Dr. med University Tübingen, Germany and Ph.D. Norwegian University of Science and Technology (NTNU). Specialist in Paediatrics and in Child- and Adolescent Psychiatry. Senior Consultant at St.Olavs University Hospital, Department of Child and Adolescent Psychiatry. Associate Professor, Regional Centre for Child and Youth Mental Health and Child Welfare.
BACKGROUND Studies on child and adolescent obsessive-compulsive disorder (OCD) indicate that symp... more BACKGROUND Studies on child and adolescent obsessive-compulsive disorder (OCD) indicate that symptom severity is similar across age, but significant age differences of symptom profile and comorbid disorders have been observed. These earlier studies have yielded mixed results, are methodologically heterogenous and tend to have fairly small sample sizes. The current study examines these differences in one of the largest samples to date and the first sample outside of an English-speaking cultural context. METHODS We compared children aged 11 years and younger to adolescents aged 12 years and older from the Nordic Long-Term Obsessive-Compulsive Disorder Treatment Study that included 269 children and adolescents with a primary diagnosis of OCD. The two groups were compared on measures of OCD severity, symptom profile, comorbid symptoms, and functional impairment. RESULTS Results showed that the younger group had a poorer level of insight, higher rates of ADHD, and disruptive disorders. The older group had higher levels of mental compulsions, miscellaneous obsessions and compulsions, and self-rated functional impairment. No differences were found on the prevalence of anxiety, tic or depressive disorders between the age groups, nor on overall OCD severity. CONCLUSION Overall, differences between the age groups were found to be less than in previous research. Defining groups by age of onset and duration of illness rather than age at evaluation did not change results. Mental health services in Scandinavia are free of cost, making early intervention more accessible, which may reduce subsequent secondary problems and explain these findings.
ADHD is a heterogeneous neurodevelopmental disorder associated with dysfunctions in several brain... more ADHD is a heterogeneous neurodevelopmental disorder associated with dysfunctions in several brain systems. Objective markers of brain dysfunction for clinical assessment are lacking. Many studies applying electroencephalography (EEG) and neuropsychological tests find significant differences between ADHD and controls, but the effect sizes (ES) are often too small for diagnostic purposes. This study aimed to compute a diagnostic index for ADHD by combining behavioral test scores from a cued visual go/no-go task and Event Related Potentials (ERPs). Sixty-one children (age 9-12 years) diagnosed with ADHD and 69 age- and gender-matched typically developing children (TDC) underwent EEG-recording while tested on a go/no-go task. Based on comparisons of ERP group-means and task-performance, variables that differed significantly between the groups with at least moderate ES were converted to a five points percentile scale and multiplied by the ES of the variable. The sum-scores of the variables constituted the diagnostic index. The index discriminated significantly between patients and TDC with a large ES. This index was applied to an independent sample (20 ADHD, 21 TDC), distinguishing the groups with an even larger ES. The diagnostic index described has the potential to support assessment. Further research establishing diagnostic indexes for differential diagnoses is needed.
The overall aim of the present thesis was to investigate important aspects of childhood obsessive... more The overall aim of the present thesis was to investigate important aspects of childhood obsessive–compulsive disorder (OCD) such as comorbidity and quality of life (QoL). Frequency and continuity of autistic symptoms from preschool age to later childhood in children with OCD were explored as a contribution to the ongoing nosological debate on whether there is an empirical base for summarizing conditions such as OCD, Tourette’s syndrome, eating disorders and autism spectrum disorders as parts of a so-called obsessive– compulsive spectrum. The establishment of proper outcome measures for the evaluation of treatment interventions has been a concern in the field (Pallanti et al., 2002). The measurement of symptom reduction only, without any assessment of subjective well-being, has been criticized (Macy et al., 2013). QoL assessment is a well-established outcome measure in somatic as well as in psychiatric treatment studies. However, in contrast to adult OCD, little is known about QoL in children with OCD and next to nothing is known about the role treatment plays in their QoL. To investigate QoL in children with OCD under different conditions (with and without comorbidity, before and after treatment) is relevant because of the paucity of studies concerning children. In the first study, comorbidity in terms of autistic traits was assessed in children and adolescents seeking treatment in a Swedish OCD Clinic (Gothenburg) and compared with controls from a general population sample. In the second study, QoL was assessed at baseline, and in the third study, both at baseline and after treatment with cognitive behavioural therapy (CBT) in children and adolescents with OCD enrolled in the Nordic Long-term OCD Treatment Study (NordLOTS) and compared with the general population. The NordLOTS is a Nordic multicentre study in which OCD treatment units for children and adolescents collaborated on common procedures for assessment, treatment and outcome evaluation (Thomsen et al., 2013). A manual for CBT with exposure and response prevention was established (Weidle et al., 2014). The QoL study included in this thesis comprised a sample of 135 children and adolescents, 7–17 years of age, with moderate to severe OCD according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders (4th edition, text rev.) (DSM-IV-TR) (2000), including nine individuals with Asperger’s syndrome/high-functioning autism. QoL was assessed at baseline and after treatment with 14 sessions of CBT by self-report and caregiver proxy reports on the Questionnaire for Measuring Health-related Quality of Life in Children and Adolescents (KINDL-R) and compared with an age- and gender-matched sample from the general population. Social competence and school functioning were assessed with the Child Behaviour Checklist, comorbidity with the Kiddie Schedule for Affective Disorders and Schizophrenia (Present and Lifetime Version), severity of OCD with the Children’s Yale–Brown Obsessive Compulsive Scale and the families’ involvement with the child’s OCD symptoms with the Family Accommodation Scale. In addition, the significance of potential factors such as onset and duration of symptoms regarding QoL change were explored. Autism spectrum disorder (ASD) symptoms occurred in about one-fifth of children with OCD and were much more common than in the general population. However, the majority of OCD patients did not have these traits, indicating that ASD and OCD co-occur in a subgroup of cases rather than in OCD as a whole. In general, ASD symptoms reported in children with OCD did not show a strong enough relationship between OCD and ASD to support a classification of ASD as a part of an obsessive–compulsive spectrum group. However, a subgroup of paediatric OCD patients had significant subclinical ASD symptom levels. This should be considered when tailoring individual treatment interventions. QoL and social competence were markedly reduced in children with OCD, both in self-reports and in parents’ reports, compared with the general population. Children with higher comorbidity had lower QoL in parents’ proxy reports. After treatment, QoL ratings in treatment responders were in the same range as in the general population, while non-responders rated no change in QoL. Comorbidity, family accommodation and psychosocial functioning were not associated with changes in QoL after treatment. To the best of our knowledge, this is the largest QoL study of paediatric patients with OCD and the first one based on the assessment of OCD and comorbid disorders by standardized semi-structured diagnostic interviews, comparing patients with matched controls from the general population. It is also the first study assessing QoL changes after treatment in paediatric OCD. QoL assessment with the KINDL-R supported outcome measures for symptom reduction used in the study to define treatment outcomes. Based on our findings, we suggest employing QoL assessment in order to…
Journal of the American Academy of Child & Adolescent Psychiatry, 2021
OBJECTIVE A lack of universal definitions for response and remission in pediatric obsessive-compu... more OBJECTIVE A lack of universal definitions for response and remission in pediatric obsessive-compulsive disorder (OCD) has hampered the comparability of results across trials. To address this problem, we conducted an individual participant data diagnostic test accuracy meta-analysis to evaluate the discriminative ability of the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) in determining response and remission. We also aimed to generate empirically derived cutoffs on the CY-BOCS for these outcomes. METHOD A systematic review of PubMed, PsycINFO, Embase and CENTRAL identified 5,401 references, 42 randomized controlled clinical trials (RCTs) were considered eligible and 21 provided data for inclusion (N 1,234). A score ≤ 2 in the Clinical Global Impressions Improvement and Severity scales were chosen to define response and remission, respectively. A two-stage random-effects meta-analysis model was established. The area under the curve (AUC) and the Youden Index were computed to indicate the discriminative ability of the CY-BOCS and to guide for the optimal cutoff, respectively. RESULTS The CY-BOCS had sufficient discriminative ability to determine response (AUC 0.89) and remission (AUC 0.92). The optimal cutoff for response was a ≥ 35% reduction from baseline to posttreatment (sensitivity [95% CI] 83.9 [83.7, 84.1]; specificity [95% CI] 81.7 [81.5, 81.9]). The optimal cutoff for remission was a posttreatment raw score ≤ 12 (sensitivity [95% CI] 82.0 [81.8, 82.2]; specificity [95% CI] 84.6 [84.4, 84.8]). CONCLUSION Meta-analysis identified empirically optimal cutoffs on the CY-BOCS to determine response and remission in pediatric OCD RCTs. Systematic adoption of standardized operational definitions for response and remission will improve comparability across trials for pediatric OCD.
The first aim of this study was to explore whether children with obsessive compulsive disorder (O... more The first aim of this study was to explore whether children with obsessive compulsive disorder (OCD) and subclinical autistic traits can be differentiated from children with OCD without these traits based on clinical OCD-related characteristics, distinct OCD symptom patterns, and type of comorbidity. The second aim was to investigate whether autistic traits predict immediate and long-term outcome of exposure-based cognitive behavioral therapy (CBT) in pediatric OCD.The participants in this study were a total of 257 children and adolescents aged 7–17 years, recruited from Denmark, Norway, and Sweden as a part of the Nordic long-term OCD treatment study (NordLOTS). Inclusion criteria were an OCD diagnosis based on DSM-IV criteria and a Children’s Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) total severity score of 16 or higher. No children with a diagnosis on the autism spectrum were included. An Autism Spectrum Screening Questionnaire (ASSQ) cut-off score of ≥ 17 was used to defin...
Journal of Obsessive-Compulsive and Related Disorders, 2021
Abstract Studies on child and adolescent obsessive-compulsive disorder (OCD) indicate that sympto... more Abstract Studies on child and adolescent obsessive-compulsive disorder (OCD) indicate that symptom severity is similar across age, but significant age differences of symptom profile and comorbid disorders have been observed. The current study examines these differences in one of the largest samples to date, and the first sample outside of an English-speaking cultural context. We compared children aged 11 years and younger to adolescents aged 12 years and older from the Nordic Long-Term Obsessive-Compulsive Disorder Treatment Study that included 269 children and adolescents with a primary diagnosis of OCD. The two groups were compared on measures of OCD severity, symptom profile, comorbid symptoms, and functional impairment. Results showed that the younger group had a poorer level of insight, higher rates of ADHD, and disruptive disorders. The older group had higher levels of mental compulsions, miscellaneous obsessions and compulsions, and self-rated functional impairment. No differences were found on the prevalence of anxiety, tic or depressive disorders between the age groups, nor on overall OCD severity. Overall, differences between the age groups were found to be less than in previous research. Defining groups by age of onset and duration of illness rather than age at evaluation did not change results.
Objective: To evaluate the outcome for very low birthweight (VLBW) infants in northern Norway. Su... more Objective: To evaluate the outcome for very low birthweight (VLBW) infants in northern Norway. Subjects and methods: All live born infants (n 536) with birthweight #1500 g born during 1978–89 to women residing in the northern health region of Norway were studied retrospectively. Data were from the Medical Birth Registry (MBR), hospital records and from follow-up recordings to 4 y of age at maternal and child health centres. Stillborn infants (n 269) with birthweight #1500 g during the same period were also registered. Results: The annual incidence of live born VLBW infants (7.1/1000 live births) did not change, but the proportion of infants born alive before 26 weeks ’ gestation increased and the stillborn part decreased significantly. The Caesarean section (CS) rate, antenatal transfer and the use of a neonatal transport team increased significantly. Four hundred and seventy-five infants (89%) were considered viable at birth, 347 (65%) survived to 1 y and 343 (64%) to 4 y. The like...
Obsessive–compulsive disorder (OCD) is characterized by recurring obsessions and compulsions ofte... more Obsessive–compulsive disorder (OCD) is characterized by recurring obsessions and compulsions often with severe impairment affecting 1–3% of children and adolescents. Cognitive behavioural therapy (CBT) is the therapeutic golden standard for paediatric OCD. However, face-to-face CBT is limited by accessibility, availability, and quality of delivery. Enhanced CBT (eCBT) a combination of face-to-face sessions at the clinic and treatment at home via webcam and a supportive app system aims to address some of these barriers. In this pilot study, we compared eCBT outcomes of 25 paediatric patients with OCD benchmarked against traditional face-to-face CBT (n = 269) from the Nordic Long-term OCD Treatment Study, the largest paediatric OCD CBT study to date. Pairwise comparisons showed no difference between eCBT and NordLOTS treatment outcomes. Mean estimate difference was 2.5 in favour of eCBT (95% CI − 0.3 to 5.3). eCBT compared to NordLOTS showed no significant differences between response...
Background Obsessive-compulsive disorder (OCD) in children can lead to a huge burden on the conce... more Background Obsessive-compulsive disorder (OCD) in children can lead to a huge burden on the concerned patients and their family members. While successful state-of-the art cognitive behavioral interventions exist, there is still a lack of available experts for treatment at home, where most symptoms manifest. Internet-based cognitive behavioral therapy (iCBT) could overcome these restrictions; however, studies about iCBT in children with OCD are rare and mostly target computerized self-help resources and only email contact with the therapist. Therefore, we intended to build up and to evaluate an iCBT approach for children with OCD, replacing successful elements of traditional in-office face-to-face CBT, with face-to-face teleconferences, online materials, and apps. Methods With the help of a pilot feasibility study, we developed the iCBT consisting of 14 teleconference sessions with the child and parents. The sessions are supported by an app assessing daily and weekly symptoms and tre...
The aims of the study were to estimate the prevalence of body dysmorphic symptoms in a sample of ... more The aims of the study were to estimate the prevalence of body dysmorphic symptoms in a sample of children and adolescents with obsessive-compulsive disorder, possible clinical correlates and whether BDD symptoms predict poorer treatment outcomes after cognitive behavioral therapy. The study included 269 children and adolescents with OCD, aged 7-17 years, from Denmark, Sweden, and Norway, who were treated with 14 weekly sessions of manualized, exposure-based CBT. Twenty-one patients (7.8%) had BDD symptoms. BDD symptoms were associated with older age (p = 0.003) and a higher prevalence of comorbid anxiety disorders (p = 0.025). In addition, patients with BDD symptoms endorsed a greater number of OCD symptoms than did those without BDD symptoms. Having symptoms of BDD did not affect the CBT outcome on OCD. The results of the study suggest that CBT for OCD is equally effective for those with and without comorbid BDD symptoms.
BACKGROUND Studies on child and adolescent obsessive-compulsive disorder (OCD) indicate that symp... more BACKGROUND Studies on child and adolescent obsessive-compulsive disorder (OCD) indicate that symptom severity is similar across age, but significant age differences of symptom profile and comorbid disorders have been observed. These earlier studies have yielded mixed results, are methodologically heterogenous and tend to have fairly small sample sizes. The current study examines these differences in one of the largest samples to date and the first sample outside of an English-speaking cultural context. METHODS We compared children aged 11 years and younger to adolescents aged 12 years and older from the Nordic Long-Term Obsessive-Compulsive Disorder Treatment Study that included 269 children and adolescents with a primary diagnosis of OCD. The two groups were compared on measures of OCD severity, symptom profile, comorbid symptoms, and functional impairment. RESULTS Results showed that the younger group had a poorer level of insight, higher rates of ADHD, and disruptive disorders. The older group had higher levels of mental compulsions, miscellaneous obsessions and compulsions, and self-rated functional impairment. No differences were found on the prevalence of anxiety, tic or depressive disorders between the age groups, nor on overall OCD severity. CONCLUSION Overall, differences between the age groups were found to be less than in previous research. Defining groups by age of onset and duration of illness rather than age at evaluation did not change results. Mental health services in Scandinavia are free of cost, making early intervention more accessible, which may reduce subsequent secondary problems and explain these findings.
ADHD is a heterogeneous neurodevelopmental disorder associated with dysfunctions in several brain... more ADHD is a heterogeneous neurodevelopmental disorder associated with dysfunctions in several brain systems. Objective markers of brain dysfunction for clinical assessment are lacking. Many studies applying electroencephalography (EEG) and neuropsychological tests find significant differences between ADHD and controls, but the effect sizes (ES) are often too small for diagnostic purposes. This study aimed to compute a diagnostic index for ADHD by combining behavioral test scores from a cued visual go/no-go task and Event Related Potentials (ERPs). Sixty-one children (age 9-12 years) diagnosed with ADHD and 69 age- and gender-matched typically developing children (TDC) underwent EEG-recording while tested on a go/no-go task. Based on comparisons of ERP group-means and task-performance, variables that differed significantly between the groups with at least moderate ES were converted to a five points percentile scale and multiplied by the ES of the variable. The sum-scores of the variables constituted the diagnostic index. The index discriminated significantly between patients and TDC with a large ES. This index was applied to an independent sample (20 ADHD, 21 TDC), distinguishing the groups with an even larger ES. The diagnostic index described has the potential to support assessment. Further research establishing diagnostic indexes for differential diagnoses is needed.
The overall aim of the present thesis was to investigate important aspects of childhood obsessive... more The overall aim of the present thesis was to investigate important aspects of childhood obsessive–compulsive disorder (OCD) such as comorbidity and quality of life (QoL). Frequency and continuity of autistic symptoms from preschool age to later childhood in children with OCD were explored as a contribution to the ongoing nosological debate on whether there is an empirical base for summarizing conditions such as OCD, Tourette’s syndrome, eating disorders and autism spectrum disorders as parts of a so-called obsessive– compulsive spectrum. The establishment of proper outcome measures for the evaluation of treatment interventions has been a concern in the field (Pallanti et al., 2002). The measurement of symptom reduction only, without any assessment of subjective well-being, has been criticized (Macy et al., 2013). QoL assessment is a well-established outcome measure in somatic as well as in psychiatric treatment studies. However, in contrast to adult OCD, little is known about QoL in children with OCD and next to nothing is known about the role treatment plays in their QoL. To investigate QoL in children with OCD under different conditions (with and without comorbidity, before and after treatment) is relevant because of the paucity of studies concerning children. In the first study, comorbidity in terms of autistic traits was assessed in children and adolescents seeking treatment in a Swedish OCD Clinic (Gothenburg) and compared with controls from a general population sample. In the second study, QoL was assessed at baseline, and in the third study, both at baseline and after treatment with cognitive behavioural therapy (CBT) in children and adolescents with OCD enrolled in the Nordic Long-term OCD Treatment Study (NordLOTS) and compared with the general population. The NordLOTS is a Nordic multicentre study in which OCD treatment units for children and adolescents collaborated on common procedures for assessment, treatment and outcome evaluation (Thomsen et al., 2013). A manual for CBT with exposure and response prevention was established (Weidle et al., 2014). The QoL study included in this thesis comprised a sample of 135 children and adolescents, 7–17 years of age, with moderate to severe OCD according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders (4th edition, text rev.) (DSM-IV-TR) (2000), including nine individuals with Asperger’s syndrome/high-functioning autism. QoL was assessed at baseline and after treatment with 14 sessions of CBT by self-report and caregiver proxy reports on the Questionnaire for Measuring Health-related Quality of Life in Children and Adolescents (KINDL-R) and compared with an age- and gender-matched sample from the general population. Social competence and school functioning were assessed with the Child Behaviour Checklist, comorbidity with the Kiddie Schedule for Affective Disorders and Schizophrenia (Present and Lifetime Version), severity of OCD with the Children’s Yale–Brown Obsessive Compulsive Scale and the families’ involvement with the child’s OCD symptoms with the Family Accommodation Scale. In addition, the significance of potential factors such as onset and duration of symptoms regarding QoL change were explored. Autism spectrum disorder (ASD) symptoms occurred in about one-fifth of children with OCD and were much more common than in the general population. However, the majority of OCD patients did not have these traits, indicating that ASD and OCD co-occur in a subgroup of cases rather than in OCD as a whole. In general, ASD symptoms reported in children with OCD did not show a strong enough relationship between OCD and ASD to support a classification of ASD as a part of an obsessive–compulsive spectrum group. However, a subgroup of paediatric OCD patients had significant subclinical ASD symptom levels. This should be considered when tailoring individual treatment interventions. QoL and social competence were markedly reduced in children with OCD, both in self-reports and in parents’ reports, compared with the general population. Children with higher comorbidity had lower QoL in parents’ proxy reports. After treatment, QoL ratings in treatment responders were in the same range as in the general population, while non-responders rated no change in QoL. Comorbidity, family accommodation and psychosocial functioning were not associated with changes in QoL after treatment. To the best of our knowledge, this is the largest QoL study of paediatric patients with OCD and the first one based on the assessment of OCD and comorbid disorders by standardized semi-structured diagnostic interviews, comparing patients with matched controls from the general population. It is also the first study assessing QoL changes after treatment in paediatric OCD. QoL assessment with the KINDL-R supported outcome measures for symptom reduction used in the study to define treatment outcomes. Based on our findings, we suggest employing QoL assessment in order to…
Journal of the American Academy of Child & Adolescent Psychiatry, 2021
OBJECTIVE A lack of universal definitions for response and remission in pediatric obsessive-compu... more OBJECTIVE A lack of universal definitions for response and remission in pediatric obsessive-compulsive disorder (OCD) has hampered the comparability of results across trials. To address this problem, we conducted an individual participant data diagnostic test accuracy meta-analysis to evaluate the discriminative ability of the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) in determining response and remission. We also aimed to generate empirically derived cutoffs on the CY-BOCS for these outcomes. METHOD A systematic review of PubMed, PsycINFO, Embase and CENTRAL identified 5,401 references, 42 randomized controlled clinical trials (RCTs) were considered eligible and 21 provided data for inclusion (N 1,234). A score ≤ 2 in the Clinical Global Impressions Improvement and Severity scales were chosen to define response and remission, respectively. A two-stage random-effects meta-analysis model was established. The area under the curve (AUC) and the Youden Index were computed to indicate the discriminative ability of the CY-BOCS and to guide for the optimal cutoff, respectively. RESULTS The CY-BOCS had sufficient discriminative ability to determine response (AUC 0.89) and remission (AUC 0.92). The optimal cutoff for response was a ≥ 35% reduction from baseline to posttreatment (sensitivity [95% CI] 83.9 [83.7, 84.1]; specificity [95% CI] 81.7 [81.5, 81.9]). The optimal cutoff for remission was a posttreatment raw score ≤ 12 (sensitivity [95% CI] 82.0 [81.8, 82.2]; specificity [95% CI] 84.6 [84.4, 84.8]). CONCLUSION Meta-analysis identified empirically optimal cutoffs on the CY-BOCS to determine response and remission in pediatric OCD RCTs. Systematic adoption of standardized operational definitions for response and remission will improve comparability across trials for pediatric OCD.
The first aim of this study was to explore whether children with obsessive compulsive disorder (O... more The first aim of this study was to explore whether children with obsessive compulsive disorder (OCD) and subclinical autistic traits can be differentiated from children with OCD without these traits based on clinical OCD-related characteristics, distinct OCD symptom patterns, and type of comorbidity. The second aim was to investigate whether autistic traits predict immediate and long-term outcome of exposure-based cognitive behavioral therapy (CBT) in pediatric OCD.The participants in this study were a total of 257 children and adolescents aged 7–17 years, recruited from Denmark, Norway, and Sweden as a part of the Nordic long-term OCD treatment study (NordLOTS). Inclusion criteria were an OCD diagnosis based on DSM-IV criteria and a Children’s Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) total severity score of 16 or higher. No children with a diagnosis on the autism spectrum were included. An Autism Spectrum Screening Questionnaire (ASSQ) cut-off score of ≥ 17 was used to defin...
Journal of Obsessive-Compulsive and Related Disorders, 2021
Abstract Studies on child and adolescent obsessive-compulsive disorder (OCD) indicate that sympto... more Abstract Studies on child and adolescent obsessive-compulsive disorder (OCD) indicate that symptom severity is similar across age, but significant age differences of symptom profile and comorbid disorders have been observed. The current study examines these differences in one of the largest samples to date, and the first sample outside of an English-speaking cultural context. We compared children aged 11 years and younger to adolescents aged 12 years and older from the Nordic Long-Term Obsessive-Compulsive Disorder Treatment Study that included 269 children and adolescents with a primary diagnosis of OCD. The two groups were compared on measures of OCD severity, symptom profile, comorbid symptoms, and functional impairment. Results showed that the younger group had a poorer level of insight, higher rates of ADHD, and disruptive disorders. The older group had higher levels of mental compulsions, miscellaneous obsessions and compulsions, and self-rated functional impairment. No differences were found on the prevalence of anxiety, tic or depressive disorders between the age groups, nor on overall OCD severity. Overall, differences between the age groups were found to be less than in previous research. Defining groups by age of onset and duration of illness rather than age at evaluation did not change results.
Objective: To evaluate the outcome for very low birthweight (VLBW) infants in northern Norway. Su... more Objective: To evaluate the outcome for very low birthweight (VLBW) infants in northern Norway. Subjects and methods: All live born infants (n 536) with birthweight #1500 g born during 1978–89 to women residing in the northern health region of Norway were studied retrospectively. Data were from the Medical Birth Registry (MBR), hospital records and from follow-up recordings to 4 y of age at maternal and child health centres. Stillborn infants (n 269) with birthweight #1500 g during the same period were also registered. Results: The annual incidence of live born VLBW infants (7.1/1000 live births) did not change, but the proportion of infants born alive before 26 weeks ’ gestation increased and the stillborn part decreased significantly. The Caesarean section (CS) rate, antenatal transfer and the use of a neonatal transport team increased significantly. Four hundred and seventy-five infants (89%) were considered viable at birth, 347 (65%) survived to 1 y and 343 (64%) to 4 y. The like...
Obsessive–compulsive disorder (OCD) is characterized by recurring obsessions and compulsions ofte... more Obsessive–compulsive disorder (OCD) is characterized by recurring obsessions and compulsions often with severe impairment affecting 1–3% of children and adolescents. Cognitive behavioural therapy (CBT) is the therapeutic golden standard for paediatric OCD. However, face-to-face CBT is limited by accessibility, availability, and quality of delivery. Enhanced CBT (eCBT) a combination of face-to-face sessions at the clinic and treatment at home via webcam and a supportive app system aims to address some of these barriers. In this pilot study, we compared eCBT outcomes of 25 paediatric patients with OCD benchmarked against traditional face-to-face CBT (n = 269) from the Nordic Long-term OCD Treatment Study, the largest paediatric OCD CBT study to date. Pairwise comparisons showed no difference between eCBT and NordLOTS treatment outcomes. Mean estimate difference was 2.5 in favour of eCBT (95% CI − 0.3 to 5.3). eCBT compared to NordLOTS showed no significant differences between response...
Background Obsessive-compulsive disorder (OCD) in children can lead to a huge burden on the conce... more Background Obsessive-compulsive disorder (OCD) in children can lead to a huge burden on the concerned patients and their family members. While successful state-of-the art cognitive behavioral interventions exist, there is still a lack of available experts for treatment at home, where most symptoms manifest. Internet-based cognitive behavioral therapy (iCBT) could overcome these restrictions; however, studies about iCBT in children with OCD are rare and mostly target computerized self-help resources and only email contact with the therapist. Therefore, we intended to build up and to evaluate an iCBT approach for children with OCD, replacing successful elements of traditional in-office face-to-face CBT, with face-to-face teleconferences, online materials, and apps. Methods With the help of a pilot feasibility study, we developed the iCBT consisting of 14 teleconference sessions with the child and parents. The sessions are supported by an app assessing daily and weekly symptoms and tre...
The aims of the study were to estimate the prevalence of body dysmorphic symptoms in a sample of ... more The aims of the study were to estimate the prevalence of body dysmorphic symptoms in a sample of children and adolescents with obsessive-compulsive disorder, possible clinical correlates and whether BDD symptoms predict poorer treatment outcomes after cognitive behavioral therapy. The study included 269 children and adolescents with OCD, aged 7-17 years, from Denmark, Sweden, and Norway, who were treated with 14 weekly sessions of manualized, exposure-based CBT. Twenty-one patients (7.8%) had BDD symptoms. BDD symptoms were associated with older age (p = 0.003) and a higher prevalence of comorbid anxiety disorders (p = 0.025). In addition, patients with BDD symptoms endorsed a greater number of OCD symptoms than did those without BDD symptoms. Having symptoms of BDD did not affect the CBT outcome on OCD. The results of the study suggest that CBT for OCD is equally effective for those with and without comorbid BDD symptoms.
Uploads
Papers by Bernhard Weidle