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Comorbid Psychopathology and the Clinical Profile of Family Accommodation in Pediatric OCD

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Abstract

Family accommodation (FA) has been linked with myriad negative outcomes in pediatric obsessive–compulsive disorder (OCD), but extant literature has yielded differential relationships between FA and clinical variables of interest. Consequently, this study examined the phenomenology, clinical profile, and effects of comorbid psychopathology on FA to better understand these behaviors. A total of 150 youths and their caregivers completed clinician- and self-reported measures at a baseline visit for a larger randomized controlled trial. Sociodemographic variables were not associated with FA, but specific types of OCD symptom clusters were. Higher OC-symptom severity and functional impairment were associated with increased FA. Comorbid anxiety disorders moderated the relationship between OC-symptom severity and FA, but comorbid attention deficit hyperactivity, oppositional defiant, and mood disorders did not. Internalizing and externalizing problems both mediated the relationship between FA and functional impairment. These findings provide clinical implications for important treatment targets and factors that may impact FA.

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Acknowledgements

The authors would like to acknowledge the contributions of Chelsea Ale, Ph.D., Noah Berman, Ph.D., Jennifer Britton, Ph.D., Ashley Brown, B.A., Kathleen Carey, CNS, Anne Chosak Ph.D., Allison Cooperman BA, Angelina Gomez, B.A., David Greenblatt, M.D., Marni Jacob, Ph.D., Joseph McGuire, Ph.D., Nicole McBride, B.S., Scott Orr, Ph.D., Jennifer Park, Ph.D., David Pauls, Ph.D., Kesley Ramsey, B.A., Robert Selles, Ph.D., Abigail Stark, B.A., and Christine Cooper Vince, Ph.D.

Funding

This work was supported by grants to the second and last authors from the National Institutes of Health (Grant Nos. 5R01MH093402 and 1R01MH09338). The funding organization was not involved in the design or conduct of the study, collection, management, analysis, and interpretation of the data or preparation, review, and approval of the manuscript. The views in this manuscript reflect that of the authors and not the National Institutes of Health.

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Authors and Affiliations

  1. UCLA Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, Room 47-417B, Los Angeles, CA, 90095, USA

    Monica S. Wu

  2. Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Daniel A. Geller & Sabine Wilhelm

  3. Department of Pediatrics, University of South Florida, St. Petersburg, FL, USA

    Sophie C. Schneider & Tanya K. Murphy

  4. School of Aging Studies, University of South Florida, Tampa, FL, USA

    Brent J. Small

  5. Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA

    Tanya K. Murphy

  6. Johns Hopkins All Children’s Hospital, St. Petersburg, FL, USA

    Tanya K. Murphy

  7. Baylor College of Medicine, Houston, TX, USA

    Eric A. Storch

Authors
  1. Monica S. Wu
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  5. Tanya K. Murphy
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  6. Sabine Wilhelm
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  7. Eric A. Storch
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Contributions

MSW, SCS, and EAS all contributed to the initial draft of the manuscript. SCS and BJS spearheaded the statistical analyses. DAG, TKM, and SW were key personnel in the trial and have reviewed/approved the final version of the manuscript.

Corresponding author

Correspondence to Monica S. Wu.

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Conflict of interest

Dr. Wu has received grant or research support from the NIMH (T32MH073517). Dr. Geller reports grant support from NIH and book honorarium from the American Academy of Child and Adolescent Psychiatry, speaking honoraria for Advanced Institute lectures from the American Academy of Child and Adolescent Psychiatry and Massachusetts General Hospital Psychiatry Academy in educational programs supported through independent medical education grants from pharmaceutical companies. Lifetime funding includes support from the Obsessive Compulsive Disorder Foundation, The Tourette Syndrome Association, The McIngvale Family Foundation, Eli Lilly, Pfizer, and Glaxo Smith Kline. Drs. Schneider and Small have no conflicts of interest to report. Dr. Murphy reports having received or is receiving research funding from Auspex Pharmaceuticals, National Institute of Mental Health, Shire Pharmaceuticals, Pfizer, F. Hoffmann–La Roche Ltd, AstraZeneca Pharmaceuticals, Centers for Disease Control and Prevention, Massachusetts General Hospital, Sunovion Pharmaceuticals, Neurocrine Biosciences, PANDAS Network, and Psyadon Pharmaceuticals. Dr. Wilhelm has received research support in the form of free medication and matching placebo from Forest Laboratories for clinical trials funded by the NIH. Dr. Wilhelm is a presenter for the Massachusetts General Hospital Psychiatry Academy in educational programs supported through independent medical education grants from pharmaceutical companies; she has received royalties from Elsevier Publications, Guilford Publications, New Harbinger Publications, and Oxford University Press. Dr. Wilhelm has also received speaking honorarium from various academic institutions and foundations, including the International Obsessive Compulsive Disorder Foundation and the Tourette Association of America. In addition, she received payment from the Association for Behavioral and Cognitive Therapies for her role as Associate Editor for the Behavior Therapy journal, as well as from John Wiley & Sons, Inc. for her role as Associate Editor on the journal Depression & Anxiety. Dr. Wilhelm has also received salary support from Novartis and Telefonica Alpha, Inc. Dr. Storch has received funding from the National Institute of Health and All Children’s Hospital Research Foundation. He receives book royalties from Elsevier, Springer, Wylie, and American Psychological Association.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Wu, M.S., Geller, D.A., Schneider, S.C. et al. Comorbid Psychopathology and the Clinical Profile of Family Accommodation in Pediatric OCD. Child Psychiatry Hum Dev 50, 717–726 (2019). https://doi.org/10.1007/s10578-019-00876-7

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