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Journal of Psychopathology and Behavioral Assessment

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01-09-2014

Self-Regulation and Other Executive Functions Relationship to Pediatric OCD Severity and Treatment Outcome

Auteurs: Joseph P. H. McNamara, Adam M. Reid, Amanda M. Balkhi, Regina Bussing, Eric A. Storch, Tanya K. Murphy, Paulo A. Graziano, Andrew G. Guzick, Gary R. Geffken

Gepubliceerd in: Journal of Psychopathology and Behavioral Assessment | Uitgave 3/2014

Abstract

The intersection of obsessive-compulsive disorder (OCD) and executive functioning (EF) in children and adolescents is an emerging topic in the current literature. Spurred by the consistent association between increased EF deficits and higher adult obsessive-compulsive severity, a few initial studies have replicated this relationship in pediatric OCD samples and also have found preliminary evidence that EF deficits are associated with worse response to first-line psychotherapeutic or psychopharmacological treatments for pediatric OCD. This study aimed to extend the literature by providing the first comprehensive investigation of how multiple EF domains, measured repeatedly over the course of treatment, impact pediatric obsessive-compulsive severity and response to multimodal treatment. Multi-level modeling results found that deficits in shifting, inhibition, emotional control, planning/organizing, monitoring and initiating all predicted higher average obsessive compulsive severity across treatment. Interestingly, out of the eight domains of EF investigated, only emotional control moderated treatment outcome such that those with worse emotional control experienced less of a reduction in obsessive-compulsive severity during treatment. The findings generally align with previous theories for the link between EF and OCD and indicate that emotional control has important implications in the treatment of pediatric OCD. In fact, emotional control may provide one explanation for why factors such as disgust sensitivity, oppositional behavior, and third-wave behavioral treatment techniques have all been linked to pediatric OCD treatment outcome. Future research should investigate augmentation strategies that target emotional control in children and adolescents.

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In previous work from our lab, we reported that an increase in average obsessive-compulsive severity predicted an increase in average depressive symptom severity during treatment (Meyer et al. 2013). In controlling for depressive symptoms in this study with the same sample as our previous study, we have found that an increase in average depressive symptoms predicted an increase in average OCD symptom severity during treatment, with a small effect size. Thus, there appears to be evidence for a bidirectional model of how depressive symptoms and obsessive-compulsive symptoms interact prospectively, however this bidirectional model would need to be tested in future research with a larger sample size and is beyond the scope of this paper.

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Titel: Self-Regulation and Other Executive Functions Relationship to Pediatric OCD Severity and Treatment Outcome
Auteurs: Joseph P. H. McNamara
Adam M. Reid
Amanda M. Balkhi
Regina Bussing
Eric A. Storch
Tanya K. Murphy
Paulo A. Graziano
Andrew G. Guzick
Gary R. Geffken
Publicatiedatum: 01-09-2014
Uitgeverij: Springer US
Gepubliceerd in: Journal of Psychopathology and Behavioral Assessment / Uitgave 3/2014
Print ISSN: 0882-2689
Elektronisch ISSN: 1573-3505
DOI: https://doi.org/10.1007/s10862-014-9408-3

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