Intensive Family-Based Cognitive-Behavioral Therapy for Pediatric Obsessive-Compulsive Disorder: Applications for Treatment of Medication Partial- or Nonresponders

Serotonin reuptake inhibitor medications and cognitive-behavioral therapy (CBT) are both effective treatments for pediatric obsessive-compulsive disorder (OCD). Despite recommendations that youth with OCD be treated with CBT alone or together with serotonin reuptake inhibitor medication, many youth are treated with medication alone or with non-CBT psychotherapy initially. Although effective, symptom remission with medication alone is rare (e.g., only 21.4% of youth achieved remission with sertraline in the Pediatric OCD Treatment Study, 2004) and residual symptoms often remain (e.g., 58% of subjects in the March et al. [1998] sertraline trial were not considered treatment responders). This paper reviews the literature on the efficacy of CBT for pediatric OCD, particularly as it relates to the treatment of youth with prior inadequate response to medication. It also describes an intensive, family-based CBT program for children and adolescents with OCD and support for its efficacy among those with prior partial- or nonresponse to medication. Finally, we present a case study of an adolescent girl with OCD who participated in the intensive treatment program after having limited benefit from medication and non-CBT psychotherapy and experienced a favorable response.     

Speech errors reflect the phonotactic constraints in recently spoken syllables, but not in recently heard syllables

Adults rapidly learn phonotactic constraints from brief production or perception experience. Three experiments asked whether this learning is modality-specific, occurring separately in production and perception, or whether perception transfers to production. Participant pairs took turns repeating syllables in which particular consonants were restricted to particular syllable positions. Speakers’ errors reflected learning of the constraints present in the sequences they produced, regardless of whether their partner produced syllables with the same constraints, or opposing constraints. Although partial transfer could be induced (Experiment 3), simply hearing and encoding syllables produced by others did not affect speech production to the extent that error patterns were altered. Learning of new phonotactic constraints was predominantly restricted to the modality in which those constraints were experienced.     

Object identification without foveal vision: Evidence from an artificial scotoma paradigm

The purpose of the present study was to investigate the degree to which foveal information is necessary for object identification. To explore this question, we used an artificial moving scotoma paradigm to eliminate a region of a currently viewed display in real time as a function of eye position. Subjects examined linear arrays of four line drawings of objects while their eye movements were recorded. Immediately following each array, a test probe was presented to test the degree to which the subject had identified those objects. Three conditions were compared, one in which a central foveal scotoma was created, one in which an extrafoveal scotoma was created, and a control condition in which the scotoma was absent. The main result was that identification accuracy was very good, but eye-movement behavior was disrupted when a foveal scotoma was present. These results suggest that foveal information is not necessary but is beneficial for perceptual encoding during object identification; the loss of foveal information can be overcome as long as compensatory extrafoveal processing is possible.     

The relationship between intelligence and multiple domains of religious belief: Evidence from a large adult US sample

High levels of religiosity have been linked to lower levels of intelligence in a number of recent studies. These results have generated both controversy and theoretical interest. Here in a large sample of US adults we address several issues that restricted the generalizability of these previous results. We measured six dimensions of religiosity (rather than just one or two), along with a multi-scale instrument to assess general intelligence. We also controlled for the influence of the personality trait openness on facets of religious belief and practice. The results indicated that lower intelligence is most strongly associated with higher levels of fundamentalism, but also modestly predicts central components of religiosity such as a sense of religious identification and private religious practice. Secondly, we found that a higher level of openness - often assumed to lead to lower religiosity - is weakly associated with reduced fundamentalism but with increased religious mindfulness, private religious practice, religious support, and spirituality. These new results provide a framework for understanding the links between reasoning and faith.     

Planning and articulation in incremental word production: syllable-frequency effects in English

We investigated the role of syllables during speech planning in English by measuring syllable-frequency effects. So far, syllable-frequency effects in English have not been reported. English has poorly defined syllable boundaries, and thus the syllable might not function as a prominent unit in English speech production. Speakers produced either monosyllabic (Experiment 1) or disyllabic (Experiment 2-4) pseudowords as quickly as possible in response to symbolic cues. Monosyllabic targets consisted of either high- or low-frequency syllables, whereas disyllabic items contained either a 1st or 2nd syllable that was frequency-manipulated. Significant syllable-frequency effects were found in all experiments. Whereas previous findings for disyllables in Dutch and Spanish-languages with relatively clear syllable boundaries-showed effects of a frequency manipulation on 1st but not 2nd syllables, in our study English speakers were sensitive to the frequency of both syllables. We interpret this sensitivity as an indication that the production of English has more extensive planning scopes at the interface of phonetic encoding and articulation. (PsycINFO Database Record (c) 2010 APA, all rights reserved).     

The role of comorbid disruptive behavior in the clinical expression of pediatric obsessive-compulsive disorder

This study explored the impact of disruptive behavior disorder (DBD) comorbidity on a number of theoretically relevant outcomes among 192 children and adolescents with obsessive-compulsive disorder (OCD). Youth were divided into three groups: OCD Only, OCD+DBD comorbidity and OCD+Other comorbidity. Relative to those without a comorbid condition and those with any non-DBD comorbidity, comorbid DBD was associated with greater family accommodation and less symptom resistance. Youth with comorbid DBD exhibited greater OCD symptom severity, OCD-related impairment, anxiety, and internalizing problems than those with no comorbidity. Those with comorbid DBD were over 3.6 times as likely to be taking an atypical antipsychotic medication relative to children without comorbidity. The present results suggest that comorbid DBD contributes to more severe illness presentation above and beyond an OCD diagnosis alone, and may be associated with differing pharmacotherapy prescribing practices.     

Moments of Spontaneity and Surprise: The Nonlinear Road to Something More

Moments of spontaneity and surprise create opportunities for change to occur through perturbations in the analyst-analysand system. These moments of authentic person-to-person contact violate anticipated patterns of intersubjective engagement. Mutative potential arises from the coconstruction of new relational configurations and the resultant modifications in the procedural memory system of both members of the analytic dyad. Three moments of spontaneity and surprise from the analysis of a man with a rigid character structure are presented and discussed.     

MBTI and historical data

The Myers-Briggs Type Indicator presents a model of personality which may be useful for understanding historical personalities, but empirical verification is necessary.     

Protection of children's rights to self-determination in research

Federal guidelines require that informed consent be obtained from participants when they are enrolled in a research study. When conducting research with children, the guidelines utilize the term permission to describe parents' agreement to enroll their children in a study. The basic components of consent and permission are well described and identical, with the exception of the person for whom the decision to participate is being made (i.e., oneself as opposed to one's child). Beyond permission, when enrolling minor participants in research, affirmative agreement to participate in research or assent must be obtained from the child participants themselves. The concept of children's assent to research, however, is poorly defined, resulting in inconsistency in its pursuit and consequently, in its utility. The interface between cognitive development, emotional, and social development must be examined as its pertains to this special situation of decision making. For this process to meaningfully protect minors, the assent process must be clarified, decisions regarding parental veto power must be more convincingly justified, and researchers must be better educated and held accountable for the valid execution of this process. Strategies for implementing the assent process more effectively are presented.