Avoidance, Insight, Impairment Recognition Concordance, and Cognitive-Behavioral Therapy Outcomes in Pediatric Obsessive-Compulsive Disorder
Avoidance, Insight, Impairment Recognition Concordance, and Cognitive-Behavioral Therapy Outcomes in Pediatric Obsessive-Compulsive Disorder
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DOI：
10.1016/j.jaac.2019.05.030
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发表时间：
2020-05-01
影响因子：
13.3
通讯作者：
Stewart, S. Evelyn
中科院分区：
文献类型：
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作者：
Selles, Robert R.;Hojgaard, David R. M. A.;Stewart, S. Evelyn
目的：自知力和回避是强迫症(OCD)的常见因素，已证实与成人强迫症的严重程度增加和治疗反应降低有关，但这些因素在儿童强迫症中尚未得到充分研究。本研究在大样本的强迫症青少年中，探讨回避、自知力和损伤认知一致性对认知行为疗法(CBT)结果的影响，以及CBT对自知力和回避的影响。方法：收集参加CBT试验的573名强迫症青少年的数据。儿童耶鲁-布朗强迫症量表项目测量治疗反应、洞察力和回避。儿童和父母的损害分级之间的标准化差异被用来计算损害识别的一致性。结果：更多的回避、有限的儿童对损伤的认识、年龄较大和较低的基线严重程度预示着治疗反应的可能性降低，但自知力不是。接受CBT治疗后，自知力和回避能力均有显著改善。当治疗后自知力和回避更差时，应答率更低。结论：与普遍认为的相反，自知力差似乎不会限制儿童强迫症的CBT反应潜力。回避和损害识别是CBT反应的预测因子，在儿童强迫症中值得进一步考虑。临床医生应该注意这些因素，以优化受这种常见的、令人衰弱的疾病影响的儿童的预后。
Objective: Insight and avoidance are commonly discussed factors in obsessive-compulsive disorder (OCD) that have demonstrated associations with increased severity as well as reduced treatment response in adults, but these factors have not been sufficiently examined in pediatric OCD. This study examined the impacts of avoidance, insight, and impairment recognition concordance on cognitive-behavioral therapy (CBT) outcomes as well as impacts of CBT on insight and avoidance in a large sample of youths affected by OCD.Method: Data from 573 OCD-affected youths enrolled in CBT trials were aggregated. Children's Yale-Brown Obsessive-Compulsive Scale items measured treatment response, insight, and avoidance. Standardized differences between child and parent ratings of impairment were used to calculate impairment recognition concordance. Binary logistic regression was used to identify variables associated with treatment response.Results: Greater avoidance, limited child recognition of impairment, older age, and lower baseline severity predicted reduced likelihood of treatment response, but insight did not. Both insight and avoidance improved significantly following CBT. Response rates were lower when posttreatment insight and avoidance were worse.Conclusion: Contrasting with prevailing belief, poor insight does not appear to limit CBT response potential in pediatric OCD. Avoidance and impairment recognition are understudied CBT response predictors and warrant further consideration in pediatric OCD. Clinicians should attend to these factors to optimize outcomes for children affected by this common, debilitating illness.