Self-Regulation and Other Executive Functions Relationship to Pediatric OCD Severity and Treatment Outcome

  • Joseph P. H. McNamara
  • Adam M. Reid
  • Amanda M. Balkhi
  • Regina Bussing
  • Eric A. Storch
  • Tanya K. Murphy
  • Paulo A. Graziano
  • Andrew G. Guzick
  • Gary R. Geffken
Article

Abstract

The intersection of obsessive-compulsive disorder (OCD) and executive functioning (EF) in children and adolescents is an emerging topic in the current literature. Spurred by the consistent association between increased EF deficits and higher adult obsessive-compulsive severity, a few initial studies have replicated this relationship in pediatric OCD samples and also have found preliminary evidence that EF deficits are associated with worse response to first-line psychotherapeutic or psychopharmacological treatments for pediatric OCD. This study aimed to extend the literature by providing the first comprehensive investigation of how multiple EF domains, measured repeatedly over the course of treatment, impact pediatric obsessive-compulsive severity and response to multimodal treatment. Multi-level modeling results found that deficits in shifting, inhibition, emotional control, planning/organizing, monitoring and initiating all predicted higher average obsessive compulsive severity across treatment. Interestingly, out of the eight domains of EF investigated, only emotional control moderated treatment outcome such that those with worse emotional control experienced less of a reduction in obsessive-compulsive severity during treatment. The findings generally align with previous theories for the link between EF and OCD and indicate that emotional control has important implications in the treatment of pediatric OCD. In fact, emotional control may provide one explanation for why factors such as disgust sensitivity, oppositional behavior, and third-wave behavioral treatment techniques have all been linked to pediatric OCD treatment outcome. Future research should investigate augmentation strategies that target emotional control in children and adolescents.

Keywords

Obsessive-compulsive disorder Children BRIEF Cognitive behavioral therapy Serotonin reuptake inhibitors Treatment outcome 

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Joseph P. H. McNamara
    • 1
  • Adam M. Reid
    • 1
    • 2
  • Amanda M. Balkhi
    • 1
    • 2
  • Regina Bussing
    • 1
    • 2
    • 5
  • Eric A. Storch
    • 4
    • 6
  • Tanya K. Murphy
    • 4
    • 6
  • Paulo A. Graziano
    • 3
  • Andrew G. Guzick
    • 1
  • Gary R. Geffken
    • 1
    • 2
  1. 1.Division of Medical Psychology, Department of PsychiatryUniversity of FloridaGainesvilleUSA
  2. 2.Department of Clinical and Health PsychologyUniversity of FloridaGainesvilleUSA
  3. 3.Center for Children and Families & Department of PsychologyFlorida International UniversityMiamiUSA
  4. 4.Department of PediatricsUniversity of South FloridaPetersburgUSA
  5. 5.Department of PediatricsUniversity of FloridaGainesvilleUSA
  6. 6.Department of Psychiatry & Behavioral NeurosciencesUniversity of South FloridaTampaUSA

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