Family Based Treatment of Early Childhood OCD

描述(由申请人提供)：儿童期起病的强迫症(OCD)是一种慢性精神障碍，影响大约2%-4%的儿童。尽管这一群体存在普遍和复杂问题的重大风险，但目前对患有强迫症的青年采取的认知行为干预措施没有解决强迫症在幼儿(5-8岁)中的独特特征，包括：认知发展差异、家庭背景、独特症状的相关性以及家庭与心理健康系统的首次接触。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基于家庭的认知行为治疗(CBT)的初步实证测试。研究结果表明，积极治疗与适度的治疗效果有关。以这项令人鼓舞的工作为起点，我们现在提出一项针对患有强迫症的幼儿的以家庭为基础的CBT计划的随机对照疗效研究。这项研究的目的是：(1)比较基于家庭的CBT和基于家庭的放松疗法(RT)在14周的急性治疗中减轻幼儿(5-8岁)强迫症症状的相对有效性，以及(2)比较基于家庭的CBT和基于家庭的RT在减少幼儿(5-8岁)在14周的急性治疗中相关残疾(功能障碍和生活质量)方面的相对有效性。次要目标是：(3)探索治疗反应的潜在调节因素和中介；(4)探索CBT和RT在14周的急性治疗中在反应过程、ASAP会话的使用、提前终止率和脱落率方面的差异；以及(5)探索CBT和RT在为期12个月的自然随访间隔内对强迫症症状、功能、复发率和其他治疗方法的利用的影响。值得注意的是，这项研究：(1)将评估强迫症症状减轻以外的结果，包括功能障碍和生活质量；(2)将检查治疗过程中的变化机制；(3)将检查反应的时间进程和维持；(4)将评估可能影响治疗反应的治疗前患者和家庭特征；(5)通过评估结果在三个种族和社会经济不同地点的普适性，代表传播的第一步。

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.