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Evaluation ViewAttendees 7

Master Clinician Seminar - Ticketed

Obsessive Compulsive and Related Disorders

Master Clinician Seminar 3 - Navigating Treacherous Waters in Pediatric OCD: Common Clinical Problems and Empirically Informed Recommendations

Friday, November 15, 2024
1:30 PM – 3:30 PM EST
Location: 308, Level 3, Downtown Marriott
Earn 2 Credit
Ticketed Session
Keywords: OCD, Child/Adolescent, Treatment
Level of Familiarity: Moderate to Advanced
Recommended Readings: Farrell, L. J., Waters, A. M., Storch, E. A., Simcock, G., Perkes, I., Grisham, J. R., Dyason, K. M., & Ollendick, T. H. (2023). Closing the gap for children with OCD: A staged-care model of cognitive behavioural therapy with exposure and response prevention. Clinical Child and Family Psychology Review, 26, 642-664. https:/doi.org/10.1007//s10567-023-00439-2,   Franklin, M. E., Engelmann, J. M., Bulkes, N. Z., Horvath, G., Piacsek, K., Osterlund, E., Freeman, J. B., Schwartz, R., Himle, M., & Riemann, B. C. (2024). Intensive CBT telehealth for pediatric OCD during the COVID-19 pandemic: Comparison with a matched sample treated in person. Journal of the American Academy of Child & Adolescent Psychiatry Open, 2(1), 26-35. ,   Kemp, J., Barker, D., Benito, K., Herren, J., & Freeman, J. (2021). Moderators of psychosocial treatment for pediatric obsessive-compulsive disorder: Summary and recommendations for future directions. Journal of Clinical Child and Adolescent Psychology: The Official Journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53, 50(4), 478–485. https://doi.org/10.1080/15374416.2020.1790378,   ,  
Pediatric OCD is associated with substantive symptoms, comorbidity, and functional impairment that can extend into adulthood, but fortunately the efficacy of treatments including cognitive-behavioral therapy (CBT) involving exposure plus response prevention (ERP) is now well established. Drs. Franklin and Piacentini will first set the stage by offering a targeted critical review of the pediatric OCD treatment literature, including discussion of the key randomized trials that have established the efficacy of ERP, both alone and in combination with concomitant serotonin reuptake inhibitors (SRIs). They will then focus on explicating common clinical barriers to optimal outcomes, including presentation of empirically supported strategies that should be brought to bear to mitigate the potentially pernicious effects of these variables. These potential pitfalls specifically include low motivational readiness, unusual obsessional presentations (e.g, fears of being buried alive or trapped in someone else’s dream), clinical management of suicidal ideation in the context of obsessions pertaining to suicide, and presentations related to disgust and incompleteness. They will also address the effects of psychiatric comorbidity and treatment decision-making in the context of comorbidity, as well as family accommodation and other family factors associated with poorer OCD outcomes along with clinical recommendations to address these concerns. Case examples will be emphasized to punctuate the core clinical procedures recommended to navigate these challenges. Moreover, ample time will be provided for questions and discussion, after which the floor will be opened to audience members to discuss theoretical and clinical issues including case presentations and examples of their own. Throughout each of the presentations, particular emphasis will be placed on provision of clinical services for pediatric OCD patients and their families who have demonstrated prior partial or non-response to cognitive-behavioral, pharmacological, or combined treatment approaches.

Outline:
A. Focused review of efficacy data for treatments including ERP, serotonergic medications, and their combination
B. Identification of empirical and clinical moderators and predictors of attenuated treatment outcome
C. Presentation of these variables and clinically recommended strategies to address them, including:
a. Low motivation for treatment
b. Unusual obsessional content
c. Suicidal ideation in context of patients presenting with obsessions pertaining to suicide
d. Not Just Right/Incompleteness concerns
e. Psychiatric comorbidity
f. Family factors including accommodation

Learning Objectives:

At the end of this session, the learner will be able to:
  1. Recognize the three most common psychiatric comorbidities in pediatric OCD and the accompanying clinical strategies to mitigate their effects.
  2. Name the recommended strategies used to address predictors of negative response including low motivation and suicidal ideation in the context of obsessions pertaining to suicide.
  3. Identify the clinical strategies used to address family accommodation at various stages of treatment and promote empirically supported techniques to encourage families to work together towards productive solutions in treatment.
  4. Long Term Goals: OCD is associated with significant impairment and comorbidity, but efficacious treatments can be brought to bear to reduce symptoms in the majority of youth who complete them.
  5. Long Term Goals: Many of the negative predictors of treatment outcome can be mitigated by the use of empirically informed strategies designed specifically to address them.