Family functioning and treatment of childhood OCD

Nor Chr. Torp & Bente S.M. Haugland

Family functioning and Family functioning and treatment of childhood OCDtreatment of childhood OCD

29th Nordic Congress of Psychiatry29th Nordic Congress of PsychiatryStockholm, 24.09. 2009Stockholm, 24.09. 2009

Nor Christian Torp, PhD candidateBente Storm Mowatt Haugland, dr psychol

Centre for Child and Adolescent Mental Health, Eastern and Southern Norway


The role of family functioningThe role of family functioning

Family functioning

Development

Maintenance

Treatment

Childhood OCD

Family functioning



Family functioning

Development

Maintenance

Treatment

Childhood OCD

Family functioning



Family functioning

Development

Maintenance

Treatment

Childhood OCD

Family functioning


Focus and measures of family Focus and measures of family functioning in NordLOTSfunctioning in NordLOTS

AccommodationAccommodationMeasure: Family Accommodation Scale (FAS). (Calvocoressi et al., 1995)• FAS is a 12 items parent-report questionnaire.

Scored on a 5 point Likert-type scale.

Expressed Emotion (EE)Expressed Emotion (EE)Measure: Five Minutes Speech Sample (FMSS).(Magana,et al., 1986).• FMSS is an 5 minute audio-taped interview where

parent are asked in their own words to describe their child and the relationship to the child.


Family Accommodation Family Accommodation and OCDand OCD

Definition:Definition:• Family Accommodation refers to the actions taken by the

family members to; facilitate rituals, following the child’s demand, provide reassurance to the child, decrease child’s responsibility and so on” (Storch et al., 2007).

Scoring categories: Scoring categories: Family Accommodation Scale (FAS)Family Accommodation Scale (FAS)• To what degree family members have accommodated the

child’s OCD symptoms during the previous month (8 items).

• Level of distress/impairment that the family members and the patient experience as a result of accommodating or not accommodating the child (4 items).


Research findings on Family Research findings on Family Accommodation and OCDAccommodation and OCD

Relationship between Family Relationship between Family Accommodation and OCDAccommodation and OCD.

• Association with OCD symptoms severity (Steketee et al., 2003).

• Association with child factors and family characteristics.


Research findings on Family Research findings on Family Accommodation and OCDAccommodation and OCD

Relationship between Family Relationship between Family Accommodation and treatment of OCDAccommodation and treatment of OCD

• Predicting treatment outcome (Steketee & Van Noppen, 2003; Storch et al., 2007;).

• Preventing relapse after treatment (Merlo et al., 2009).


Expressed Emotion (EE) Expressed Emotion (EE) and OCDand OCD

DefinitionDefinition”…the affective attitudes and behaviors (…) of a significant other

towards a psychiatric patient” (Van Humbeeck et al., 2002).

Scoring categories in Five Minute Speech Sample Scoring categories in Five Minute Speech Sample (FMSS) (FMSS) (Magana et al., 1986).

• Critisism (Crit).• Emotional overinvolvement (EOI).


Research findings on EE and Research findings on EE and psychiatric disorders in childrenpsychiatric disorders in children

Significant higher levels of EE in families with:Significant higher levels of EE in families with:• Children with depression (Crit) (Asarnow, 1994).• Children with externalizing disorders (Crit) (Peris & Baker,

2000).• Children with anxiety disorders (Crit/EOI) (Gar & Hudson, 2008).

High EE predicts:High EE predicts:• Treatment outcome in depressed children (Asarnow et al.,

1999).• Level of functioning one year after treatment in children with

anxiety disorders (Angelosante, 2006).• Treatment outcome in children with OCD (Leonard et al, 1993).

Also:Also:• EE changes after family-based CBT for children with anxiety

disorders and their families (Angelosante, 2006).


The role of the family in The role of the family in treatment of childhood OCDtreatment of childhood OCD

Parents are included in treatment to:Parents are included in treatment to:

• Facilitate understanding of treatments principle.

• Assist with generalization of treatment gains by enlisting the parent as an “at-home coach”.

• Reduce family accommodation of OCD symptoms.

• Encourage optimal effort by the child during in-session exposures and homework assignments.

Treatment outcome

Diagnosis,Symptom levelcomorbidity

Expressed emotionFamily accomodation

Predictors of treatment outcome

Expressed emotions Familiy accomodation

Child characteristics(e.g. severity, comorbidity of OCD, gender, age),

Family characteristics

(e.g. demographic variables, parental mental health e.g.)

NordLOTS research questions with regard NordLOTS research questions with regard to family functioning and treatment of OCDto family functioning and treatment of OCD


ConclusionsConclusionsResearch status; the role of family functioning in Research status; the role of family functioning in

childhood OCD.childhood OCD.

• OCD may frequently have a profound negative impact on the lives of the child and other family members.

• Research on the role of family functioning and childhood OCD is to a large degree based on case reports and studies with small samples.

• There is little direct empirical evidence supporting a causal pathway between family functioning and childhood OCD. Indirectly, however there does appear to be support for a reciprocal relationship.

• Involving the parents in treatment of OCD in children may contribute to a successful outcome, however more and larger studies are needed to confirm this assumption.

Thank you,for your time.


Family functioning and treatment of childhood OCD

Documents

torp bente

christian torp

family characteristics

degree family members

measures of family functioning

hauglandfamily accommodation

child factors

hauglandresearch findings