Child Psychiatry & Human Development

, Volume 43, Issue 3, pp 337–353 | Cite as

Maternal and Child Expressed Emotion as Predictors of Treatment Response in Pediatric Obsessive–Compulsive Disorder

  • Amy Przeworski
  • Lori A. Zoellner
  • Martin E. Franklin
  • Abbe Garcia
  • Jennifer Freeman
  • John S. March
  • Edna B. Foa
Original Article
First Online:

Abstract

Expressed emotion (EE) is associated with symptoms and treatment outcome in various disorders. Few studies have examined EE in pediatric OCD and none of these has assessed the child’s perspective. This study examined the relationship among maternal and child EE, child OCD severity, and OCD-related functioning pre- and post-treatment. At pre-treatment, mothers completed speech samples about the child with OCD and an unaffected sibling. Children with OCD completed speech samples about parents. There were low rates of high maternal EE (child with OCD: 16.1%; sibling: 2.6%) and high child EE about parents (mothers: 11.9%; fathers: 10.2%). High EE was primarily characterized by high criticism, not high overinvolvement. High maternal EE and child EE regarding fathers were associated with pre-treatment child OCD severity but not post-treatment severity. High child and maternal EE were predictive of post-treatment OCD-related functioning. EE may be an important child and maternal trait associated with pre-treatment OCD severity and generalization of treatment gains.

Keywords

Expressed emotion Obsessive–compulsive disorder OCD Family Treatment 
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Notes

Acknowledgments

The Pediatric OCD Treatment (POTS) Study was supported by NIMH grants R01 MH55121 and R01 MH55126. We would like to thank Matthew Sacks and Constance Hamlin for their help with data collection. The POTS Team consisted of: Principal investigators: Edna Foa, PhD and John S. March, MD, MPH; Coinvestigators: University of Pennsylvania: Martin Franklin, PhD, Jonathan Huppert, PhD, Moira Rynn, MD, Ning Zhao, PhD, Lori Zoellner, PhD;Duke University Medical Center: Pat Gammon, PhD, Allan Chrisman, MD, John Curry, PhD, David Fitzgerald, PhD, Kevin Sullivan, BA; Brown University: Henrietta Leonard, MD, Abbe Garcia, PhD, Jennifer Freeman, PhD; Principal Statistician: Xin Tu, PhD (University of Pennsylvania).

References

  1. 1.
    Barrett P, Shortt A, Healy L (2002) Do parent and child behaviours differentiate families whose children have obsessive-compulsive disorder from other clinic and non-clinic families? J Child Psychol Psychiatry 43(5):597–607PubMedCrossRefGoogle Scholar
  2. 2.
    Leff JP, Vaughn CE (1985) Expressed emotion in families: its significance for mental illness. Guilford Press, New YorkGoogle Scholar
  3. 3.
    Vaughn C, Leff J (1976) The measurement of expressed emotion in the families of psychiatric patients. Br J Soc Clin Psychol 15(2):157–165PubMedCrossRefGoogle Scholar
  4. 4.
    Asarnow JR, Goldstein MJ, Tompson M, Guthrie D (1993) One-year outcomes of depressive disorders in child psychiatric in-patients: evaluation of the prognostic power of a brief measure of expressed emotion. J Child Psychol Psychiatry 34(2):129–137PubMedCrossRefGoogle Scholar
  5. 5.
    Greenberg JS, Seltzer MM, Hong J, Orsmond GI (2006) Bidirectional effects of expressed emotion and behavior problems and symptoms in adolescents and adults with autism. Am J Ment Retard 111(4):229–249PubMedCrossRefGoogle Scholar
  6. 6.
    Miklowitz DJ, Axelson DA, George EL, Taylor DO, Schneck CD, Sullivan AE, Dickinson LM, Birmaher B (2009) Expressed emotion moderates the effects of family-focused treatment for bipolar adolescents. J Am Acad Child Adolesc Psychiatry 48(6):643–651PubMedCrossRefGoogle Scholar
  7. 7.
    Salkovskis P, Shafran R, Rachman S, Freeston MH (1999) Multiple pathways to inflated responsibility beliefs in obsessional problems: possible origins and implications for therapy and research. Behav Res Ther 37:1055–1072PubMedCrossRefGoogle Scholar
  8. 8.
    Rachman S, Hodgson R (1980) Obsessions and compulsions. Prentice Hall, Englewood CliffsGoogle Scholar
  9. 9.
    Van Noppen B, Steketee G, McCorkle BH, Pato M (1997) Group and multifamily behavioral treatment for obsessive compulsive disorder: a pilot study. J Anxiety Disord 11(4):431–446PubMedCrossRefGoogle Scholar
  10. 10.
    Calvocoressi L, Lewis B, Harris M, Trufan SJ, Goodman WK, McDougle CJ, Price LH (1995) Family accommodation in obsessive-compulsive disorder. Am J Psychiatry 152(3):441–443PubMedGoogle Scholar
  11. 11.
    Renshaw KD, Steketee G, Chambless DL (2005) Involving family members in the treatment of OCD. Cogn Behav Therapy 34:164–175CrossRefGoogle Scholar
  12. 12.
    Lieb R, Wittchen H-U, Hofler M, Fuetsch M, Stein MB, Merikangas KR (2000) parental psychopathology, parenting styles, and the risk of social phobia in offspring: a prospective-longitudinal community study. Arch Gen Psychiatry 57(9):859–866PubMedCrossRefGoogle Scholar
  13. 13.
    Last CG, Strauss CC (1990) School refusal in anxiety-disordered children and adolescents. J Am Acad Child Adolesc Psychiatry 29(1):31–35PubMedCrossRefGoogle Scholar
  14. 14.
    Chambless DL, Steketee G (1999) Expressed emotion and behavior therapy outcome: a prospective study with obsessive compulsive and agoraphobic outpatients. J Consult Clin Psychol 67(5):658–665PubMedCrossRefGoogle Scholar
  15. 15.
    Hibbs ED, Hamburger SD, Lenane M, Rapoport JL, Kruesi MJP, Keysor CS, Goldstein MJ (1991) Determinants of expressed emotion in families of disturbed and normal children. J Child Psychol Psychiatry 32(5):757–770PubMedCrossRefGoogle Scholar
  16. 16.
    Hibbs ED, Zahn TP, Hamburger SD, Kruesi MM, Rapoport JL (1992) Parental expressed emotion and psychophysiological reactivity in disturbed and normal children. Br J Psychiatry 160(4):504–510PubMedCrossRefGoogle Scholar
  17. 17.
    Hibbs ED, Hamburger SD, Kruesi MJ, Lenane M (1993) Factors affecting expressed emotion in parents of ill and normal children. Am J Orthopsychiatry 63(1):103–112PubMedCrossRefGoogle Scholar
  18. 18.
    Magana AB, Goldstein MJ, Karno M, Miklowitz DJ et al (1986) A brief method for assessing expressed emotion in relatives of psychiatric patients. Psychiatry Res 17(3):203–212PubMedCrossRefGoogle Scholar
  19. 19.
    Leonard HL, Swedo SE, Lenane MC, Rettew DC et al (1993) A 2- to 7-year follow-up study of 54 obsessive-compulsive children and adolescents. Arch Gen Psychiatry 50(6):429–439PubMedCrossRefGoogle Scholar
  20. 20.
    McCarty CA, Lau AS, Valeri SM, Weisz JR (2004) Parent-child interactions in relation to critical and emotionally overinvolved expressed emotion (EE): is EE a proxy for behavior? J Abnorm Child Psychol 32(1):83–93PubMedCrossRefGoogle Scholar
  21. 21.
    Wamboldt FS, O’Connor SL, Wamboldt MZ, Gavin LA, Klinnert MD (2000) The five minute speech sample in children with asthma: deconstructing the construct of expressed emotion. J Child Psychol Psychiatry Allied Discip 41(07):887–898CrossRefGoogle Scholar
  22. 22.
    Vostanis P, Nicholls J, Harrington R (1994) Maternal expressed emotion in conduct and emotional disorders of childhood. J Child Psychol Psychiatry 35(2):365–376PubMedCrossRefGoogle Scholar
  23. 23.
    McCreadie R, Robertson L, Hall D, Berry I (1993) The Nithsdale schizophrenia surveys. XI: relatives’ expressed emotion. Stability over five years and its relation to relapse. Br J Psychiatry 162(3):393–397PubMedCrossRefGoogle Scholar
  24. 24.
    Peris TS, Baker BL (2000) Applications of the expressed emotion construct to young children with externalizing behavior: stability and prediction over time. J Child Psychol Psychiatry 41(4):457–462PubMedCrossRefGoogle Scholar
  25. 25.
    Schreiber J, Breier A, Pickar D (1995) Expressed emotion. Trait or state? Br J Psychiatry 166(5):647–649PubMedCrossRefGoogle Scholar
  26. 26.
    Hodes M, Garralda ME, Rose G, Schwartz R (1999) Maternal expressed emotion and adjustment in children with epilepsy. J Child Psychol Psychiatry 40(7):1083–1093PubMedCrossRefGoogle Scholar
  27. 27.
    Simoneau T, Miklowitz D, Saleem R (1998) Expressed emotion and interactional patterns in the families of bipolar patients. J Abnorm Psychol 107(3):497–507PubMedCrossRefGoogle Scholar
  28. 28.
    Suveg C, Kendall P, Comer J, Robin J (2006) Emotion-focused cognitive-behavioral therapy for anxious youth: a multiple-baseline evaluation. J Contemp Psychotherapy 36(2):77–85CrossRefGoogle Scholar
  29. 29.
    Briggs-Gowan MJ, Horwitz SM, Schqab-Stone ME, Leventhal JM, Leaf PJ (2000) Mental health in pediatric settings: distribution of disorders and factors related to service use. J Am Acad Child Adolesc Psychiatry 39:841–849PubMedCrossRefGoogle Scholar
  30. 30.
    Southam-Gerow MA, Kendall PC (2002) Emotion regulation and understanding: implications for child psychopathology and therapy. Clin Psychol Rev 22(2):189–222PubMedCrossRefGoogle Scholar
  31. 31.
    Banerjee M (1997) Hidden emotions: preschoolers’ knowledge of appearance-reality and emotion display rules. Soc Cogn 15:107–132CrossRefGoogle Scholar
  32. 32.
    Thomson RA (1987) Development of children’s inferences of the emotions of others. Dev Psychol 23:124–131CrossRefGoogle Scholar
  33. 33.
    Thomson RA (1994) Emotion regulation: a theme in search of definition. Monogr Soc Res Child Dev 59:24–52Google Scholar
  34. 34.
    Marshall VG, Longwell L, Goldstein MJ, Swanson JM (1990) Family factors associated with aggressive symptomatology in boys with attention deficit hyperactivity disorder: a research note. J Child Psychol Psychiatry 31(4):629–636PubMedCrossRefGoogle Scholar
  35. 35.
    Pediatric OCD Treatment Study (2004) Cognitive-behavior therapy, sertraline, and their combination for children and adolescents with obsessive-compulsive disorder. J Am Med Assoc 292(16):1969–1976CrossRefGoogle Scholar
  36. 36.
    American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, 4th edn. American Psychiatric Press, Washington, DCGoogle Scholar
  37. 37.
    Silverman WK, Albano AM (1996) Anxiety disorders interview schedule for DSM-IV: child version. Graywind Publications Incorporated, San AntonioGoogle Scholar
  38. 38.
    Albano AM, Marten PA, Holt CS, Heimberg RG, Barlow DH (1995) Cognitive-behavioral group treatment for social phobia in adolescents: a preliminary study. J Nerv Ment Dis 183(10):649–656PubMedCrossRefGoogle Scholar
  39. 39.
    Silverman WK, Saavedra LM, Pina AA (2001) Test-retest reliability of anxiety symptoms and diagnoses with the anxiety disorders interview schedule for DSM-IV: child and parent versions. J Am Acad Child Adolesc Psychiatry 40(8):937–944PubMedCrossRefGoogle Scholar
  40. 40.
    Wood JJ, Piacentini JC, Bergman RL, McCracken J, Barrios V (2002) Concurrent validity of the anxiety disorders section of the anxiety disorders interview schedule for DSM-IV: child and parent versions. J Clin Child Adolesc Psychol 31(3):335–342PubMedGoogle Scholar
  41. 41.
    Franklin M, Foa EB, March JS (2003) The pediatric obsessive-compulsive disorder treatment study: rationale, design, and methods. J Child Adolesc Psychopharmacol 13(Suppl 2):S39–S51PubMedCrossRefGoogle Scholar
  42. 42.
    Scahill L, Riddle MA, McSwiggin-Hardin M, Ort SI et al (1997) Children’s yale-brown obsessive compulsive scale: reliability and validity. J Am Acad Child Adolesc Psychiatry 36(6):844–852PubMedCrossRefGoogle Scholar
  43. 43.
    Piacentini J, Peris TS, Bergman RL, Chang S, Jaffer M (2003) Functional impairment in childhood OCD: development and psychometrics properties of the child obsessive-compulsive impact scale-revised (COIS-R). J Clin Child Adolesc Psychol 36(4):645–653Google Scholar
  44. 44.
    Piacentini J, Jaffer M, Bergman RL, McCracken J, Keller M (eds) (2001) Measuring impairment in childhood OCD: psychometric properties of the COIS. In: Annual meeting, American academy of child and adolescent psychiatry, HonoluluGoogle Scholar
  45. 45.
    Geller DA, Hoog SL, Heiligenstein JH, Ricardi RK, Tamura ROY, Kluszynski S, Jacobson JG (2001) Fluoxetine treatment for obsessive-compulsive disorder in children and adolescents: a placebo-controlled clinical trial. J Am Acad Child Adolesc Psychiatry 40(7):773–779PubMedCrossRefGoogle Scholar
  46. 46.
    Amato AM (1993) Manual for coding expressed emotion from the five-minute speech sample: UCLA family projectGoogle Scholar
  47. 47.
    Leeb B, Hahlweg K, Goldstein MJ, Feinstein E, Mueller U, Dose M, Magana-Amato A (1991) Cross-national reliability, concurrent validity, and stability of a brief method for assessing expressed emotion. Psychiatry Res 39(1):25–31PubMedCrossRefGoogle Scholar
  48. 48.
    McGuire JB, Earls F (1994) Research note: the test-re test stability of the five minute speech sample in parents of disadvantaged, minority children. J Child Psychol Psychiatry 35(5):971–979PubMedCrossRefGoogle Scholar
  49. 49.
    Fisher RA (1922) On the interpretation of Chi-square from contingency tables, and the calculation of p. J R Stat Soc 85:87–94CrossRefGoogle Scholar
  50. 50.
    Asarnow J, Tompson M, Woo S, Cantwell DP (2001) Is expressed emotion a specific risk factor for depression or a nonspecific correlate of psychopathology. J Abnorm Child Psychol 29(6):573–583PubMedCrossRefGoogle Scholar
  51. 51.
    Peris TS, Hinshaw SP (2003) Family dynamics and preadolescent girls with ADHD: the relationship between expressed emotion, ADHD symptomatology, and comorbid disruptive behavior. J Child Psychol Psychiatry 44(8):1177–1190PubMedCrossRefGoogle Scholar
  52. 52.
    McCarty CA, Weisz JR (2002) Correlates of expressed emotion in mothers of clinically-referred youth: an examination of the five-minute speech sample. J Child Psychol Psychiatry 43(6):759–768PubMedCrossRefGoogle Scholar
  53. 53.
    Allsopp M, Verduyn C (1990) Adolescents with obsessive-compulsive disorder: a case note review of consecutive patients referred to a provincial regional adolescent psychiatry unit. J Adolesc 13(2):157–169PubMedCrossRefGoogle Scholar
  54. 54.
    Aunola K, Nurmi J-E (2005) The role of parenting styles in children’s problem behavior. Child Dev 76(6):1144–1159PubMedCrossRefGoogle Scholar
  55. 55.
    Bögels SM, Melick Mv (2004) The relationship between child-report, parent self-report, and partner report of perceived parental rearing behaviors and anxiety in children and parents. Pers Individ Dif 37(8):1583–1596CrossRefGoogle Scholar
  56. 56.
    Rapee RM (1997) The potential role of childrearing practices in the development of anxiety and depression. Clin Psychol Rev 17:47–67PubMedCrossRefGoogle Scholar
  57. 57.
    Rapee RM (2001) The development of generalised anxiety. In: Vasey MW, Dadds MR (eds) The developmental psychopathology of anxiety. Oxford University Press, New York, pp 481–503Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Amy Przeworski
    • 1
  • Lori A. Zoellner
    • 2
  • Martin E. Franklin
    • 3
  • Abbe Garcia
    • 4
  • Jennifer Freeman
    • 4
  • John S. March
    • 5
  • Edna B. Foa
    • 3
  1. 1.Department of Psychological SciencesCase Western Reserve UniversityClevelandUSA
  2. 2.University of WashingtonSeattleUSA
  3. 3.University of Pennsylvania School of MedicinePhiladelphiaUSA
  4. 4.Brown University Medical SchoolProvidenceUSA
  5. 5.Duke University Medical CenterDurhamUSA

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