD dyads would score higher on aversiveness, withdrawal and overinvolvement, and lower on confidence, warmth and autonomy granting relative to a community control group engaged in

Overall implications and conclusion

Interactions between a parent and child with OCD tend to be characterised as critical (Alonso et al., 2004, Barrett et al., 2002, Lennertz et al., 2010). This study substantiated those findings by observing more withdrawal and aversiveness and less warmth across parents and children in OCD-dyads. Interestingly, while there was no clear support for parental or child enhancement of responsibility specific to OCD dyads, there was a trend for children with OCD enhancing their own responsibility in

References (75)

  • A. Futh et al.

    Obsessive–compulsive disorder in children and adolescents: Parental understanding, accommodation, coping and distress

    Journal of Anxiety Disorders

    (2012)
  • R. Ladouceur et al.

    Excessive responsibility in obsessional concerns: a fine-grained experimental analysis

    Behaviour Research and Therapy

    (1997)
  • R. Ladouceur et al.

    Experimental manipulations of responsibility: an analogue test for models of obsessive–compulsive disorder

    Behaviour Research and Therapy

    (1995)
  • P.F. Lovibond et al.

    The structure of negative emotional states: comparison of the Depression Anxiety Stress Scales (DASS) with the beck depression and anxiety inventories

    Behaviour Research and Therapy

    (1995)
  • H. Lyneham et al.

    Interrater reliability of the anxiety disorders interview schedule for DSM-IV: child and parent version

    Journal Of The American Academy Of Child & Adolescent Psychiatry

    (2007)
  • H.J. Lyneham et al.

    Agreement between telephone and in-person delivery of structured interview for anxiety disorders in children

    Journal of the American Academy of Child & Adolescent Psychiatry

    (2005)
  • J.S. March et al.

    The multidimensional anxiety scale for children (MASC): factor structure, reliability and validity

    Journal of the American Academy of Child and Adolescent Psychiatry

    (1997)
  • J.S. March et al.

    Test-retest reliability of the multidimensional anxiety scale for children

    Journal of Anxiety Disorders

    (1999)
  • B.D. McLeod et al.

    Examining the association between parenting and childhood anxiety: a meta-analysis

    Clinical Psychology Review

    (2007)
  • P. Muris et al.

    Parental rearing practices, fearfulness, and problem behaviours clinically referred children

    Personality and Individual Differences

    (1996)
  • S. Rachman

    Obsessions, responsibility and guilt

    Behaviour Research and Therapy

    (1993)
  • N.A. Rector et al.

    Obsessive beliefs in first-degree relatives of patients with OCD: A test of the cognitive vulnerability model

    Journal of Anxiety Disorders

    (2009)
  • J. Reeves et al.

    An experimental manipulation of responsibility in children: a test of the inflated responsibility model of obsessive–compulsive disorder

    Journal of Behavior Therapy and Experimental Psychiatry

    (2010)
  • J. Rhéaume et al.

    Perfectionism, responsibility and Obsessive–Compulsive symptoms

    Behaviour Research and Therapy

    (1995)
  • R.M. Rapee

    Potential role of childrearing practices in the development of anxiety and depression

    Clinical Psychology Review

    (1997)
  • P.M. Salkovskis

    Obsessional-compulsive problems: a cognitive-behavioural analysis

    Behaviour Research and Therapy

    (1985)
  • P.M. Salkovskis

    Cognitive-behavioral factors and the persistence of intrusive thoughts in obsessional problems

    Behavior, Research and Therapy

    (1989)
  • P.M. Salkovskis et al.

    Responsibility attitudes and interpretations are characteristic of obsessive compulsive disorder

    Behaviour Research and Therapy

    (2000)
  • P.M. Salkovskis et al.

    Multiple pathways to inflated responsibility beliefs in obsessional problems: possible origins and implications for therapy and research

    Behaviour Research and Therapy

    (1999)
  • L. Scahill et al.

    Children’s Yale-Brown obsessive compulsive scale: reliability and validity

    Journal of the American Academy of Child & Adolescent Psychiatry

    (1997)
  • W.K. Silverman et al.

    Test-retest reliability of anxiety symptoms and diagnoses with the anxiety disorders interview schedule for DSM-IV:Child and parent versions

    Journal of the American Academy of Child and Adolescent Psychiatry

    (2001)
  • S.H. Spence

    A measure of anxiety symptoms among children

    Behaviour Research and Therapy

    (1998)
  • E.A. Storch et al.

    The children’s Yale-Brown obsessive–compulsive scale: psychometric properties of child- and parent-report formats

    Journal of Anxiety Disorders

    (2006)
  • E.A. Storch et al.

    Psychometric evaluation of the Children's Yale–Brown Obsessive-Compulsive Scale

    Psychiatry Research

    (2004)
  • C.M. Turner

    Cognitive–behavioural theory and therapy for obsessive–compulsive disorder in children and adolescents: Current status and future directions

    Clinical Psychology Review

    (2006)
  • S.P. Whiteside et al.

    Exploring the utility of the Spence Children’s Anxiety Scales parent-and child-report forms in a North American sample

    Journal of Anxiety Disorders

    (2008)
  • K.A. Wilson et al.

    Inflated perceptions of responsibility and obsessive–compulsive symptoms

    Behaviour Research and Therapy

    (1999)
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      Following completion of the task, problem-solving discussions were coded using a macro-coding protocol based on previously published research, and revised according to the current study's objectives, to best assess behaviours considered important in the quality of both parent-child interactions and problem solving. The protocol implemented methods and behavioural dimensions used in previous studies, which have examined parent-child interactions between OCD, control, and/or anxious groups (see Barrett et al., 2002; Farrell et al., 2013; Mathieu et al., 2015; McLeod et al., 2007; Schlup et al., 2011; Siqueland et al., 1996). These studies generally report reliable coding established by two independent raters trained in coding the behavioural dimensions.

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