title: Dysregulation in pediatric obsessive compulsive disorder.
abstract: Although obsessive compulsive disorder (OCD) and common co-occurring conditions share deficits in self-regulatory abilities, there has been minimal examination of impaired self-regulation (dysregulation) in youth with OCD. This study examined the association of dysregulation with symptom severity, impairment, and treatment outcome in pediatric OCD. Clinicians assessed obsessive-compulsive severity, family accommodation and global severity in 144 youth with OCD. Youth completed self-report severity ratings of anxiety and depressive symptoms. Parents completed the Child Behavior Checklist (CBCL), and both children and parents completed parallel ratings of obsessive-compulsive impairment. Ninety-seven youth received cognitive behavioral therapy (CBT) and were re-assessed after treatment. Dysregulation was assessed using the CBCL-Dysregulation Profile. Before treatment, dysregulated youth exhibited greater obsessive-compulsive symptom severity, depressive mood, family accommodation, and impairment than non-dysregulated youth. The magnitude of dysregulation directly predicted child-rated impairment, parent-rated impairment, and family accommodation, beyond obsessive-compulsive severity. The magnitude of pretreatment dysregulation predicted treatment discontinuation but not treatment response. Obsessive-compulsive symptom severity and dysregulation level significantly decreased after CBT. Dysregulated youth with OCD presented as more clinically severe than their non-dysregulated counterparts, and may require more individualized interventions to reduce dysregulated behavior to prevent CBT attrition. For treatment completers, CBT was associated with a decrease in dysregulation level.
authors.affiliation: Department of Psychology, University of South Florida, Tampa, FL, USA; Department of Pediatrics, University of South Florida, Tampa, FL, USA. Electronic address: jfmcguire@mail.usf.edu.
authors.forename: Joseph F
authors.initials: JF
authors.lastname: McGuire
authors.forename: Brent J
authors.initials: BJ
authors.lastname: Small
authors.forename: Adam B
authors.initials: AB
authors.lastname: Lewin
authors.forename: Tanya K
authors.initials: TK
authors.lastname: Murphy
authors.forename: Alessandro S
authors.initials: AS
authors.lastname: De Nadai
authors.forename: Vicky
authors.initials: V
authors.lastname: Phares
authors.forename: Gary
authors.initials: G
authors.lastname: Geffken
authors.forename: Eric A
authors.initials: EA
authors.lastname: Storch
mesh_terms: D000293:Adolescent; D002648:Child; D002653:Child Behavior Disorders / Q000150:complications* / Q000453:epidemiology / Q000534:rehabilitation*; D015928:Cognitive Behavioral Therapy; D005190:Family / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D009771:Obsessive-Compulsive Disorder / Q000150:complications* / Q000453:epidemiology / Q000534:rehabilitation*; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: Attrition; Children; Dysregulation; Impairment; Obsessive compulsive disorder; Symptom severity; Treatment outcome