Study Highlights Ways Clinicians Can Help Families Overcome Burden of Pediatric OCD

The challenges faced by children with obsessive-compulsive disorder (OCD) can ripple outward to negatively impact family function in myriad ways, concluded a study published online this week in the Journal of the American Academy of Child and Adolescent Psychiatry. The findings of the study point to several ways that clinicians can work with families to overcome the burden that pediatric OCD may place on them.

For the study, S. Evelyn Stewart, M.D., an associate professor of psychiatry at the University of British Columbia, and colleagues recruited children with OCD, their mothers, and their fathers from pediatric OCD programs in Boston and Vancouver, Canada. A total of 354 mothers, fathers, and affected young people were evaluated using several measures, including the OCD Family Functioning Scale—which gauges OCD-related family functioning impairment at current and worst-ever symptom time points.

The study revealed that disruptions in morning and bedtime routines presented the greatest challenges for families, which can lead to “accommodation” by family members (including ritual facilitation and enabling avoidance of triggers). Such behaviors can worsen OCD symptoms and disease severity, as well as treatment response, the authors noted. “In addition to treatment of OCD symptoms, direct coaching by the treatment team is advisable regarding sleep hygiene, management of bedtime routines, and reduction/prevention of related parental accommodation,” Stewart and colleagues wrote. 

The study also highlighted the emotional challenges that families of youth with OCD face, as youth and parents alike reported feelings of stress and anxiety, followed by frustration/anger in youth and sadness in parents. Additionally, nearly half of the mothers and one-third of the fathers interviewed reported daily occupational impairment.

“It is striking that the majority of youth, mothers, and fathers reported living with stress and anxiety either often or always, both at the time of assessment and at worst OCD severity. This has strong clinical implications, given that distress tolerance is required by family members in order to resist family accommodation,” they wrote. “Participation in family-based CBT may assist in amelioration of both family accommodation and coercive and disruptive behaviors.”

The authors concluded, “[T]hese results highlight the need for routine screening and a multi-informant approach with respect to family impacts in pediatric OCD.”

For related information, see the AJP study “A Diffusion Tensor Imaging Study in Children With ADHD, Autism Spectrum Disorder, OCD, and Matched Controls: Distinct and Non-Distinct White Matter Disruption and Dimensional Brain-Behavior Relationships.”

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