Impact of comorbidity on cognitive-behavioral therapy response in pediatric obsessive-compulsive disorder.
OBJECTIVE
To examine the impact of psychiatric comorbidity on cognitive-behavioral therapy response in children and adolescents with obsessive-compulsive disorder.


METHODS
Ninety-six youths with obsessive-compulsive disorder (range 7-19 years) received 14 sessions of weekly or intensive family-based cognitive-behavioral therapy. Assessments were conducted before and after treatment. Primary outcomes included scores on the Children's Yale-Brown Obsessive-Compulsive Scale, response rates, and remission status.


RESULTS
Seventy-four percent of participants met criteria for at least one comorbid diagnosis. In general, participants with one or more comorbid diagnoses had lower treatment response and remission rates relative to those without a comorbid diagnosis. The number of comorbid conditions was negatively related to outcome. The presence of attention-deficit/hyperactivity disorder and disruptive behavior disorders was related to lower treatment response rates, and the presence of disruptive behavior disorders and major depressive disorder were related to lower remission rates.


CONCLUSIONS
The presence of a comorbid disorder, particularly disruptive behavior, major depressive, and attention-deficit/hyperactivity disorders, has a negative impact on treatment response. Assessing for psychiatric disorders before treatment entry and treating these comorbid conditions before or during cognitive-behavioral therapy may improve final outcome. Comorbid anxiety or tic disorders do not seem to negatively affect response.
Storch
Eric A
EA
Drs. Storch, Merlo, Geffken, Lehmkuhl, Murphy, and Goodman and Ms. Jacob are with the Department of Psychiatry, and Mr. Larson is with the Department of Clinical and Health Psychology, University of Florida.. Electronic address: estorch@psychiatry.ufl.edu.
Merlo
Lisa J
LJ
Drs. Storch, Merlo, Geffken, Lehmkuhl, Murphy, and Goodman and Ms. Jacob are with the Department of Psychiatry, and Mr. Larson is with the Department of Clinical and Health Psychology, University of Florida.
Larson
Michael J
MJ
Drs. Storch, Merlo, Geffken, Lehmkuhl, Murphy, and Goodman and Ms. Jacob are with the Department of Psychiatry, and Mr. Larson is with the Department of Clinical and Health Psychology, University of Florida.
Geffken
Gary R
GR
Drs. Storch, Merlo, Geffken, Lehmkuhl, Murphy, and Goodman and Ms. Jacob are with the Department of Psychiatry, and Mr. Larson is with the Department of Clinical and Health Psychology, University of Florida.
Lehmkuhl
Heather D
HD
Drs. Storch, Merlo, Geffken, Lehmkuhl, Murphy, and Goodman and Ms. Jacob are with the Department of Psychiatry, and Mr. Larson is with the Department of Clinical and Health Psychology, University of Florida.
Jacob
Marni L
ML
Drs. Storch, Merlo, Geffken, Lehmkuhl, Murphy, and Goodman and Ms. Jacob are with the Department of Psychiatry, and Mr. Larson is with the Department of Clinical and Health Psychology, University of Florida.
Murphy
Tanya K
TK
Drs. Storch, Merlo, Geffken, Lehmkuhl, Murphy, and Goodman and Ms. Jacob are with the Department of Psychiatry, and Mr. Larson is with the Department of Clinical and Health Psychology, University of Florida.
Goodman
Wayne K
WK
Drs. Storch, Merlo, Geffken, Lehmkuhl, Murphy, and Goodman and Ms. Jacob are with the Department of Psychiatry, and Mr. Larson is with the Department of Clinical and Health Psychology, University of Florida.
D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D019958:Attention Deficit and Disruptive Behavior Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D002648:Child; D015928:Cognitive Behavioral Therapy; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D011379:Prognosis; D016896:Treatment Outcome