The moderating effect of age on the associations of cognitive and metacognitive beliefs with pediatric OCD symptoms

Obsessional intrusive thoughts in children: An interview based study

OBJECTIVES

We aimed to investigate the experience of obsessional intrusive thoughts (OITs) in a sample of children aged 8 to 10 years old and to test the main tenets of the cognitive model of OCD. Specifically, we assessed: (1) the prevalence of OITs experienced by young children; (2) their frequency and content; (3) the emotions they evoke; (4) the reasons why they are upsetting; (5) how they are appraised (6) and what control strategies they use.

METHODS

Forty-nine children (28 girls, 21 boys; mean age 9.1 years) from the community completed two self-report questionnaires assessing anxiety and obsessive-compulsive symptoms. Children were interviewed using the Children's Anxious Thoughts Interview, which assessed their experiences of OITs.

RESULTS

From the 49 participants, 71.43% reported having experienced at least one OIT. The most frequent contents related to harm and doubt. Of the total sample, 28.6% reported having experienced one OIT recently with at least moderate frequency; these participants reported higher anxiety and obsessive-compulsive interference, described feeling nervous and anxious when experiencing their OIT, and rated their OIT as highly important and distracting. The most frequently reported control strategies were cognitive - suppression, distraction and thought replacement.

CONCLUSIONS

Almost two thirds of community children reported experiencing OITs. The findings from this study provide preliminary support for the application of the cognitive model of OCD in children. Subtle differences from previous research with adults are discussed.

Cognitive Beliefs Across the Symptom Dimensions of Pediatric Obsessive-Compulsive Disorder: Type of Symptom Matters

The cognitive model of obsessive-compulsive disorder (OCD) posits that dysfunctional cognitive beliefs are crucial to the onset and maintenance of OCD; however, the relationship between these cognitive beliefs and the heterogeneity of OCD symptoms in children and adolescents remains unknown. We examined how the major belief domains of the cognitive model (inflated responsibility/threat estimation, perfectionism/intolerance of uncertainty, importance/control of thoughts) and dysfunctional metacognitions were related to OCD symptoms across the following dimensions: doubting/checking, obsessing, hoarding, washing, ordering, and neutralization. Self-report ratings from 137 treatment-seeking youth with OCD were analyzed. When cognitive beliefs and symptom dimensions were analyzed in tandem, inflated responsibility/threat estimation and dysfunctional metacognitions were uniquely related to doubting/checking, obsessing, and hoarding and perfectionism/intolerance of uncertainty to ordering. Cognitive beliefs explained a large proportion of variation in doubting/checking (61%) and obsessing (46%), but much less so in ordering (15%), hoarding (14%), neutralization (8%), and washing (3%). Similar relations between cognitive beliefs and symptom dimensions were present in children and adolescents. Cognitive beliefs appear to be relevant for pediatric OCD related to harm, responsibility, and checking, but they do not map clearly onto contamination and symmetry-related symptoms. Implications for OCD etiology and treatment are discussed.

The Obsessive-Compulsive Symptoms in Tic Disorders and the Psychometric Properties of Children's Yale-Brown Obsessive-Compulsive Scale: An Evidence-Based Survey in a Chinese Sample

OBJECTIVE

Patients with tic disorders (TDs) usually also have obsessive-compulsive disorder (OCD). The severity of obsessive-compulsive symptoms (OCSs) in TD is widely evaluated using the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS). However, there is no survey on the severity of OCSs in patients with TD based on a Chinese sample, and the reliability and validity of the CY-BOCS in patients with TD have not been well established in China. This study examined the severity of OCSs in TDs and the psychometric properties of the CY-BOCS in Chinese pediatric patients with TD.

METHODS

A total of 367 patients who were diagnosed with TD [152 with Tourette syndrome (TS)] were enrolled in the Department of Psychiatry at Beijing Children's Hospital in China. The mean age of the patients was 9.21 ± 2.06 years (range: 5-16 years). The Yale Global Tic Severity Scale (YGTSS) and CY-BOCS were used as screening tools. The psychometric properties of the CY-BOCS were assessed using Cronbach's alpha, test-retest reliability, and construct validity.

RESULTS

The OCSs in TDs were 3.93 ± 5.15 based on the CY-BOCS in the whole sample. The older adolescent group showed higher scores than the young adolescent groups (Z = -3.37, p = 0.001). However, the young adolescent group showed a higher incidence rate of OCSs than the older adolescent group (p < 0.01). Men with TDs also showed a higher incidence rate of OCSs than women (p = 0.03). The reliability and validity analyses of the CY-BOCS showed Cronbach's alpha and test-retest reliability values of 0.81 and 0.82, respectively. The CY-BOCS showed an acceptable level in the two-factor structure (obsession and compulsive) in patients with TD. The comparative fit index (CFI) was 0.84 for TD, 0.86 for Tourette, 0.94 for the younger adolescent group, and 0.74 for the older adolescent group.

CONCLUSION

More OCSs were identified in the TS group and the older adolescent group with TDs. The CY-BOCS showed good psychometric properties in children and adolescents with TD, especially in younger patients with TD. OCSs might be associated with age and functional impairment of TD.