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Nor Chr. Torp & Bente S.M. Haugland
Family functioning and Family functioning and treatment of childhood OCDtreatment of childhood OCD
29th Nordic Congress of Psychiatry29th Nordic Congress of PsychiatryStockholm, 24.09. 2009Stockholm, 24.09. 2009
Nor Christian Torp, PhD candidateBente Storm Mowatt Haugland, dr psychol
Centre for Child and Adolescent Mental Health, Eastern and Southern Norway
Nor Chr. Torp & Bente S.M. Haugland
The role of family functioningThe role of family functioning
Family functioning
Development
Maintenance
Treatment
Childhood OCD
Family functioning
Nor Chr. Torp & Bente S.M. Haugland
The role of family functioningThe role of family functioning
Family functioning
Development
Maintenance
Treatment
Childhood OCD
Family functioning
Nor Chr. Torp & Bente S.M. Haugland
The role of family functioningThe role of family functioning
Family functioning
Development
Maintenance
Treatment
Childhood OCD
Family functioning
Nor Chr. Torp & Bente S.M. Haugland
Focus and measures of family Focus and measures of family functioning in NordLOTSfunctioning in NordLOTS
AccommodationAccommodationMeasure: Family Accommodation Scale (FAS). (Calvocoressi et al., 1995)• FAS is a 12 items parent-report questionnaire.
Scored on a 5 point Likert-type scale.
Expressed Emotion (EE)Expressed Emotion (EE)Measure: Five Minutes Speech Sample (FMSS).(Magana,et al., 1986).• FMSS is an 5 minute audio-taped interview where
parent are asked in their own words to describe their child and the relationship to the child.
Nor Chr. Torp & Bente S.M. Haugland
Family Accommodation Family Accommodation and OCDand OCD
Definition:Definition:• Family Accommodation refers to the actions taken by the
family members to; facilitate rituals, following the child’s demand, provide reassurance to the child, decrease child’s responsibility and so on” (Storch et al., 2007).
Scoring categories: Scoring categories: Family Accommodation Scale (FAS)Family Accommodation Scale (FAS)• To what degree family members have accommodated the
child’s OCD symptoms during the previous month (8 items).
• Level of distress/impairment that the family members and the patient experience as a result of accommodating or not accommodating the child (4 items).
Nor Chr. Torp & Bente S.M. Haugland
Research findings on Family Research findings on Family Accommodation and OCDAccommodation and OCD
Relationship between Family Relationship between Family Accommodation and OCDAccommodation and OCD.
• Association with OCD symptoms severity (Steketee et al., 2003).
• Association with child factors and family characteristics.
Nor Chr. Torp & Bente S.M. Haugland
Research findings on Family Research findings on Family Accommodation and OCDAccommodation and OCD
Relationship between Family Relationship between Family Accommodation and treatment of OCDAccommodation and treatment of OCD
• Predicting treatment outcome (Steketee & Van Noppen, 2003; Storch et al., 2007;).
• Preventing relapse after treatment (Merlo et al., 2009).
Nor Chr. Torp & Bente S.M. Haugland
Expressed Emotion (EE) Expressed Emotion (EE) and OCDand OCD
DefinitionDefinition”…the affective attitudes and behaviors (…) of a significant other
towards a psychiatric patient” (Van Humbeeck et al., 2002).
Scoring categories in Five Minute Speech Sample Scoring categories in Five Minute Speech Sample (FMSS) (FMSS) (Magana et al., 1986).
• Critisism (Crit).• Emotional overinvolvement (EOI).
Nor Chr. Torp & Bente S.M. Haugland
Research findings on EE and Research findings on EE and psychiatric disorders in childrenpsychiatric disorders in children
Significant higher levels of EE in families with:Significant higher levels of EE in families with:• Children with depression (Crit) (Asarnow, 1994).• Children with externalizing disorders (Crit) (Peris & Baker,
2000).• Children with anxiety disorders (Crit/EOI) (Gar & Hudson, 2008).
High EE predicts:High EE predicts:• Treatment outcome in depressed children (Asarnow et al.,
1999).• Level of functioning one year after treatment in children with
anxiety disorders (Angelosante, 2006).• Treatment outcome in children with OCD (Leonard et al, 1993).
Also:Also:• EE changes after family-based CBT for children with anxiety
disorders and their families (Angelosante, 2006).
Nor Chr. Torp & Bente S.M. Haugland
The role of the family in The role of the family in treatment of childhood OCDtreatment of childhood OCD
Parents are included in treatment to:Parents are included in treatment to:
• Facilitate understanding of treatments principle.
• Assist with generalization of treatment gains by enlisting the parent as an “at-home coach”.
• Reduce family accommodation of OCD symptoms.
• Encourage optimal effort by the child during in-session exposures and homework assignments.
Treatment outcome
Diagnosis,Symptom levelcomorbidity
Expressed emotionFamily accomodation
Predictors of treatment outcome
Expressed emotions Familiy accomodation
Child characteristics(e.g. severity, comorbidity of OCD, gender, age),
Family characteristics
(e.g. demographic variables, parental mental health e.g.)
NordLOTS research questions with regard NordLOTS research questions with regard to family functioning and treatment of OCDto family functioning and treatment of OCD
Nor Chr. Torp & Bente S.M. Haugland
ConclusionsConclusionsResearch status; the role of family functioning in Research status; the role of family functioning in
childhood OCD.childhood OCD.
• OCD may frequently have a profound negative impact on the lives of the child and other family members.
• Research on the role of family functioning and childhood OCD is to a large degree based on case reports and studies with small samples.
• There is little direct empirical evidence supporting a causal pathway between family functioning and childhood OCD. Indirectly, however there does appear to be support for a reciprocal relationship.
• Involving the parents in treatment of OCD in children may contribute to a successful outcome, however more and larger studies are needed to confirm this assumption.