Family Based Treatment of Early Childhood OCD

描述（由申请人提供）：儿童期开始的强迫症（OCD）是一种慢性精神障碍，影响大约2-4%的儿童。尽管在这一人群中存在普遍和复杂的问题，但目前针对青少年强迫症的认知行为干预措施并没有解决幼儿（5-8岁）强迫症的独特特征，包括：认知发育差异、家庭背景、独特的症状相关性以及家庭与心理健康系统的初次接触。为了填补这一知识基础上的关键空白，我们的研究小组完成了针对幼儿强迫症的手动家庭认知行为治疗（CBT）的初步实证测试。研究结果表明，积极治疗与中度治疗效果相关。以这项令人鼓舞的工作为起点，我们现在提出一项随机对照疗效研究，以家庭为基础的CBT计划治疗患有强迫症的幼儿。本研究旨在：(1)比较以家庭为基础的CBT与以家庭为基础的放松治疗（RT）减轻幼儿（5-8岁）14周急性治疗中强迫症症状的相对疗效；(2)比较以家庭为基础的CBT与以家庭为基础的RT在减轻幼儿（5-8岁）14周急性治疗中相关残疾（功能损害和生活质量）的相对疗效。次要目的是：(3)探索治疗反应的潜在调节因子和介质，(4)探索14周急性治疗期间CBT和RT在反应时间、ASAP疗程的使用、过早终止率和退出率方面的差异，以及(5)探索CBT和RT在12个月的自然随访间隔内对强迫症症状、功能、复发率和其他治疗使用的影响。值得注意的是，本研究：(1)将评估强迫症症状减轻以外的结果，包括功能损害和生活质量；(2)检查治疗过程中变化的机制；(3)将检查反应的时间、过程和维持情况；(4)将评估可能影响治疗反应的治疗前患者和家庭特征；(5)通过评估三个种族和社会经济不同地点的研究结果的普遍性，代表了传播的第一步。

DESCRIPTION (provided by applicant): Childhood-onset Obsessive Compulsive Disorder (OCD) is a chronic psychiatric disturbance that affects approximately 2-4% of children. Despite the significant risk of pervasive and compounding problems for this population, current cognitive-behavioral interventions for youth with OCD do not address the unique features of OCD in young children (ages 5-8), including: cognitive developmental differences, family context, unique symptom correlates, and a family's initial contact with the mental health system. To fill this critical gap in the knowledge base, our research group completed preliminary empirical testing for a manualized family-based cognitive-behavioral treatment (CBT) for OCD in young children. Results of the study indicate that the active treatment was associated with a moderate treatment effect. With this encouraging work as our starting point, we now propose a randomized controlled efficacy study of our family-based CBT program for young children with OCD. The proposed research aims to: (1) Compare the relative efficacy of family-based CBT to family- based Relaxation Treatment (RT) in reducing OCD symptoms in young children (aged 5-8) over 14 weeks of acute treatment, and (2) Compare the relative efficacy of family-based CBT to family based RT in reducing associated disability (functional impairment and quality of life) in young children (aged 5-8) over 14 weeks of acute treatment. Secondary aims are to: (3) Explore potential moderators and mediators of response to treatment, (4) Explore differences in time course of response, use of ASAP sessions, rates of premature termination, and drop out rates between CBT and RT over 14-weeks of acute treatment, and (5) Explore the impact of CBT and RT over a 12-month naturalistic follow-up interval on OCD symptoms, functioning, relapse rates, and utilization of other treatments. Notably, this research: (1) will evaluate outcome beyond OCD symptom reduction, including functional impairment and quality of life; (2) will examine mechanisms of change during treatment; (3) will examine time course and maintenance of response; (4) will evaluate pre- treatment patient and family characteristics that may affect treatment response and (5) represents a first step towards dissemination by evaluating the generalizability of findings across three ethnically and socioeconomically diverse sites.