The Role Of Dysregulation in Pediatric Obsessive Compulsive Disorder: An Examination of Symptom Severity, Impairment and Treatment Outcome

Pediatric OCD is frequently complicated by co-occurrences with ADHD, mood and anxiety disorders. Although each of these disorders is associated with impaired self-regulation, there has been little examination of impaired self-regulation (i.e., dysregulation) in youth with OCD. Dysregulation is characterized by affective, behavioral and cognitive problems, and can be assessed using the Child Behavior Checklist-Dysregulation Profile (CBCL-DP). Dysregulation may help account for the varied yet related findings identified for symptom severity, impairment and treatment outcome in pediatric OCD. This study examined the role of dysregulation on symptom severity, impairment and treatment outcome in a large sample of youth with OCD. A total of 144 youth with primary OCD participated in this study. Clinicians administered the Children\u27s Yale-Brown Obsessive Compulsive Scale (CY-BOCS), Clinical Global Impression of Severity (CGI-S) and a 13-item scale of family accommodation. Children completed the Multidimensional Anxiety Scale for Children (MASC), and the Child Depression Inventory (CDI). Parents completed the CBCL, with both children and parents completing parallel versions of the Child OCD Impact Scale (COIS-C/P). Within this sample, 97 of these youth received exposure-based CBT and completed the same assessment battery along with the Clinical Global Impression of Improvement (CGI-I) after treatment. Twenty-nine youth (20%) with OCD met categorical criteria for dysregulation. Dysregulated youth had greater obsessive-compulsive symptom severity, depressive mood, and exhibited greater rates of family accommodation and impairment than children without dysregulation. Hierarchical regressions revealed that the level of dysregulation predicted child-and-parent rated impairment, above and beyond obsessive-compulsive severity. Additionally, dysregulation predicted clinician-rated family accommodation above and beyond obsessive-compulsive severity. When examining treatment outcome to exposure-based CBT, a logistic regression indicated that baseline dysregulation did not predict treatment responder status. Although not predicting treatment response, it was found that youth who discontinued treatment (18%) had significantly higher dysregulation than youth who completed treatment (p \u3c .02). For youth who completed exposure-based CBT, a significant decrease in obsessive-compulsive symptom severity and dysregulation was observed (p \u3c .01). Collectively, these findings suggest that youth with OCD and dysregulation experience more severe symptoms and have greater impairment than youth with more regulated functioning. As dysregulation was associated with treatment discontinuation, dysregulated youth with OCD may require more individualized interventions to treat dysregulated behavior prior to receiving exposure-based CBT. For youth who complete treatment, exposure-based CBT reduces obsessive-compulsive symptom severity and its benefits generalize to reductions in dysregulated behaviors as well