OBJECTIVE Insight and avoidance are commonly discussed factors in obsessive-compulsive disorder (OCD) that have demonstrated associations with increased severity as well as reduced treatment response in adults, but these factors have not been sufficiently examined in pediatric OCD. This study examined the impacts of avoidance, insight, and impairment recognition concordance on cognitive-behavioral therapy (CBT) outcomes as well as impacts of CBT on insight and avoidance in a large sample of youths affected by OCD. METHOD Data from 573 OCD-affected youths enrolled in CBT trials were aggregated. Children's Yale-Brown Obsessive-Compulsive Scale items measured treatment response, insight, and avoidance. Standardized differences between child and parent ratings of impairment were used to calculate impairment recognition concordance. Binary logistic regression was used to identify variables associated with treatment response. RESULTS Greater avoidance, limited child recognition of impairment, older age, and lower baseline severity predicted reduced likelihood of treatment response, but insight did not. Both insight and avoidance improved significantly following CBT. Response rates were lower when posttreatment insight and avoidance were worse. CONCLUSION Contrasting with prevailing belief, poor insight does not appear to limit CBT response potential in pediatric OCD. Avoidance and impairment recognition are understudied CBT response predictors and warrant further consideration in pediatric OCD. Clinicians should attend to these factors to optimize outcomes for children affected by this common, debilitating illness.

中文翻译：

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小儿强迫症中的回避，洞察力，识别障碍的一致性和认知行为疗法的结果。

目的洞察力和回避是强迫症中普遍讨论的因素，已证明它们与成人的严重程度增加以及治疗反应降低相关，但是这些因素在儿科强迫症中并未得到充分检查。这项研究检查了回避，洞察力和障碍识别一致性对认知行为疗法（CBT）结果的影响，以及CBT对大量受强迫症影响的年轻人的洞察力和回避的影响。方法汇总了参加CBT试验的573名受OCD影响的年轻人的数据。儿童耶鲁布朗强迫症量表测量了治疗反应，见识和避免情况。儿童和父母的减损等级之间的标准化差异用于计算减损识别的一致性。二元逻辑回归用于确定与治疗反应相关的变量。结果更大程度的回避，对障碍的识别能力有限，年龄较大以及基线严重程度较低，可以预测出治疗反应的可能性降低，但洞察力却没有。CBT后，洞察力和回避力均得到显着改善。当治疗后的洞察力和避免能力较差时，反应率较低。结论与普遍的看法相反，缺乏洞察力似乎并未限制小儿强迫症中CBT反应的潜力。避免和损伤识别是CBT反应预测的未充分研究的指标，值得在儿科OCD中进一步考虑。临床医生应注意这些因素，以优化受这种常见的，令人虚弱的疾病影响的儿童的结局。