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Family functioning and treatment of childhood OCD

Family functioning and treatment of childhood OCD. 29th Nordic Congress of Psychiatry Stockholm, 24.09. 2009 Nor Christian Torp, PhD candidate Bente Storm Mowatt Haugland, dr psychol Centre for Child and Adolescent Mental Health, Eastern and Southern Norway. The role of family functioning.

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Family functioning and treatment of childhood OCD

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  1. Family functioning and treatment of childhood OCD 29th Nordic Congress of Psychiatry Stockholm, 24.09. 2009 Nor Christian Torp, PhD candidate Bente Storm Mowatt Haugland, dr psychol Centre for Child and Adolescent Mental Health, Eastern and Southern Norway Nor Chr. Torp & Bente S.M. Haugland

  2. The role of family functioning Development Maintenance Treatment Family functioning Childhood OCD Family functioning Nor Chr. Torp & Bente S.M. Haugland

  3. The role of family functioning Development Maintenance Treatment Family functioning Childhood OCD Family functioning Nor Chr. Torp & Bente S.M. Haugland

  4. The role of family functioning Development Maintenance Treatment Family functioning Childhood OCD Family functioning Nor Chr. Torp & Bente S.M. Haugland

  5. Focus and measures of family functioning in NordLOTS • Accommodation • Measure: 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) • 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. Nor Chr. Torp & Bente S.M. Haugland

  6. Family Accommodation and OCD • 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: • 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). Nor Chr. Torp & Bente S.M. Haugland

  7. Research findings on Family Accommodation and OCD • Relationship between Family Accommodation and OCD. • Association with OCD symptoms severity (Steketee et al., 2003). • Association with child factors and family characteristics. Nor Chr. Torp & Bente S.M. Haugland

  8. Research findings on Family Accommodation and OCD • Relationship between Family Accommodation and treatment of OCD • Predicting treatment outcome (Steketee & Van Noppen, 2003; Storch et al., 2007;). • Preventing relapse after treatment(Merlo et al., 2009). Nor Chr. Torp & Bente S.M. Haugland

  9. Expressed Emotion (EE) and OCD • Definition • ”…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 • (FMSS) (Magana et al., 1986). • Critisism (Crit). • Emotional overinvolvement (EOI). Nor Chr. Torp & Bente S.M. Haugland

  10. Research findings on EE and psychiatric disorders in children • 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: • 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: • EE changes after family-based CBT for children with anxiety • disorders and their families (Angelosante, 2006). Nor Chr. Torp & Bente S.M. Haugland

  11. The role of the family in treatment of childhood OCD • 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. Nor Chr. Torp & Bente S.M. Haugland

  12. ConclusionsResearch status; the role of family functioning in 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. Nor Chr. Torp & Bente S.M. Haugland

  13. Thank you,for your time. Nor Chr. Torp & Bente S.M. Haugland

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