Cognitive-behavioral treatment of childhood obsessive-compulsive disorder in community-based clinical practice: clinical significance and benchmarking against efficacy

Objective

To evaluate the feasibility and outcomes of evidence-based (EB) manualized, cognitive-behavioral treatment (CBT) for childhood obsessive-compulsive disorder (OCD), when delivered in an outpatient community-based specialist clinic.

Method

This study, conducted in an outpatient private clinic in South-East Queensland Australia, involved thirty-three children and adolescents with OCD. Children were assessed at pre- and post-treatment, by means of diagnostic interviews, symptom severity interviews, and self-report. Treatment involved 12 sessions CBT delivered either individually or in small groups and included parental involvement.

Results

Manualized CBT could be transported to the community setting effectively, with 63% of the current sample responding positively, based on post-treatment diagnosis. Significant change was evident across a wide-range of outcomes; including, diagnostic severity, symptom severity, child reported depression and anxiety, and both child and parent reported OCD functional impairment.

Conclusions

This study provides evidence for the transportability of manualized CBT in clinical community practice for pediatric OCD. The next important step is larger community based dissemination and effectiveness studies to advance both research and clinical practice outcomes.     

True or false: do 5-year-olds understand belief?

In 3 studies (N = 188) we tested the hypothesis that children use a perceptual access approach to reason about mental states before they understand beliefs. The perceptual access hypothesis predicts a U-shaped developmental pattern of performance in true belief tasks, in which 3-year-olds who reason about reality should succeed, 4- to 5-year-olds who use perceptual access reasoning should fail, and older children who use belief reasoning should succeed. The results of Study 1 revealed the predicted pattern in 2 different true belief tasks. The results of Study 2 disconfirmed several alternate explanations based on possible pragmatic and inhibitory demands of the true belief tasks. In Study 3, we compared 2 methods of classifying individuals according to which 1 of the 3 reasoning strategies (reality reasoning, perceptual access reasoning, belief reasoning) they used. The 2 methods gave converging results. Both methods indicated that the majority of children used the same approach across tasks and that it was not until after 6 years of age that most children reasoned about beliefs. We conclude that because most prior studies have failed to detect young children's use of perceptual access reasoning, they have overestimated their understanding of false beliefs. We outline several theoretical implications that follow from the perceptual access hypothesis.     

A longitudinal study of student-teacher relationship quality, difficult temperament, and risky behavior from childhood to early adolescence

This study examines the mediating role of student-teacher relationship quality (conflict and closeness) in grades 4, 5, and 6 on the relation between background characteristics, difficult temperament at age 4½ and risky behavior in 6th grade. The longitudinal sample of participants (N = 1156) was from the NICHD Study of Early Child Care and Youth Development. Structural equation modeling was used to estimate paths from (a) background characteristics to student-teacher relationship quality and risky behavior, (b) temperament to student-teacher relationship quality and risky behavior, and (c) student-teacher relationship quality to risky behavior. Findings indicate that students' family income, gender, receipt of special services, and more difficult temperament were associated with risky behavior. In addition, student-teacher conflict was a mediator. Students with more difficult temperaments were more likely to report risky behavior and to have conflict in their relationships with teachers. More conflict predicted more risky behavior. Closer student-teacher relationships were associated with less risky behavior. Results suggest negative relationships, specifically student-teacher relationships, may increase the risk that certain adolescents will engage in risky behavior.     

Morphemes in their place: Evidence for position-specific identification of suffixes

Previous research strongly suggests that morphologically complex words are recognized in terms of their constituent morphemes. A question thus arises as to how the recognition system codes for morpheme position within words, given that it needs to distinguish morphological anagrams like overhang and hangover. The present study focused specifically on whether the recognition of suffixes occurs in a position-specific fashion. Experiments 1 and 2 revealed that morphologically complex nonwords (gasful ) are rejected more slowly than orthographic controls (gasfil ) but that the same interference effect is not present when the morphemic constituents are reversed ( fulgas vs. filgas). Experiment 3 went further in demonstrating that reversing the morphemes within words (e.g., nesskind) does not yield morpheme interference effects against orthographic controls (e.g., nusskind). These results strongly suggest that suffix identification is position specific, which imposes important constraints on the further development of models of morphological processing.     

Reviews

Dnevniki ("Diaries") by Eduard Kuznetsov. Les Editeurs Réunis, Paris, 1973. 374 pp.

Sergei by Sergei Kourdakov. Oliphants, London, 1973. 205 pp. £2.50.

Zakonodatelstvo o religii v SSSR. Doklad Komitetu prav cheloveka ("Legislation on Religion in the USSR. Report submitted to the Human Rights Committee") by I. R. Shafarevich, Paris, 1973. 81 pp.     

Direct Comparison of Episodic Encoding and Retrieval of Words: An Event-related fMRI Study

Functional magnetic resonance imaging (fMRI) was used to compare directly episodic encoding and retrieval. During encoding, subjects studied visually presented words and reported via keypress whether each word represented a pleasant or unpleasant concept (intentional, deep encoding). During the retrieval phase, subjects indicated (via keypress) whether visually presented words had previously been studied. No reliable differences were found during the recognition phase for words that had been previously studied and those that had not been studied. Areas preferentially active during encoding (relative to retrieval) included left superior frontal cortex, medial frontal cortex, left superior temporal cortex, posterior cingulate, left parahippocampal gyrus, and left inferior frontal gyrus. Regions more active in retrieval than encoding included bilateral inferior parietal cortex, bilateral precuneus, right frontal polar cortex, right dorsolateral prefrontal cortex, and right inferior frontal/insular cortex.     

Role of Researchers in the Ethical Conduct of Research: A Discourse Analysis From Different Stakeholder Perspectives

The ethical conduct of research rests largely on researchers, and as such, an understanding of how they perceive and enact their role in research is paramount. However, the literature around ethics and research mostly focuses on researchers’ perception of Research Ethics Boards (REB; also known as Institutional Review Boards) roles and functions. To fill that gap, we analyzed the perceptions of researchers, REB members, and influential parties (n = 40) about researchers’ role in the ethical conduct of research through discourse analysis. Three discourses emerged: researchers as reflective practitioners, protectors of participants, and technicians. Understanding the commonalities and differences among the discourses may foster a shared and compelling institutional research culture.     

The validity of psychotherapy 1

How good is psychotherapy as a tool of research into human nature? There is an orthodox defence of it as a research tool, which relies on showing that interpretations are true of the patient when they satisfy certain criteria. This defence is examined and rejected. The reply is considered that an interpretation which ‘keeps things moving’ is true, or an approximation to the truth. This reply is rejected by comparing and contrasting an interpretation in psychotherapy with one from brainwashing sessions. Two suppositions about psychotherapy (which weaken its discovery powers) are deliberately adopted — the suppositions that the material produced is ‘perspective’ and ‘method’ dependent. An unorthodox defence of psychotherapy is then offered — by means of a watery sense of ‘discover’. This enables us to outline a weak sense in which psychotherapy is a valid enterprise, but one which is still strong enough for research purposes.