Academic journal article American Journal of Psychotherapy

Behavioral Avoidance Test for Childhood Obsessive-Compulsive Disorder; A Home-Based Observation

Academic journal article American Journal of Psychotherapy

Behavioral Avoidance Test for Childhood Obsessive-Compulsive Disorder; A Home-Based Observation

Article excerpt

Obsessive-compulsive disorder (OCD) is one of the most debilitating of the anxiety disorders. As our knowledge about this childhood condition continues to grow, there is a need for controlled treatment-outcome trials with precise assessments that are sensitive to treatment change, to guide the development of effective interventions. To evaluate the efficacy of a treatment protocol, it is necessary to have reliable and sensitive measures of OCD symptoms, including measures of obsessions, compulsions, and related levels of distress and avoidance. Whilst structured diagnostic interviews, semistructured clinical interviews, and self-report measures have been widely used in the assessment of childhood OCD, related levels of behavioral distress and avoidance have not been measured in treatment-outcome trials.

This study investigated the sensitivity of a behavioral avoidance test (BAT), conducted in the home environment, in assessing treatment-outcome effects for children and adolescents with OCD following a 14-week cognitivebehavioral therapy (CBT) family intervention, in comparison to children in an 8-week "waitlist" control group. The results of the current study strongly support the sensitivity of a standardized BAT in assessing treatment-related changes in children and adolescents with OCD. Implications and future directions for research are discussed.

Childhood Obsessive-Compulsive Disorder (OCD) is a complex and puzzling psychological condition, and is one of the most debilitating of the anxiety disorders. With recent epidemiological data indicating a lifetime prevalence rate of 2-3% (1), this childhood disorder is much more common than had been previously believed. The impact of this chronic condition in childhood is often associated with deterioration in school performance (2) and poor peer relationships (3). In addition, childhood OCD is often associated with disruptions to family life, with significant distress experienced by parents and siblings (4, 5). Despite the higher than expected prevalence rates, and the demonstrated negative impact that OCD has during childhood, our understanding of this disabling anxiety disorder is still in its infancy.

It has only been in recent years that research has begun to examine treatment issues related to childhood OCD. This research has included a limited number of Cognitive-Behavioral Therapy (CBT) treatment trials (6-12), which were designed to be sensitive to developmental considerations (13). These initial CBT trials have shown promising results for the treatment of childhood OCD, demonstrating significant decreases in diagnostic status and symptom severity at posttreatment and at follow-up for the children in these studies (10).

As research flourishes in this area, there remains a need for continued controlled treatment-outcome trials. Useful assessment strategies that are sensitive to treatment change are required. In order to evaluate the efficacy of a treatment protocol, it is necessary to have reliable and sensitive measures of OCD symptoms, including measures of obsessions, compulsions, and related levels of distress and avoidance (14). Whilst structured diagnostic interviews, semistructured clinical interviews, and self-report measures have been adapted from the adult research and widely used in the assessment of childhood OCD, related levels of behavioral distress and avoidance have not been measured in treatment-outcome trials. It is important to obtain a measure of avoidance because children who engage in extensive avoidance behaviors may not show any overt symptoms, and consequently may not be accurately diagnosed based on the standard assessment methods, which do not sufficiently assess levels of avoidance in OCD. One such assessment strategy that assesses both avoidance and related distress, which has been used extensively in the adult anxiety literature to assess treatment change, is the Behavioral Avoidance Test (BAT). Assessment protocols that include a standardized BAT are likely to detect important treatment-related changes in OCD symptoms, in particular, levels of behavioral avoidance and distress. …

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