Date of Award

Summer 7-16-2024

Document Type

Dissertation

Degree Name

Doctor of Philosophy in Clinical Psychology (PhD)

Department

Clinical Psychology

First Advisor/Committee Member

Thane M. Erickson, Ph.D.

Second Advisor/Committee Member

Jenny L. Vaydich, Ph.D.

Third Advisor/Committee Member

Lisa K. Barrois, Ph.D.

Abstract

Family systems play an integral role in the development and maintenance of mental health disorders. In the context of pediatric obsessive-compulsive disorder (OCD), accommodation is a common interpersonal phenomenon in which families may unwittingly reinforce symptoms and avoidance behavior of the patient. Treatments for severe pediatric OCD such as intensive outpatient programs (IOP) often involve family to reduce accommodation. Little research has investigated baseline symptoms as predictors of change in accommodation in IOP contexts serving patients with high-acuity OCD. The current study examined the role of baseline OCD, anxiety, depression, and functional impairment in changes in accommodation throughout OCD treatment in an IOP setting. Predictors included both informant (i.e., parent and clinician) and child reports and both in-person and telehealth formats of IOP. Participants included 123adolescents (n = 52 in-person; n = 71 telehealth) aged 10-21 years old with severe OCD. In multilevel models, in-person participants started treatment with higher accommodation but improved more rapidly than telehealth participants. As expected, baseline symptom levels rated by children and informants predicted higher baseline accommodation, with slight differences between groups. Contrary to hypotheses, no baseline symptoms predicted accommodation change trajectories in either group. Overall, IOP treatment for pediatric OCD was associated with improvements in accommodation regardless of individual differences in baseline symptoms.

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