Family Based Treatment of Early Childhood OCD

描述（由申请人提供）：儿童期发作的强迫症（OCD）是一种慢性精神障碍，影响约2-4%的儿童。尽管这一人群普遍和复杂的问题的重大风险，目前的认知行为干预与青少年强迫症不解决的独特功能的强迫症在幼儿（5-8岁），包括：认知发展差异，家庭环境，独特的症状相关性，和家庭的初步接触精神卫生系统。为了填补知识基础中的这一关键空白，我们的研究小组完成了对幼儿强迫症的手动化家庭认知行为治疗（CBT）的初步实证测试。研究结果表明，活性治疗与中度治疗效应相关。有了这个令人鼓舞的工作作为我们的出发点，我们现在提出了一个随机对照的有效性研究，我们的家庭为基础的CBT计划与强迫症的幼儿。拟议的研究旨在：（1）比较以家庭为基础的CBT与以家庭为基础的放松治疗（RT）在减轻幼儿强迫症症状方面的相对功效。（5-8岁）超过14周的急性治疗，（2）比较以家庭为基础的CBT与以家庭为基础的RT在减少相关残疾方面的相对功效（功能障碍和生活质量）在幼儿（5-8岁）超过14周的急性治疗。次要目标是：（3）探索对治疗反应的潜在调节剂和介导剂，（4）探索在14周急性治疗期间CBT和RT之间反应的时间过程、ASAP会话的使用、提前终止率和脱落率的差异，以及（5）探索CBT和RT在12个月自然随访间隔内对OCD症状、功能、复发率的影响，以及其他治疗方法的应用。值得注意的是，这项研究：（1）将评估OCD症状减轻以外的结果，包括功能障碍和生活质量;（2）将检查治疗期间的变化机制;（3）将检查反应的时间过程和维持;（4）将评估可能影响治疗反应的治疗前患者和家庭特征，以及（5）这是通过评估在三个种族和社会经济多样的地点得出的结论的普遍性而向传播迈出的第一步。

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.