Family factors predict treatment outcome for pediatric obsessive-compulsive disorder.
OBJECTIVE
To examine family conflict, parental blame, and poor family cohesion as predictors of treatment outcome for youths receiving family-focused cognitive behavioral therapy (FCBT) for obsessive-compulsive disorder (OCD).


METHODS
We analyzed data from a sample of youths who were randomized to FCBT (n = 49; 59% male; M age = 12.43 years) as part of a larger randomized clinical trial. Youths and their families were assessed by an independent evaluator (IE) pre- and post-FCBT using a standardized battery of measures evaluating family functioning and OCD symptom severity. Family conflict and cohesion were measured via parent self-report on the Family Environment Scale (Moos & Moos, 1994), and parental blame was measured using parent self-report on the Parental Attitudes and Behaviors Scale (Peris, Benazon, et al., 2008b). Symptom severity was rated by IEs using the Children's Yale-Brown Obsessive Compulsive Scale (Scahill et al., 1997).


RESULTS
Families with lower levels of parental blame and family conflict and higher levels of family cohesion at baseline were more likely to have a child who responded to FCBT treatment even after adjusting for baseline symptom severity compared with families who endorsed higher levels of dysfunction prior to treatment. In analyses using both categorical and continuous outcome measures, higher levels of family dysfunction and difficulty in more domains of family functioning were associated with lower rates of treatment response. In addition, changes in family cohesion predicted response to FCBT, controlling for baseline symptom severity.


CONCLUSIONS
Findings speak to the role of the family in treatment for childhood OCD and highlight potential targets for future family interventions.
Division of Child and Adolescent Psychiatry, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles.
Tara S
TS
Peris
Division of Child and Adolescent Psychiatry, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles.
Catherine A
CA
Sugar
Division of Child and Adolescent Psychiatry, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles.
R Lindsey
RL
Bergman
Division of Child and Adolescent Psychiatry, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles.
Susanna
S
Chang
Division of Child and Adolescent Psychiatry, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles.
Audra
A
Langley
Division of Child and Adolescent Psychiatry, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles.
John
J
Piacentini
D000293:Adolescent; D002648:Child; D015928:Cognitive Behavioral Therapy; D005190:Family / Q000523:psychology*; D054541:Family Conflict / Q000523:psychology; D005196:Family Therapy; D005260:Female; D006801:Humans; D008297:Male; D009771:Obsessive-Compulsive Disorder / Q000523:psychology / Q000628:therapy*; D010290:Parents / Q000523:psychology; D011569:Psychiatric Status Rating Scales; D057566:Self Report; D012720:Severity of Illness Index; D016896:Treatment Outcome