Examining parent-report of Children's emotion regulation in paediatric OCD: Associations with symptom severity, externalising behaviour and family accommodation

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Abstract

Paediatric Obsessive-Compulsive Disorder (OCD) is associated with significant family accommodation (FA), which frequently results in heightened parental distress, increased OCD severity and impairment. Examining factors which might drive FA is an important focus for the field. This study aimed to examine parents' report of children's emotion regulation (ER) and associations with OCD severity, externalising symptoms, and FA. Participants were 76 youth (7 to 17 years) with a primary diagnosis of OCD and one of their parents. Following child diagnostic and OCD symptom interviews, parents completed study questionnaires. Results indicated that parent-report of children's emotional Lability/Negativity was significantly and positively correlated with child externalising symptoms and FA, whereas children's adaptive ER was significantly and negatively correlated with externalising symptoms only. Furthermore, children's emotional Lability/Negativity predicted externalising symptoms, even when accounting for OCD severity. Lability/Negativity did not predict FA after controlling for OCD severity and externalising symptoms, however it was a significant moderator of the relationship between OCD severity and FA. These findings extend the growing body of literature on ER and OCD in youth and highlight the importance for clinicians to specifically address such deficits in ER as a part of OCD treatment.

Section snippets

Child variables and family accommodation

Despite the clinical significance of FA, knowledge regarding its predictors is limited. Understanding what drives parental accommodation may inform new approaches to supporting families in managing their child's OCD related distress and symptoms. Most studies examining predictors of FA in paediatric OCD have highlighted significant associations with child OCD symptom severity (Pinto, Van Noppen, & Calvocoressi, 2013; Storch et al., 2007). However, a recent meta-analysis involving 41 studies on

Emotion regulation in paediatric OCD

Emotion Regulation (ER) is broadly understood to be an interactive process that occurs between the individual and their environment, whereby individuals determine which emotions they experience, when they experience them, and how they express them based on their interpretations of the environment (Gross, 1998). The goal of ER is to alter the magnitude and/or duration of emotional responses (Gross, 2013; Gross, Sheppes, & Urry, 2011), and efforts at modulating and modifying emotional experiences

The present study

The current study aimed to explore ER among a sample of youth who had a primary diagnosis of OCD using a well-validated parent-report measure of child ER (Emotion Regulation Checklist; Shields & Cicchetti, 1997) which includes an adaptive ER subscale (Emotion Regulation subscale) and a maladaptive ER subscale (Lability/Negativity subscale). Specifically, this study aimed to: (a) examine the degree to which parents' report of children's (adaptive) ER and their Lability/Negativity was associated

Participants

Participants in this study were 76 youth (and their parents) aged 7 to 17 years (M = 12.48, SD = 2.49) with a primary diagnosis of OCD, which was on average within the severe range (Children's Yale–Brown Obsessive–Compulsive Scale, CY-BOCS; Scahill et al., 1997: M = 27.43, SD = 3.54). Most participants had comorbid conditions, with 28.6% having a diagnosis of OCD only, 24.7% being diagnosed with OCD and one other secondary diagnosis, and 46.7% being diagnosed with OCD and two or more comorbid

Results

All statistical analyses were conducted using the Statistical Package for the Social Sciences (SPSS) version 24 and the PROCESS Macro version 3.0 (Hayes, 2018). Missing data in the sample ranged from 5.26% (FAS-SR and CBCL, n = 4) to 6.58% (ERC, n = 5). Person-mean imputation was applied to individual scale items for respective measures when fewer than 10% of the items on a scale had incomplete data. This was done to reduce the missing data for subscale and total scores where relevant (Shrive,

Discussion

This study aimed to explore parents' report of children's ER in childhood OCD, and its associations with OCD symptom severity, child externalising symptoms, and FA. As predicted in the first hypothesis, children's emotional Lability/Negativity was significantly and positively correlated with child externalising symptoms and FA, whereas children's (adaptive) ER was negatively correlated with externalising symptoms only. There was also support for the second hypothesis whereby children's

Acknowledgements

This study was partially supported by funding from the National Health and Medical Research Council (APP1058025). The first author was a recipient of a Griffith University Postgraduate Research Scholarship and a Griffith University International Postgraduate Research Scholarship for the completion of their postgraduate research studies. The fifth author was the recipient of an Australian Postgraduate Award scholarship for the completion of their postgraduate research studies (still underway).

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