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PARC PUBLICATIONS
Virtual Reality in the Treatment of Anxiety-Related Disorders ...
Kim H, Han EC, Muntz PB, et al. Curr Psychiatry Rep. 2025;27(9):519-528.
This review highlights virtual reality (VR) as an emerging modality for anxiety-related disorders, including phobias, social anxiety, and OCD. VR allows controlled, immersive exposure to feared stimuli, supporting treatment engagement and fidelity. Innovations include customizable environments and real-time data tracking. Challenges include high costs, therapist training gaps, and limited real-world adoption. Clinical implications emphasize VR as an adjunct to traditional CBT, showing comparable efficacy while enhancing accessibility and patient motivation. Future research should optimize protocols, address practical barriers, and explore long-term outcomes.
The Exposure Guide: A Practical Measure of Exposure Quality
Benito KM, Herren JA, Norris LA, et al. Behav Ther. 2025;56(3):594-604.
The Exposure Guide is a short, practical tool designed to measure how well exposure therapy is delivered in treatment for youth with anxiety disorders like OCD. Because exposure therapy’s success depends on how closely therapists follow key principles, researchers created the EG based on core behavioral ideas and feedback from experts and clinicians. When tested across hundreds of therapy sessions, the guide showed good to excellent agreement between different raters and strong links to a more detailed quality coding system, suggesting it reliably captures exposure quality. Future work will test it in everyday clinical settings.
Who Calls, Who Engages? Families Seeking Treatment for Anxiety and OCD
Jenkins E, Kemp J, Benito K, et al. Brown Univ Child Adolesc Behav Lett. 2025 Mar;41(3):1-4.
This research examined patterns of treatment-seeking among families of youth with anxiety and OCD. Factors influencing engagement included symptom severity, caregiver beliefs, socioeconomic resources, and prior therapy experiences. Families with higher symptom impairment or prior positive therapy experiences were more likely to initiate and maintain treatment. Findings emphasize the importance of outreach, screening, and support to enhance engagement, particularly among underrepresented populations.
What Works for Whom in Pediatric OCD...
Norris LA, Barker DH, Rosen AR, et al. Psychol Med. 2025;55:e27. Published 2025 Feb 6.
This methodological paper describes approaches to synthesizing pediatric OCD treatment data across multiple trials using causally interpretable meta-analysis. Harmonization of trial protocols enables evaluation of moderators and predictors of treatment response. Results suggest variability in treatment efficacy across subgroups, highlighting the need for individualized treatment planning. The study demonstrates how rigorous meta-analytic techniques can inform precision medicine in pediatric OCD.
Caregiver Satisfaction with Anxiety Treatment for Autistic Youth
Norris LA, Rabner JC, Marklin M, et al. J. Autism Dev Disord. Published online February 10, 2025.
This study explores caregiver perspectives on anxiety treatment for autistic youth using mixed methods. Quantitative data assessed satisfaction levels, while qualitative interviews identified themes such as perceived effectiveness, communication with providers, and barriers to care. Caregivers generally reported high satisfaction when treatments were individualized and collaborative. Challenges included limited provider expertise in autism and logistical barriers. Findings underscore the importance of tailoring interventions to both anxiety and autism-specific needs, improving provider training, and addressing systemic obstacles to enhance caregiver engagement and treatment outcomes.
Evaluating the Relationship Between Therapist Negative Beliefs about Exposure ...
Kemp J, Norris LA, Fenley A, et al. Cogn Behav Pract. Published online September 24, 2024.
This study looked at whether therapists’ worries or negative beliefs about exposure therapy affect how they actually use it with anxious children and teens. Therapists filled out a questionnaire about their beliefs and were trained to deliver exposure therapy while sessions were video‑recorded and coded. Results suggested that therapists who started with fewer negative beliefs tended to use exposure more often, and that doing more challenging, anxiety‑raising exposure exercises during training was linked to reductions in negative beliefs over time. Although the sample was small and findings were only marginally significant, the study highlights how therapist attitudes might shape real therapy behavior.
Open Trial of a Telehealth Adaptation of a Team-Based Approach to Delivery ...
Freeman J, O’Connor E, Herren J, et al. Evid Based Pract Child Adolesc Ment Health. 2024 Oct 1;9(4):575-86.
This open trial evaluates a telehealth adaptation of a team-based model for delivering CBT to youth with anxiety and OCD. The approach emphasizes collaboration among clinicians, caregivers, and patients to ensure consistent exposure practice across settings. Results indicate that telehealth delivery maintained treatment integrity and improved accessibility, with preliminary outcomes showing symptom reduction and high caregiver satisfaction. Findings support telehealth as a viable modality for team-based interventions, addressing barriers such as geographic limitations and scheduling challenges while promoting systemic involvement in treatment.
Prazosin Treatment of Sleep Problems in Youth with PTSD
Green B. J Psychiatr Pract. 2014;20(4):253-259.
This study evaluates the efficacy and safety of prazosin, an alpha-1 adrenergic antagonist, for treating sleep disturbances in youth diagnosed with post-traumatic stress disorder (PTSD). Prazosin targets nightmares and insomnia associated with hyperarousal. The results indicate that prazosin significantly reduces nightmare frequency and improves overall sleep quality without major adverse effects. Improvements in sleep were also associated with reductions in daytime PTSD symptoms, suggesting a secondary benefit on overall functioning. The findings support prazosin as a potential pharmacologic option for pediatric PTSD-related sleep disturbances, highlighting the need for further controlled trials to confirm long-term efficacy and safety.
Treatment of OCD in Children and Youth: A Meta-Analysis
Steele DW, Kanaan G, Caputo EL, et al. Pediatrics. Published online December 6, 2024.
This meta-analysis synthesized results from randomized controlled trials evaluating treatments for obsessive-compulsive disorder in children and adolescents. The authors compared cognitive-behavioral therapy, pharmacological treatments with selective serotonin reuptake inhibitors, and combined approaches. Findings demonstrated that cognitive-behavioral therapy, particularly exposure and response prevention, produced the largest effect sizes and most consistent symptom reduction. Combined treatment showed additional benefit for some youth, especially those with more severe symptoms. Medication alone was effective but generally less robust than therapy. The results support cognitive-behavioral therapy as the first-line treatment for pediatric OCD and emphasize the importance of evidence-based interventions.
Modernize the Academic Medical Center Through Innovation Career Pathways
Kemp J. Brown Univ Child Adolesc Behav Lett. 2024 Jul;40(7):1-6.
This paper discusses the need to transform academic medical centers to support innovation and translational research. It outlines structured career pathways that integrate interdisciplinary training, protected time for innovation, and institutional support for entrepreneurship. The authors argue that traditional academic promotion systems often undervalue practice transformation and commercialization efforts, creating barriers for clinician‑scientists and innovators. Proposed strategies include mentorship models, dual‑rank faculty tracks, seed funding mechanisms, and formal recognition of innovation achievements in promotion criteria. By aligning incentives with innovation goals, the framework aims to enhance the capacity of academic medical centers to generate and implement solutions that improve patient care and health system performance.
Pediatric Accommodation Scale: Psychometric Evaluation of a Therapist-Report Format
Phillips KE, Buinewicz SAP, Kagan E, et al. Child Psychiatry Hum Dev. 2024;55(3):667-679.
This study looked at a version of the Pediatric Accommodation Scale (PAS) that therapists fill out to rate how much family members help avoid or reduce a child’s anxiety symptoms during treatment. “Accommodation” means things like changing routines or giving reassurance to reduce a child’s distress. The therapist‑report form (PAS‑TR) was tested with 90 youths in cognitive‑behavioral therapy to see how reliable and valid it is as a measurement tool. Results showed it may not be very strong before treatment starts but could be useful for tracking accommodation changes as therapy goes on.
Brief Assessment Tools for Obsessive Compulsive Disorders in Children ...
Adam GP, Caputo EL, Kanaan G, et al. Pediatrics. Published online December 6, 2024.
This systematic review evaluated the diagnostic accuracy of brief screening tools for obsessive-compulsive disorder (OCD) in children and adolescents compared with expert clinical interviews as the reference standard. The review included 22 studies assessing 27 variants of nine brief measures. Evidence suggests the 8-item Child Behavior Checklist-Obsessive Compulsive Subscale (CBCL-OCD/OCS) has moderate strength of evidence with acceptable sensitivity and specificity (summary AUC 0.84) to prompt further evaluation. Other tools showed promise but had insufficient evidence for broad conclusions. Most studies had methodological limitations and predominantly white samples, highlighting the need for more diverse validation research.
Mechanisms of Change in Exposure Therapy for Anxiety and Related Disorders ...
Benito K, Pittig A, Abramowitz J, et al. Clin Psychol Sci. 2025;13(4):687-719.
This article outlines a research agenda for understanding how exposure therapy produces change in anxiety and related disorders, developed by the Exposure Therapy Consortium. It highlights the need to clarify theoretical mechanisms such as expectancy violation, extinction, distress tolerance, and self‑efficacy, and to distinguish mechanisms from facilitators and measures. The agenda emphasizes improving measurement tools, rigorous study design and analysis, and accounting for individual and contextual differences that influence outcomes. Coordinated, multi‑site research with shared tools and larger samples is recommended to accelerate progress in optimizing exposure therapy.
Diagnosis and Management of OCD in Children
Steele DW, Caputo EL, Kanaan G, et al. Rockville (MD): Agency for Healthcare Research & Quality; December 2024.
This comprehensive review outlines best practices for diagnosing and managing pediatric OCD. It covers clinical assessment strategies, evidence-based treatments, and pharmacological options. Emphasis is placed on cognitive-behavioral therapy (CBT) with exposure and response prevention (ERP) as the first-line intervention, supplemented by medication when necessary. The paper also addresses developmental considerations, comorbidities, and family involvement. Recommendations aim to improve early identification, treatment adherence, and outcomes for children with OCD.
The Next Trial: Protocol for a Two-Phase Randomized Controlled Trial ...
Conelea C, Breitenfeldt C, Wilens A, et al. Trials. 2024;25(1):835. Published 2024 Dec 18.
This paper describes the design and rationale for a two-phase randomized controlled trial aimed at improving treatment outcomes for youth with obsessive-compulsive disorder who do not respond adequately to first-line interventions. Phase one evaluates initial treatment strategies, while phase two tests augmentation or sequencing approaches for partial or nonresponders. The protocol emphasizes personalized treatment selection, systematic assessment of response, and rigorous outcome measurement. By examining adaptive treatment pathways, the study seeks to identify more effective, data-driven approaches for youth with persistent OCD symptoms and to inform clinical decision-making following initial treatment failure.
A Team-Based Partner-Driven Model for Delivering Outpatient Exposure Treatment ...
Freeman J, Kemp J, O'Connor E, et al. JAACAP Open. 2024;3(4):1284-1301. Published 2024 Aug 21.
This article describes a team-based, partner-driven model for delivering outpatient exposure therapy for children and adolescents with anxiety disorders and obsessive-compulsive disorder. The model emphasizes collaboration among clinicians, caregivers, and patients, with caregivers trained as active partners in planning and implementing exposures between sessions. Treatment focuses on increasing exposure frequency, generalization to real-world settings, and consistency across home, school, and community contexts. Clear role delineation, structured communication, and ongoing coaching help maintain fidelity while improving efficiency. The approach aims to increase access to effective exposure-based care, enhance treatment engagement, and improve clinical outcomes in routine outpatient settings.
Executive Functioning, Family Accommodation, and Treatment Response...
Killion B, Marklin M, O'Connor E, et al. Child Psychiatry Hum Dev. Published online November 25, 2024.
This study examined predictors of treatment response among youth with OCD and comorbid ADHD enrolled in a partial hospital program. The authors focused on executive functioning deficits and family accommodation as potential moderators of outcomes. Results indicated that greater executive functioning impairments, particularly in inhibition and organization, were associated with poorer treatment response. Higher levels of family accommodation were also linked to less symptom improvement. Youth with both OCD and ADHD showed more severe baseline symptoms and required greater clinical support. Findings suggest that executive dysfunction and accommodation behaviors may interfere with exposure-based treatment and should be directly targeted to optimize outcomes in intensive OCD care settings.
Be Curious, Not Judgmental. A DBT Emotion Regulation Handout ...
McHugh SA, Gold AL. Brown Univ Child Adolesc Behav Lett. 2024 Oct;40(10):1-0.
This DBT emotion regulation handout encourages individuals to approach unwanted emotions with curiosity rather than judgment. It teaches that emotions provide information and can be understood, even when they are uncomfortable or intense. By noticing emotions without labeling them as bad or wrong, individuals can reduce secondary emotions such as shame, guilt, or anger about having the feeling in the first place. The handout emphasizes mindful awareness, asking questions about what triggered the emotion, what it urges one to do, and what it might be communicating. This curious stance supports emotional flexibility, problem solving, and more effective coping responses.
Exploring Communicative Competence in Autistic Children Who are Minimally Verbal
Naples A, Tenenbaum EJ, Jones RN, et al. Autism. 2023;27(5):1391-1406.
This study introduced the Low Verbal Investigatory Survey (LVIS), a brief parent‑report tool to measure how autistic children with very limited spoken language communicate. About 30% of autistic children are considered minimally verbal, but simply counting spoken words doesn’t show whether or how they communicate using gestures, sounds, or other means. The LVIS asks about a range of communication behaviors and takes about 5 minutes to complete. In tests with 147 children aged 1–8, LVIS scores were strongly related to longer, established assessments of language and cognitive ability, suggesting it’s a useful quick way to estimate communicative capacity.
What Caregivers Like the Most (and Least) About CBT for Youth Anxiety ...
Norris LA, Rabner JC, Crane ME, et al. J. Anxiety Disord. 2023;98:102742.
This study explored caregiver perspectives on youth CBT for anxiety. Caregivers valued structured sessions, exposure exercises, and collaborative problem-solving but expressed frustration over homework adherence, session length, and limited communication with therapists. Mixed-methods data indicated caregiver satisfaction correlates with perceived child progress. Findings suggest that optimizing parent engagement, setting clear expectations, and improving communication may enhance adherence and treatment effectiveness.
Comorbid OCD and ADHD in Youth ...
Marklin M, Killion B, O'Connor E, et al. Brown Univ Child Adolesc Behav Lett. 2023 Nov;39(11):1-4.
This paper reviews the clinical presentation and treatment challenges associated with comorbid obsessive-compulsive disorder and attention-deficit/hyperactivity disorder in youth. The authors highlight overlapping symptoms, including executive functioning deficits, impulsivity, and emotional dysregulation, which can complicate diagnosis and treatment. Comorbidity is associated with greater symptom severity, poorer treatment adherence, and reduced response to standard OCD interventions. The paper recommends maintaining exposure and response prevention as a core treatment while adapting delivery to address attentional and organizational deficits. Integrated approaches that target executive functioning, parent involvement, and careful medication management are emphasized to optimize outcomes for this population.
Interpersonal Effectiveness in Action: The Therapeutic Milieu ...
Egolf A, Gold AL. Brown Univ Child Adolesc Behav Lett. 2023 Mar;39(3):1-4.
This article explores the application of Dialectical Behavior Therapy (DBT) assertiveness skills within therapeutic milieus. It emphasizes structured opportunities for patients to practice interpersonal effectiveness in real-world settings, supported by staff coaching and feedback. Findings suggest that integrating assertiveness training into daily interactions promotes skill generalization, improves communication, and enhances treatment engagement. The paper advocates for embedding DBT principles into milieu-based care to strengthen outcomes.
Therapist Perceptions of Experiential Training for Exposure Therapy
Frank HE, Rifkin LS, Sheehan K, et al. Behav Cogn Psychother. 2023;51(3):214-229.
This mixed‑methods study explored how 12 therapists perceived an experiential training approach, where they personally underwent exposure exercises, and examined barriers and facilitators to using exposure therapy afterward. Participants generally reported more positive attitudes toward exposure and increased confidence, noting that experiencing exposures themselves helped dispel myths and improve empathy for clients. However, real‑world implementation was often hindered by organizational challenges such as limited supervisory support, time constraints, and contextual factors, especially in community mental health settings. While experiential training showed promise for improving therapist attitudes and intentions to use exposure, broader contextual supports are needed to translate these changes into sustained practice.
A Team-Based Service Model for Increasing Equitable Access to Care
Jackson M, Kemp J, Freeman J. Brown Univ Child Adolesc Behav Lett. 2023;39(10):1–4.
This study examines a collaborative, team-based service approach designed to improve equitable access to healthcare. By integrating multiple professionals and coordinating care, the model addresses systemic barriers that disproportionately affect underserved populations. The research evaluates outcomes such as patient engagement, adherence to treatment, and overall health improvements. Findings suggest that team-based models enhance accessibility, reduce disparities, and improve patient satisfaction, highlighting the importance of interprofessional collaboration in delivering efficient, equitable care across diverse communities.
Diversity In Private Education: The Impact of Racial Discrimination on Students' Mental Health
Probherbs K, Freeman J. Brown Univ. Child Adolesc. Behav. Lett. 2023 Nov;39(11):1-6.
This article examines how racial discrimination within private education settings affects students’ mental health and well-being. It highlights that students of color often experience both overt and subtle forms of racial bias, including exclusion, microaggressions, and lower expectations from peers and staff. These experiences are linked to higher levels of anxiety, depression, stress, and academic disengagement. The authors argue that inadequate diversity, equity, and inclusion practices exacerbate these harms. They recommend comprehensive anti–racism training, supportive counseling services, and systemic policy changes to create safer, more inclusive environments that validate students’ identities and promote psychological resilience.
VR Treatments for Anxiety Disorders are Unambiguously Successful ...
Wray TB, Kemp JJ, Larsen MA. Cogn Behav Ther. 2023;52(6):603-624.
Although VR-based interventions show strong efficacy for anxiety disorders, uptake among therapists remains low. Barriers include cost, lack of technical training, limited institutional support, and concerns about patient safety or engagement. Solutions involve simplified VR systems, integration into standard CBT training, supervision support, and policy incentives. Addressing these gaps could expand access to effective, scalable treatment, especially for patients facing barriers to in-person therapy.
Predictors of Treatment Outcome and Length of Stay ...
Garcia AM, Case B, Freeman JB, et al. Evid Based Pract Child Adolesc Ment Health. 2024 Oct 1;9(4):439-52.
The study examined 185 youth with pediatric obsessive‑compulsive disorder (OCD) treated in a partial hospital program (PHP) to identify factors associated with clinical improvement and length of stay (LOS). It characterized symptom change from admission to discharge and analyzed demographic and clinical predictors of outcome and LOS. While specific statistical results are not widely available, the study aimed to determine which baseline characteristics (such as OCD severity, comorbid symptoms, and other clinical variables) might predict greater symptom reduction and longer or shorter stays in PHP care. Findings may help tailor treatment plans and optimize resource use in pediatric OCD programs.
Intensive CBT Telehealth for Pediatric OCD During the Covid-19 Pandemic
Franklin ME, Engelmann JM, Bulkes NZ, et al. JAACAP Open. 2023;2(1):26-35. Published 2023 Oct 5.
This study evaluated the feasibility and outcomes of delivering intensive cognitive-behavioral therapy for pediatric obsessive-compulsive disorder via telehealth during the COVID-19 pandemic. The intervention emphasized exposure and response prevention adapted for remote delivery. Results indicated significant reductions in OCD symptom severity and functional impairment, comparable to outcomes from in-person intensive programs. Treatment adherence and family engagement remained high despite remote delivery. The findings support telehealth as a viable and effective modality for intensive pediatric OCD treatment, particularly during periods of limited in-person access, and suggest broader applicability for increasing access to specialized care.
Parent-Identified Barriers to Accessing Exposure Therapy ...
Frank HE, Cain G, Freeman J, et al. Front Psychiatry. 2023;14:1068255. Published 2023 Mar 20
This qualitative study explores barriers parents face when seeking exposure therapy for their children. Themes include lack of provider expertise, logistical challenges, misconceptions about exposure, and systemic obstacles such as insurance limitations. Parents also reported difficulty finding accurate information and navigating referral processes. Findings highlight the need for improved education, streamlined access pathways, and policy changes to enhance availability of evidence-based treatments for pediatric anxiety and OCD.
Cyclical Exacerbation of Suicidal Ideation in Female Outpatients...
Owens SA, Schmalenberger KM, Bowers S, et al. J. Psychopathol Clin Sci. 2023;132(6):704-715.
This study followed 38 naturally cycling female psychiatric outpatients who reported recent suicidal thoughts, asking them to rate their symptoms every day for about 40 days. Researchers found that suicidal thoughts and related emotional symptoms (like depression, hopelessness, anxiety, irritability, and mood swings) tended to get worse around the time of menstruation compared with other phases of the menstrual cycle. The relationship remained even after considering other factors. These results suggest that the menstrual cycle may be an important, predictable influence on short‑term suicide risk in females with ongoing suicidal ideation.
Exposure to Exposure: A Protocol for Leveraging Exposure Principles During Training ...
Kemp J, Benito K, Herren J, et al. Front Psychiatry. 2023;14:1096259. Published 2023 Feb 15.
This paper presents a training protocol designed to improve therapist implementation of exposure-based interventions by directly applying exposure principles within the training itself. The approach targets common therapist-level barriers, including fear of client distress, low self-efficacy, and negative beliefs about exposure. Trainees engage in graduated, experiential exercises that mirror client exposures, promoting habituation and mastery of core techniques. Preliminary results suggest that this method increases therapist confidence, reduces avoidance, and improves fidelity to exposure protocols. The study emphasizes that addressing therapist-level mechanisms is essential for translating evidence-based exposure therapy into routine clinical practice.
Digital Hoarding: A New Subtype of Traditional Hoarding Disorder?
Renschler K, Freeman J. Brown Univ Child Adolesc Behav Lett. 2023 Feb;39(2):1-4.
This article explores the emerging phenomenon of digital hoarding, characterized by excessive accumulation of digital files and reluctance to delete them. The study examines similarities and differences between digital and traditional hoarding, including underlying cognitive and emotional processes. Findings suggest that digital hoarding may share core features with hoarding disorder but also presents unique challenges related to technology use and accessibility. The paper calls for further research to clarify diagnostic criteria and develop targeted interventions.
Expanding the Reach of Evidence-Based Mental Health interventions to Private Practice...
Frank HE, Milgram L, Freeman JB, et al. Front Health Serv. 2022;2:892294. Published 2022 Jul 22.
This study explored why evidence-based mental health treatments, including exposure therapy for anxiety, are not widely used in private practice, even though they are effective. Researchers interviewed 20 private practice clinicians to understand barriers and supports using a policy ecology framework, which looks at factors at multiple levels, including organizational, regulatory (for example, insurance reimbursement), and social influences. Common barriers included limited reimbursement for longer sessions, lack of colleague support or consultation, costs and time for training, and variable client demand for evidence-based treatments. Solo practitioners reported less support but more scheduling flexibility. Findings suggest strategies to increase use of these treatments in private practice.
Using Team-Based Behavioral Therapy by Telehealth to Treat Youth with Anxiety and OCD
Freeman J, O'Connor E, Kemp J, et al. Patient-Centered Outcomes Research Institute (PCORI); March 2023.
This open‑trial study evaluated a telehealth, team‑based cognitive behavioral therapy (CBT) model for children and adolescents (ages 5–18) with anxiety and obsessive‑compulsive disorder. Delivered remotely due to COVID‑19, weekly exposure therapy sessions were conducted by bachelor’s‑level clinicians under monthly supervision by PhD psychologists. Of 46 participants, treatment engagement and satisfaction were high, and anxiety and OCD symptoms significantly decreased, with 68 % classified as treatment responders. Patient‑ and caregiver‑reported functional impairment and quality of life also improved. The model greatly increased clinician capacity by leveraging non‑licensed staff, suggesting telehealth team‑based CBT can improve access, engagement, and outcomes for youth with anxiety and OCD.
Response Inhibition in Youth Undergoing Intensive Treatment for OCD
Conelea CA, Morris S, McLaughlin N, et al. J. Obsessive Compuls Relat Disord. 2023;36:100764.
This study examined the role of response inhibition in predicting treatment outcomes among youth receiving intensive interventions for obsessive-compulsive disorder (OCD). Using neurocognitive tasks to assess inhibitory control, the authors investigated whether deficits in response inhibition were associated with baseline symptom severity and subsequent response to intensive cognitive-behavioral therapy, including exposure and response prevention. Results indicated that poorer response inhibition correlated with higher initial OCD severity and partially predicted slower symptom reduction during treatment. These findings suggest that executive function, particularly inhibitory control, may influence the pace and effectiveness of intensive OCD therapy, highlighting the potential value of integrating cognitive training or targeted support to optimize outcomes.
Comparison of Patient-Reported Distress During Harm Avoidance ....
Milgram L, Sheehan K, Cain G, et al. J. Obsessive Compuls Relat Disord. 2022 Oct 1;35:100760.
The study compared distress levels reported by 280 youths with obsessive‑compulsive disorder (OCD) during exposure tasks targeting harm avoidance versus incompleteness within a partial hospitalization treatment program. Researchers measured distress using the Subjective Units of Distress Scale (SUDS) throughout exposures. Results showed that incompleteness exposures elicited lower overall distress and more often “flat” (unchanging) distress trajectories than harm avoidance exposures. These findings suggest that distress processes may differ depending on the core OCD symptom motivation, which could have implications for planning exposure therapy in youth with different symptom presentations.
Systematic Review and Meta-Analysis: An Empirical Approach ...
Farhat LC, Vattimo EFQ, Ramakrishnan D, et al. J. Am Acad Child Adolesc Psychiatry. 2022;61(4):495-507.
This study addressed the lack of standard definitions for treatment response and remission in pediatric obsessive‑compulsive disorder (OCD) by conducting an individual‑participant data meta‑analysis of 21 randomized controlled trials with 1,234 children and adolescents. The researchers evaluated how well the Children’s Yale‑Brown Obsessive‑Compulsive Scale (CY‑BOCS) distinguished treatment response and remission, using Clinical Global Impressions scores as reference. They found that a ≥35% reduction in CY‑BOCS best identified response and a post‑treatment score of ≤12 best identified remission, both with strong sensitivity and specificity. The authors recommend adopting these empirically derived cutoffs to improve consistency across pediatric OCD trials.
Treating Pediatric Hoarding Behaviors with an Exposure Response Prevention Model
Gardiner K, Herren J, Freeman J, et al. Brown Univ Child Adolesc Behav Lett. 2022 Sep;38(9):1-5.
This case study applied a developmentally adapted Exposure and Response Prevention (ERP) approach to treat a child with hoarding behaviors. The intervention included psychoeducation, creating a hierarchy of distressing items, in-session and homework exposures to discarding, and parent-supported reinforcement. Over the course of treatment, the child showed significant reductions in hoarding behaviors and anxiety about discarding, with improvements maintained at follow-up. The study highlights the importance of family involvement, tailored ERP exercises, and addressing avoidance behaviors, suggesting that ERP-informed cognitive-behavioral strategies can be effective for pediatric hoarding, though more controlled research is needed.
Symptoms, Impairment and Treatment Needs Among Youth with Orthostatic Intolerance ...
Benito KG, Ramanathan A, Lobato D, et al. Children's Health Care. 2022 Jul 3;51(3):316-35.
This study investigated the clinical presentation, functional impairment, and treatment requirements of youth diagnosed with orthostatic intolerance (OI) in a secondary care setting. The authors assessed symptom severity, comorbidities, and daily functioning, highlighting the impact of OI on academic, social, and psychological domains. Results indicated high rates of fatigue, dizziness, and concentration difficulties, often accompanied by anxiety or mood symptoms, leading to significant impairment. Findings emphasize the need for comprehensive, multidisciplinary management strategies that address both physiological and psychological aspects. The study underscores the importance of individualized treatment planning to optimize functioning and quality of life in affected youth.
Clinician-Reported Determinants of Evidence-Based Practice Use in Private Practice Mental Health
Milgram L, Freeman JB, Benito KG, et al. J. Contemp. Psychother. 2022 Dec;52(4):337-46.
This study examined factors influencing the use of evidence-based practices among mental health clinicians working in private practice settings. Using clinician self-report data, the authors identified determinants across multiple levels, including provider attitudes, training background, perceived client fit, financial constraints, and practice infrastructure. Results indicated that positive beliefs about evidence-based practices and prior formal training predicted greater use, whereas time constraints, reimbursement issues, and lack of consultation reduced implementation. The findings highlight the role of both individual and systemic barriers in private practice and underscore the need for targeted training, ongoing consultation, and structural supports to increase adoption of evidence-based mental health interventions.
Precision Implementation an Approach to Mechanism Testing in Implementation Research
Frank HE, Kemp J, Benito KG, et al. Adm Policy Ment Health. 2022;49(6):1084-1094.
The article proposes precision implementation, a framework for testing causal mechanisms in implementation science by adapting the experimental therapeutics model used in the NIH’s science of behavior change. It emphasizes identifying causal dose–response relationships between implementation strategies, mechanisms, and outcomes to understand how and why strategies work. The authors discuss balancing scientific rigor with real‑world implementation conditions and illustrate the framework with examples of applying it to improve provider uptake of evidence‑based practices in routine care. This approach aims to make implementation research more precise, mechanistic, and useful for tailoring strategies.
The Relationship Between Homework Adherence and Outcome ...
Walther M, Milgram L, Cain G, et al. J. Obsessive Compuls Relat Disord. 2022 Jul 1;34:100729.
This study investigated how adherence to homework assignments influences treatment outcomes in family-based cognitive-behavioral therapy (CBT) for early-onset obsessive-compulsive disorder (OCD). Participants included children with OCD and their families who completed structured exposures and response prevention exercises outside therapy sessions. Analyses demonstrated that higher homework adherence predicted greater symptom reduction and improved functional outcomes. Family involvement was found to enhance adherence, highlighting the role of parental support in treatment success. The findings underscore the critical importance of implementing and monitoring homework tasks in family-based CBT to maximize therapeutic efficacy for early-onset OCD.
Improving Delivery Behaviors During Exposure Therapy ...
Benito KG, Herren J, Freeman JB, et al. Evid Based Pract Child Adolesc Ment Health. 2021 Apr 3;6(2):173-90.
This study evaluated whether a structured training program could improve community therapists’ delivery of exposure therapy for anxiety disorders. Using a cluster randomized controlled design, therapists were assigned to either receive the training or continue usual practice. Training focused on enhancing therapist adherence, competence, and implementation of key exposure therapy techniques. Results showed that trained therapists demonstrated significantly better delivery behaviors, including more consistent use of exposure exercises, higher treatment fidelity, and improved therapist confidence. The findings suggest that targeted, evidence-based training can effectively strengthen community therapists’ skills, supporting better treatment quality and potentially improved outcomes for youth with anxiety.
Improving Delivery Behaviors During Exposure for Pediatric OCD ...
Benito KG, Herren J, Freeman JB, et al. Behav Ther. 2021;52(4):806-820.
This trial evaluates a training intervention aimed at improving therapist behaviors during exposure therapy for pediatric OCD. Using a multiple-baseline design, results show that targeted training significantly enhances adherence to exposure principles and delivery quality. Findings underscore the value of structured, behavior-focused training to increase fidelity and effectiveness of exposure-based treatments in community settings.
OCD: Focus on Functional Links, Not Content, of Obsessions
Milgram L, Freeman J, Benito K. Brown Univ Child Adolesc Behav Lett. 2021 Dec 1;37(12).
In understanding and treating OCD, research suggests it’s more helpful to look at how obsessions function—the thoughts’ emotional impact, what they trigger, and how people respond—rather than just what the thoughts are about. This means that two people may have very different obsession themes (e.g., germs vs. harm) but similar patterns of distress, avoidance, and compulsive responses. Cognitive behavioral approaches emphasize these underlying functional links (like anxiety and attempts to neutralize thoughts) because it’s these reactions—not the specific content—that drive and maintain OCD symptoms. Targeting these functions can improve treatment focus and outcomes.
Emotion Dysregulation Is Substantially Elevated in Autism ...
Conner CM, Golt J, Shaffer R, et al. Autism Res. 2021;14(1):169-181.
This study found that children and adolescents with autism spectrum disorder (ASD) have much higher rates of emotion dysregulation than their peers in the general population, using the Emotion Dysregulation Inventory (EDI). Youth with ASD in community and inpatient samples were four to seven times more likely to show clinically elevated emotional reactivity compared to a matched general US sample. Higher emotion dysregulation was linked with greater use of psychiatric services, including hospitalization, emergency services, and psychotropic medications, even after accounting for age, sex, race, intellectual disability, and ADHD symptoms.
Autism Severity Aggregates with Family Psychiatric History ...
Sipsock D, Tokadjian H, Righi G, et al. Autism Res. 2021;14(12):2524-2532.
This study investigated the association between autism symptom severity and family psychiatric history in a large, community-based autism sample. The authors examined rates of psychiatric conditions among first-degree relatives and assessed whether familial psychopathology was related to autism severity in probands. Results indicated that greater autism severity was associated with higher rates of family history of psychiatric disorders, including mood, anxiety, and neurodevelopmental conditions. These findings suggest shared familial or genetic risk factors that influence both autism severity and broader psychiatric vulnerability. The study supports dimensional models of autism and highlights the importance of considering family psychiatric history in assessment and research.
Exposure Therapy for Youth with Comorbid ADHD: Challenges and Solutions
Cain G, Herren J, Freeman J. Brown Univ Child Adolesc Behav Lett. 2021 Jul;37(7):1-4.
This paper examines how comorbid ADHD affects the delivery and effectiveness of exposure-based therapy for youth with anxiety and obsessive-compulsive disorder. ADHD-related difficulties, including inattention, impulsivity, and poor emotion regulation, can interfere with engagement in exposures, homework completion, and response prevention. The authors outline practical adaptations to improve outcomes, such as shorter and more frequent exposures, increased structure, external reminders, behavioral reinforcement, and greater parent involvement. Rather than viewing ADHD as a contraindication, the paper argues that exposure therapy remains effective when thoughtfully modified. Addressing executive functioning deficits alongside anxiety treatment is critical for maximizing therapeutic response in this population.
Treating Harm Avoidance, Incompleteness and Disgust in OCD
Milgram L, Freeman J, Benito K. Brown Univ Child Adolesc Behav Lett. 2021 Dec;37(12):1-4.
This approach recognizes that obsessive‑compulsive disorder is maintained not just by fear of harm but also by incompleteness (a “not‑just‑right” feeling) and disgust motives, especially in contamination symptoms. Effective treatment extends beyond standard exposure and response prevention (ERP) to explicitly address these emotional drivers. Interventions target harm‑avoidant thoughts through graded exposure and cognitive restructuring, reduce compulsions driven by incompleteness via response prevention tailored to “just‑right” urges, and incorporate strategies to decrease disgust sensitivity (e.g., habituation and cognitive reframing). Tailoring therapy to these core motivations can improve outcomes for subgroups with strong incompleteness or disgust components.
Considering Trends of Restraints and Seclusions by Patient Race
Victor C, Brannan E, Hunt J, et al. Brown Univ. Child Adolesc. Behav. Lett. 2021 Sep;37(9):1-4.
The article reviews research on racial differences in the use of restraints and seclusion in clinical and behavioral health settings. Evidence indicates that patients from racial and ethnic minority groups, especially Black patients, are more likely to experience physical restraint or seclusion than White patients. Studies show that Black patients face increased risk of restraint even after accounting for age, gender, and clinical factors in pediatric psychiatric units. Similar patterns appear in emergency departments and inpatient psychiatry, suggesting that systemic and individual bias may influence the use of restrictive practices rather than clinical need alone.
Trajectory of Change in Parental Accommodation ...
O'Connor EE, Carper MM, Schiavone E, et al. Child Psychiatry Hum Dev. 2023;54(1):232-240.
The study tracked parental accommodation (PA)—parents’ involvement in their child’s OCD rituals—across a 14‑week family‑based treatment for early‑onset pediatric OCD. In the early treatment phase, reductions in PA occurred before improvements in overall symptoms (but not OCD‑specific ones), while decreases in child functional impairment came before changes in PA. In the later stages, declines in PA preceded improvements in both OCD symptoms and impairment. Findings suggest that targeting and reducing parental accommodation throughout treatment, especially later on, may help optimize clinical outcomes for children with OCD.
Delivering Exposure Therapy via Telehealth: Benefits and Challenges
Schiavone E, Freeman J, O'Connor E. Brown Univ Child Adolesc Behav Lett. 2021 Mar;37(3):1-6.
This paper reviews the advantages and limitations of delivering exposure-based interventions through telehealth platforms. Benefits include increased access to specialized care, improved generalization of exposure tasks to real-world environments, and reduced logistical barriers for patients. Challenges include managing safety, maintaining therapeutic alliance, addressing technological limitations, and ensuring treatment fidelity. The authors discuss strategies to mitigate these challenges, such as enhanced clinician training, structured protocols, and parent or caregiver involvement. Overall, the paper concludes that telehealth-delivered exposure therapy is feasible and effective when implemented with appropriate safeguards and adaptations.
Cognitive Reappraisal and Acceptance ...
Troy AS, Shallcross AJ, Brunner A, et al. Emotion. 2018;18(1):58-74.
This experimental study investigates the effects of cognitive reappraisal and acceptance strategies on emotional regulation, physiological responses, and perceived cognitive effort. Participants engaged in tasks requiring either reappraisal or acceptance during emotional challenges. Results indicate both strategies reduce negative affect, but reappraisal involves higher cognitive costs and physiological activation compared to acceptance. Findings suggest that acceptance may offer a more efficient approach for emotion regulation, with implications for clinical interventions targeting anxiety and mood disorders.
Relationship Between Parental Accommodation and Sleep-Related Problems ...
Chevalier LL, O'Connor EE, Holly LE, et al. J. Dev Behav Pediatr. 2021;42(2):114-121.
This study examined whether higher levels of parental accommodation are linked with more sleep‑related problems in 122 children with elevated anxiety symptoms ages 8 to 17. Parents completed measures of accommodation behaviors and their child’s sleep problems, and regressions tested associations controlling for child anxiety severity and age. Parental accommodation predicted a significant amount of variance in children’s sleep difficulties for both mothers and fathers. Specific behaviors such as co‑sleeping, letting the child sleep with lights on, and other sleep accommodations were linked with more frequent sleep‑related problems. The findings suggest that parental accommodation may contribute to sleep difficulties in anxious youth.
Parent and Child Emotion and Distress Responses ...
O'Connor EE, Holly LE, Chevalier LL, et al. J. of Clinical Psychology. 2020 Jul;76(7):1390-407.
This study examines how parental accommodation of a child’s anxiety, such as providing reassurance, altering routines, or allowing avoidance, relates to emotional responses in both parents and children. Results show that higher levels of accommodation are associated with greater child anxiety severity. Although accommodation may reduce distress in the short term, it contributes to the maintenance of anxiety symptoms over time. Parents who frequently accommodate also report higher levels of emotional distress and difficulty regulating their own emotions. The findings highlight the role of parental emotional processes in accommodation behaviors and support interventions that help caregivers reduce accommodation while improving coping and emotional regulation skills.
Gender Differences in Emotion Dysregulation in an Autism Inpatient Psychiatric Sample
Wieckowski AT, Luallin S, Pan Z, et al. Autism Res. 2020;13(8):1343-1348.
This study examines gender-related differences in emotion dysregulation among autistic youth hospitalized for acute psychiatric care. Findings indicate that girls with autism exhibited higher levels of internalizing symptoms, emotional distress, and emotion regulation difficulties compared with boys, despite similar levels of autism severity. Girls were also more likely to present with mood and anxiety symptoms contributing to inpatient admission. Results highlight the importance of gender-sensitive assessment and treatment approaches for emotion dysregulation in autistic youth, particularly in high-acuity psychiatric settings.
Distress Variance and Specificity of Symptom Dimensions in Posttraumatic Stress Disorder
Clapp JD, Kemp JJ, Woodward MJ, et al. J. Psychopathol. Behav. Assess. 2020 Jun;42(2):328-39.
This research examines variability in distress across PTSD symptom dimensions using a quadripartite model. Findings reveal that re-experiencing and hyperarousal symptoms are associated with higher distress compared to avoidance and numbing. Results underscore the need for symptom-specific interventions and suggest that distress variability may influence treatment response. The study contributes to refining PTSD conceptualization and improving targeted therapeutic strategies.
Autism Heterogeneity in a Densely Sampled U.S. Population ...
McCormick CEB, Kavanaugh BC, Sipsock D, et al. Autism Res. 2020;13(3):474-488.
This study examines variability in autism traits across a large, community-based U.S. sample. By analyzing the first 1,000 participants in the RI-CART registry, the research highlights heterogeneity in cognitive, behavioral, and clinical presentations. Findings emphasize diverse symptom profiles, comorbidities, and functional outcomes, underscoring the need for individualized assessment and intervention. The study provides a rich dataset for future research on genotype-phenotype correlations, intervention responsiveness, and personalized care strategies for autistic individuals.
2. Autism Severity Aggregates with Family Psychiatric History in a Community-Based Autism Sample
This paper investigates the relationship between autism severity and family psychiatric history. Using community-based samples, it finds that higher severity correlates with greater prevalence of psychiatric conditions among relative
A Neurocognitive Comparison of Pediatric OCD and Trichotillomania
Wilton EP, Flessner CA, Brennan E, et al. J. Abnorm Child Psychol. 2020;48(5):733-744.
This study investigates neurocognitive functioning in youth with obsessive-compulsive disorder (OCD) and trichotillomania to clarify shared and distinct mechanisms. While both groups exhibited impairments in inhibitory control, differences emerged in cognitive flexibility and habit formation. Findings suggest overlapping yet distinct neurocognitive profiles, supporting the classification of these disorders as related but separable conditions and informing tailored intervention strategies.
Managing Emergent Life Events in Exposure Therapy for Pediatric Anxiety
Gervasio M, Herren J. Brown Univ Child Adolesc Behav Lett. 2020 Sep;36(9):1-4.
This paper addresses how unexpected life events can arise during the course of exposure-based treatment for pediatric anxiety disorders and how clinicians can manage these disruptions without undermining therapeutic progress. The authors discuss clinical decision-making strategies for balancing treatment flexibility with fidelity to exposure principles. Recommendations include assessing whether events represent true safety concerns versus anxiety-driven avoidance, maintaining exposure momentum when possible, and incorporating real-life stressors as therapeutic opportunities. The paper emphasizes the importance of therapist judgment, collaboration with families, and clear communication to ensure continued treatment effectiveness amid changing life circumstances.
Disgust Propensity and Sensitivity in Childhood Anxiety and OCD
Georgiadis C, Schreck M, Gervasio M, et al. J. Anxiety Disord. 2020;76:102294.
This study investigates the role of disgust propensity (tendency to experience disgust) and sensitivity (distress about disgust) in pediatric anxiety and OCD. Results indicate that both constructs are elevated in these populations but relate differently to obsessional content. Disgust sensitivity shows stronger associations with contamination-related symptoms, while propensity correlates with broader anxiety features. Findings highlight the importance of assessing disgust dimensions in clinical evaluations and tailoring interventions to address these mechanisms.
Core Motivations of Childhood OCD ...
Schreck M, Georgiadis C, Garcia A, et al. Child Psychiatry Hum Dev. 2021;52(5):957-965.
The study explored whether two motivational dimensions, harm avoidance (avoiding feared harmful outcomes) and incompleteness (feeling that things are “not just right”), underlie symptom patterns in children with obsessive‑compulsive disorder (OCD). Youth self‑reported OCD symptoms with the OCI‑CV and clinicians rated harm avoidance and incompleteness motivations. Structural equation modeling showed that harm avoidance was linked with checking, obsessing, and neutralizing symptoms, while incompleteness was linked with checking, ordering, and neutralizing symptoms. These results support considering functional motivations behind compulsions, not just symptom content, to better conceptualize and treat pediatric OCD.
Effect of Clinician Training in the Modular Approach to Therapy ...
Merry SN, Hopkins S, Lucassen MFG, et al. JAMA Netw Open. 2020;3(8):e2011799. Published 2020 Aug 3.
This randomized clinical trial tested whether training clinicians in the Modular Approach to Therapy for Children (MATCH) increases the use of empirically supported treatments and improves outcomes for youth in mental health services. Training in MATCH led clinicians to use evidence based treatment content more often and with higher competence compared to usual care. However, there were no differences in clinical outcomes or service efficiency between youth treated by MATCH‑trained clinicians and those receiving usual care. Both groups showed similar improvements in symptoms that were maintained at 3 month follow‑up. The high use of empirically supported treatments in usual care may explain the lack of outcome differences.
Case Report: Functional Assessment of Behavior in Complex Diagnoses
Han G, Gold AL, Righi G, et al. Brown Univ. Child Adolesc. Behav. Lett. 2020;36(8):1-7.
This case report demonstrates the use of functional behavioral assessment in a patient with multiple diagnoses, applying a transdiagnostic lens. The approach identifies underlying behavioral functions rather than focusing solely on diagnostic categories. Interventions targeted maintaining factors such as escape and attention-seeking behaviors, resulting in improved functioning across settings. The report highlights the utility of functional assessment for complex cases, promoting individualized treatment strategies that address shared mechanisms across disorders. Findings advocate for broader adoption of transdiagnostic frameworks in clinical practice to enhance flexibility and effectiveness.
A Comparative Study of Suicidality and its Association with Emotion Regulation ...
Conner CM, Golt J, Righi G, et al. J. Autism Dev Disord. 2020;50(10):3545-3560.
This study examines rates of suicidality and their association with emotion regulation difficulties in individuals with autism spectrum disorder (ASD) compared to census-matched controls. Results show significantly elevated suicidality in the ASD group, strongly linked to deficits in emotion regulation. Findings underscore emotion regulation as a key transdiagnostic risk factor and highlight the need for targeted assessment and intervention to reduce suicide risk in autistic populations.
A Randomized-Controlled Examination of the Effect of Cognitive Reappraisal ...
O'Connor EE, Langer DA, Comer JS, et al. J. Anxiety Disord. 2020;74:102260.
This randomized controlled study evaluates whether teaching cognitive reappraisal reduces maternal accommodation of child anxiety symptoms. Mothers receiving reappraisal instruction demonstrated decreased accommodation behaviors compared to controls. Results suggest that targeting parental emotion regulation can indirectly reduce anxiety-maintaining behaviors, supporting parent-focused interventions as a valuable component of child anxiety treatment.
Moderators of Psychosocial Treatment for Pediatric OCD ...
Kemp J, Barker D, Benito K, et al. J. Clin Child Adolesc Psychol. 2021;50(4):478-485.
The article reviews evidence on factors that change how youth with obsessive‑compulsive disorder respond to psychosocial treatments such as cognitive‑behavioral therapy (CBT). Few rigorous studies have tested moderators of treatment outcomes, and most analyses use small samples with limited power. Some variables studied include family history of OCD, tic disorders, symptom severity, comorbidity, and family accommodation, but no robust moderators have emerged. The authors recommend pooling data across studies and using advanced statistical methods like individual participant data meta‑analysis to better identify moderators. More research is needed to guide clinicians on which treatments work best for specific patient subgroups.
Therapist Behavior During Exposure Tasks Predicts Habituation and Clinical Outcome in ...
Benito KG, Machan J, Freeman JB, et al. Behav Ther. 2021;52(3):523-538.
This study analyzed 459 recorded exposure therapy sessions with 111 children and teens receiving treatment for OCD to see how therapist behaviors during exposures relate to patients’ fear reduction (habituation) and overall improvement. Researchers found that when therapists encouraged facing feared situations more and avoided behaviors like accommodation (helping avoid fear), unrelated talk, and distancing language, patients showed more fear habituation and better clinical outcomes after therapy. The effects of specific therapist actions also depended on the level of fear the youth had at that moment. Findings help clarify what therapist actions may make exposure therapy more effective.
The Effects of Safety Behavior Availability Versus Utilization ...
Kemp JJ, Blakey SM, Wolitzky-Taylor KB, et al. Cogn Behav Ther. 2019;48(6):517-528.
This study examined how the availability and use of safety behaviors influence inhibitory learning during exposure-based interventions. The authors distinguished between allowing access to safety behaviors and actively engaging in them during exposure tasks. Results indicated that merely having safety behaviors available did not significantly impair inhibitory learning, whereas actively using safety behaviors reduced expectancy violation and learning of threat nonoccurrence. These findings suggest that clinicians may permit limited availability of safety cues without undermining exposure, provided that clients are guided to refrain from using them. The study refines exposure theory by clarifying how safety behaviors affect learning mechanisms and treatment outcomes.
Getting Unstuck: Dialectical Strategies to Reduce Suffering and Build a Life Worth Living
Gold AL, Yaptangco M. Brown Univ Child Adolesc Behav Lett. 2019 Mar;35(3):1-6.
This paper outlines the application of dialectical behavior therapy (DBT) strategies to help individuals reduce emotional suffering and behavioral rigidity. Core DBT principles—mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness—are presented as tools for addressing avoidance, emotional overwhelm, and maladaptive coping. The authors emphasize balancing acceptance and change to help individuals “get unstuck” from unhelpful patterns. Clinical examples illustrate how dialectical strategies can foster psychological flexibility, improve emotional resilience, and support engagement in meaningful, values-driven living.
I Heard it Through the Grapevine: Where and What Parents Learn ...
O'Connor EE, Langer DA. J. Clin Psychol. 2019;75(4):710-725.
This study investigates how parents obtain information about youth mental health treatments. Results show that informal sources, such as other parents and online communities, are frequently used, while professional guidance is less common. Information quality varies, influencing treatment decisions and expectations. Findings highlight the importance of improving access to accurate, evidence-based resources for families to support informed decision-making and engagement in care.
Testing Robustness of Child Steps Effects with Children and Adolescents...
Weisz JR, Bearman SK, Ugueto AM, et al. J. Clin Child Adolesc Psychol. 2020;49(6):883-896.
This randomized controlled effectiveness trial evaluated whether the modular Child STEPs treatment program produces consistent benefits for youth with anxiety, depression, trauma, or conduct problems when delivered under more clinically feasible conditions. Fifty community clinicians were randomly assigned to training and consultation in Child STEPs or to provide usual care, and 156 youth ages 6‑16 were randomized to receive Child STEPs or usual care. Both groups showed statistically significant improvement on measures of internalizing, externalizing, and overall problems over time. However, Child STEPs did not outperform usual care on any outcome, suggesting its effectiveness may depend on specific implementation conditions and study design factors.
Developing Targeted Training Strategies for Exposure Therapy
Kemp J. Brown Univ. Child Adolesc. Behav. Lett. 2019 Aug;35(8):1-7.
This paper focuses on improving dissemination and implementation of exposure-based interventions by identifying therapist-specific barriers and tailoring training accordingly. The authors propose targeted training strategies that address clinician knowledge gaps, negative beliefs about exposure, and avoidance of distress-inducing techniques. Training models emphasize experiential learning, ongoing consultation, performance feedback, and fidelity monitoring rather than didactic instruction alone. The paper argues that aligning training methods with known mechanisms of therapist behavior change can enhance adoption and sustainment of exposure therapy in routine clinical settings. The findings support a precision-training approach to improve evidence-based practice delivery.
The Pattern of Symptom Change During Prolonged Exposure Therapy ...
Brown LA, Clapp JD, Kemp JJ, et al. Psychol Med. 2019;49(12):1980-1989.
This study examined symptom trajectories in active duty military personnel undergoing either Prolonged Exposure (PE) therapy or Present-Centered Therapy (PCT) for post-traumatic stress disorder (PTSD). Using session-by-session assessments, the authors investigated the timing and pattern of symptom change across treatment. Results showed that PE was associated with more rapid and substantial reductions in PTSD symptoms compared to PCT, with significant improvements often observed within the first few sessions. PCT led to gradual symptom decline, but with smaller overall effect sizes. These findings support the efficacy of PE in military populations and highlight the value of monitoring symptom trajectories to optimize treatment planning.
Pediatric OCD in the Era of RDoC
Garnaat SL, Conelea CA, McLaughlin NCR, et al. J. Obsessive Compuls Relat Disord. 2019;23:10.1016/j.jocrd.2018.03.002.
This paper discusses pediatric OCD within the Research Domain Criteria (RDoC) framework, emphasizing dimensional approaches to understanding symptoms and underlying mechanisms. It highlights constructs such as cognitive control, reward processing, and threat sensitivity as relevant to OCD. Findings support integrating neurobiological and behavioral data to refine diagnosis and personalize treatment, moving beyond categorical models toward mechanism-based interventions.
Sensitivity to AV Synchrony and its Relation to Language Abilities in Children ...
Righi G, Tenenbaum EJ, McCormick C, et al. Autism Research. 2018 Apr;11(4):645-53.
The study examined whether young children with autism spectrum disorder (ASD) differ from typically developing peers in detecting audio and visual speech timing and how this relates to language skills. Children viewed videos of a speaker where the audio and visual tracks were either in sync or delayed while eye movements were tracked. Typically developing children showed greater attention to synchronous audiovisual speech than children with ASD. Across all children, stronger preference for synchronous speech and more attention to facial features like the mouth were associated with better language abilities. The findings link audiovisual processing and language proficiency in ASD.
Clinical Considerations for Implementing Exposure and Response Prevention ...
Herren J, Brannan E. Brown Univ. Child Adolesc. Behav. Lett. 2018 Jun;34(6):1-7.
Exposure and response prevention (ERP) is a first‑line treatment for obsessive‑compulsive disorder in children and adolescents and involves having youth face feared stimuli while refraining from compulsive rituals to reduce anxiety over time. Clinicians must tailor ERP to the child’s developmental level, build a fear hierarchy, and involve parents as partners in treatment planning and implementation. Psychoeducation for families and collaboration help reduce parental accommodation of symptoms, which otherwise can undermine progress. Challenges include motivating children, managing comorbid behavior problems, and selecting age‑appropriate exposures. Skilled planning and active family involvement improve engagement and long‑term gains in pediatric OCD treatment.
Behavioral Outcomes of Specialized Psychiatric Hospitalization ...
Pedersen KA, Santangelo SL, Gabriels RL, et al. J. Autism Dev Disord. 2018;48(11):3658-3667
This research evaluates behavioral changes in autistic youth following specialized psychiatric hospitalization across multiple sites. Using standardized measures, it identifies improvements in self-injurious behavior, aggression, and adaptive functioning, though outcomes vary by site and patient characteristics. The study highlights the importance of individualized treatment planning, structured interventions, and monitoring to maximize behavioral gains in intensive psychiatric care settings.
When the Torch is Passed, Does the Flame Still Burn? Testing a "train the supervisor" model
Weisz JR, Ugueto AM, Herren J, et al. J. Consult Clin Psychol. 2018;86(9):726-737.
This study evaluated a “train-the-supervisor” model to sustain evidence-based CBT delivery for youth. Supervisors were trained to oversee and mentor therapists in the Child Steps Program. Results indicated high fidelity and therapist competence were maintained after initial supervision, supporting scalable dissemination. Findings suggest that empowering supervisors may sustain program quality and promote broader implementation of evidence-based interventions in community settings.
Evidence Base Update of Psychosocial Treatments for Pediatric OCD ...
Freeman J, Benito K, Herren J, et al. J. Clin Child Adolesc Psychol. 2018;47(5):669-698.
This paper reviews which non-medication treatments truly help children and teens with obsessive-compulsive disorder. The strongest evidence supports cognitive behavioral therapy, especially exposure and response prevention. In this treatment, children slowly face their fears while learning not to do compulsive behaviors. Over time, anxiety decreases and confidence grows. The paper also shows that involving parents improves outcomes, since family members often unknowingly help OCD rituals. Researchers emphasize the need to make effective treatments easier to access in everyday settings like community clinics, schools, and telehealth. Overall, the message is clear: evidence-based therapy works, and expanding access is essential for families.
Assessing Acute Secondary Treatment Outcomes in Early-Onset OCD
Cancilliere MK, Freeman J, Garcia A, et al. Child Psychiatry Hum Dev. 2018;49(5):718-729.
This paper examines the effectiveness of secondary treatments for children with early-onset OCD who did not fully respond to initial interventions. Acute outcomes are assessed using symptom severity, functional impairment, and quality-of-life measures. Findings show that targeted secondary treatments, including intensified therapy or adjunctive medication, can significantly reduce symptoms and improve functioning. The study highlights the need for tailored follow-up strategies and careful monitoring to optimize treatment efficacy in pediatric OCD populations.
Measuring Fear Change within Exposures ...
Benito KG, Machan J, Freeman JB, et al. J. Consult Clin Psychol. 2018;86(7):615-630.
This study examined how changes in fear during exposure therapy sessions relate to treatment outcomes. Using a functionally-defined habituation framework, the authors assessed within-session reductions in subjective fear and physiological arousal as indicators of learning. Results indicated that greater within-session habituation predicted larger symptom reductions across anxiety and obsessive-compulsive disorders. The findings suggest that measuring fear change dynamically, rather than relying solely on static pre-post assessments, provides a meaningful predictor of treatment efficacy. Clinically, the study supports structuring exposures to maximize observable habituation to enhance therapeutic outcomes.
Predictors of Impatient Psychiatric Hospitalization for Children and Adolescents with ASD
Righi G, Benevides J, Mazefsky C, et al. J. Autism Dev Disord. 2018;48(11):3647-3657.
This study examined factors that increase the likelihood of psychiatric hospitalization among children and adolescents with autism spectrum disorder (ASD). Using two large matched cohorts, one of hospitalized youth and one of non-hospitalized outpatients, researchers analyzed individual and family characteristics. Results showed that lower adaptive functioning, greater severity of social-communication symptoms, non-married primary caregiver status, presence of mood disorders, and sleep problems independently increased the risk of psychiatric hospitalization. Identifying these predictors can help clinicians recognize higher-risk individuals and provide targeted interventions to prevent crises and improve outcomes for children and adolescents with ASD.
Cognitive Performance of Youth with Primary Generalized Anxiety Disorder Versus Primary OCD
Kim KL, Christensen RE, Ruggieri A, et al. Depress Anxiety. 2019;36(2):130-140.
This study compares cognitive functioning in youth with generalized anxiety disorder (GAD) and obsessive-compulsive disorder (OCD). Neuropsychological assessments evaluated domains such as attention, memory, and executive functioning. Results showed distinct profiles: OCD was associated with deficits in cognitive flexibility and inhibitory control, while GAD exhibited more generalized attentional difficulties. Findings highlight disorder-specific cognitive impairments, informing tailored interventions and supporting the need for differential diagnosis based on neurocognitive markers.
Attempting to "Increase Intake from the Input" ...
Tenenbaum EJ, Amso D, Righi G, et al. J. Autism Dev Disord. 2017;47(6):1791-1805.
This research examines strategies to enhance language acquisition in children with autism by improving attention to linguistic input. Through structured interventions and experimental paradigms, the study demonstrates that focused attention increases word learning and generalization. Results emphasize the importance of attentional mechanisms in language development for autistic children and suggest practical approaches for educators and therapists to optimize vocabulary growth and communication outcomes.
Secondary Outcomes from the Pediatric OCD Treatment Study II
Conelea CA, Selles RR, Benito KG, et al. J. Psychiatr Res. 2017;92:94-100.
This paper reports on secondary outcomes from the Pediatric OCD Treatment Study II, which compared cognitive-behavioral therapy (CBT), pharmacotherapy with selective serotonin reuptake inhibitors (SSRIs), and combination treatments. While primary outcomes focused on symptom reduction, secondary analyses examined functional improvement, quality of life, comorbid symptom change, and family accommodation. Findings indicated that CBT, alone or combined with medication, led to significant gains in daily functioning, reduced family accommodation, and improvements in anxiety and depressive symptoms. The study emphasizes that effective OCD treatment extends beyond symptom reduction, highlighting the importance of multidimensional assessment and interventions targeting broader psychosocial functioning in youth.
The Effect of Heterogeneous Race Exposure During Infancy
Montoya L, Westerlund A, Troller-Renfree S, Righi G, Nelson CA. Cogn Dev. 2017;42:74-83.
The study investigated how infants’ exposure to caregivers of one versus multiple races influenced their face‑processing preferences from 4 to 12 months. Using looking time measures with race face pairs, researchers found that infants exposed to multiple races did not show stronger preferences for specific race faces compared to those with single‑race exposure, except at 10 months when diverse‑exposed infants looked more evenly at both faces. Overall, infants did not show own‑race preferences, and face preference declined with age. The results suggest caregiver race exposure had little effect on infants’ race preferences in this sample.
Measures for Diagnosing and Measuring Severity of OCD Symptoms in Children
Frank H, Stewart E, Herren J, et al. The Wiley Handbook of Obsessive Compulsive Disorders. 2017 Aug 1;1:95-123.
This review summarizes assessment tools for pediatric OCD, including clinician-administered scales (CY-BOCS), self-report measures, and functional impairment indices. It evaluates reliability, validity, and clinical utility, recommending standardized approaches for diagnosis and treatment monitoring. Findings emphasize the importance of developmentally appropriate measures for accurate assessment.
Examining Psychometric Properties of Pediatric Quality of Life ...
Wellen B, Skriner LC, Freeman J, et al. Child Psychiatry Hum Dev. 2017;48(1):180-188.
This study tested how reliable and valid the Pediatric Quality of Life Enjoyment and Satisfaction Questionnaire (PQ‑LES‑Q) is for measuring quality of life and life satisfaction in children and teens. The PQ‑LES‑Q is a 15‑item self‑report questionnaire used with youth ages 6–17. In a large sample of adolescents, the original factor structure was confirmed and the measure showed excellent internal consistency and strong links with related measures of resilience, well‑being, depression, and anxiety. Results were consistent across gender, race, and ethnicity, supporting its use as a reliable and valid tool for assessing quality of life in youth.
Children's and Parents' Ability to Tolerate Child Distress: Impact on CBT for Pediatric OCD
Selles RR, Franklin M, Sapyta J, et al. Child Psychiatry Hum Dev. 2018;49(2):308-316.
This study examined how children’s and parents’ ability to tolerate a child’s distress relates to outcomes in family‑based cognitive behavioral therapy (CBT) for pediatric obsessive‑compulsive disorder. Clinicians rated distress tolerance for 46 children ages 5 to 8 and their mothers and fathers at baseline and after treatment. All groups showed large improvements in distress tolerance with CBT. Fathers’ higher tolerance at the start predicted greater reduction in OCD symptoms. Changes in children’s and fathers’ distress tolerance over treatment were also linked with larger symptom decreases, suggesting that improving tolerance of distress may support better therapy results for youth with OCD.
Internet-Delivered, Family-Based Treatment for Early-Onset OCD ...
Comer JS, Furr JM, Kerns CE, et al. J. of Consulting & Clinical Psychology. 2017 Feb;85(2):178.
This pilot randomized trial tested an internet-delivered, family-based therapy for young children with early-onset obsessive-compulsive disorder. The treatment combined cognitive-behavioral therapy principles with parental coaching delivered online to increase accessibility and reduce barriers to care. Families were randomly assigned to the internet-delivered intervention or a comparison condition. Results showed that children receiving the online family-based treatment experienced significant reductions in OCD symptoms and functional impairment compared with the control group. Parents also reported improved confidence in managing their child’s symptoms. The study suggests that remote, family-centered approaches may be feasible, acceptable, and effective for treating early-onset OCD in community settings.
Specialized Inpatient Psychiatry Units for Youth with Autism and Serious Problem Behaviors ...
Pedersen KA, Santangelo SL, Gabriels RL, et al. J. Autism Dev Disord. 2018;48(11):3658-3667
This paper evaluates specialized inpatient units designed for autistic youth with severe behavioral challenges. The model incorporates structured environments, individualized interventions, and caregiver involvement. Outcomes reveal reductions in aggression, self-injury, and overall behavioral dysregulation. Findings support the effectiveness of tailored inpatient care for complex cases and highlight the importance of multidisciplinary approaches and transition planning for sustained improvement.
Factors Associated with Practitioners' Use of Exposure Therapy for Childhood Anxiety Disorders
Whiteside SP, Deacon BJ, Benito K, et al. J. Anxiety Disord. 2016;40:29-36.
Factors Associated with Practitioners’ Use of Exposure Therapy for Childhood Anxiety Disorders examines why evidence-based exposure therapy is underused in clinical practice. Using survey data from mental health practitioners, the study found that greater use of exposure therapy was associated with stronger theoretical orientation toward cognitive-behavioral therapy, higher confidence and training in exposure techniques, and more positive beliefs about its safety and effectiveness. Barriers included concerns about client distress, parental resistance, and lack of training or supervision. The authors conclude that increasing education, supervision, and addressing clinician misconceptions are critical for improving the dissemination and implementation of exposure therapy for anxious youth.
Maternal Depression and Youth internalizing and Externalizing Symptomatology
O'Connor EE, Langer DA, Tompson MC. J. Abnorm Child Psychol. 2017;45(3):557-568.
This research explores links between maternal depression and child psychopathology. Results indicate that both chronic and current maternal depressive symptoms predict higher internalizing (anxiety, depression) and externalizing (behavioral problems) symptoms in youth. Findings underscore the need for family-focused interventions addressing maternal mental health to improve child outcomes.
Targeting Clinician Concerns About Exposure Therapy: A Pilot Study ...
Farrell NR, Kemp JJ, Blakey SM, et al. Behav Res Ther. 2016;85:53-59.
This pilot study evaluates whether enhanced training reduces clinician concerns about exposure therapy. Results show that targeted training addressing misconceptions and fears improves therapist confidence and adherence to exposure principles compared to standard training. Findings support incorporating belief-focused strategies into training programs to increase uptake of evidence-based practices.
Using Family-Based Exposure with Response Prevention to Treat OCD ...
Herren J, Freeman J, Garcia A. J. Clin Psychol. 2016;72(11):1152-1161.
This case study illustrates family‑based cognitive‑behavioral therapy (CBT) incorporating exposure with response prevention (ERP) for a 7‑year‑old boy with obsessive‑compulsive disorder (OCD). Treatment emphasized active family involvement, focusing on reducing parental accommodation of compulsions, understanding the functional relationship between obsessions and rituals, and structuring exposures that promote habituation to anxiety. Over the course of therapy, the child showed marked improvements in OCD symptoms and overall functioning, highlighting the feasibility and effectiveness of adapting ERP for young children within a family context. Findings underscore the importance of parental participation and developmentally tailored strategies in early childhood OCD treatment.
Elevated Autism Spectrum Disorder Traits in Young Children with OCD
Stewart E, Cancilliere MK, Freeman J, et al. Child Psychiatry Hum Dev. 2016;47(6):993-1001.
This study looked at whether young children (ages 5–8) with obsessive‑compulsive disorder (OCD) show higher levels of autism‑spectrum traits even when they don’t have an autism diagnosis. Using two common questionnaires, researchers found that scores on the Social Responsiveness Scale (SRS) were elevated and linked to greater OCD severity, while scores on the Social Communication Questionnaire (SCQ) were not elevated. This suggests that many young children with OCD show behaviors or social‑communication difficulties that resemble autism traits, and these may relate to how severe their OCD symptoms are. Clinicians should consider this overlap in assessment and treatment planning.
Exposure Therapy Practices and Mechanism Endorsement: A Survey of Specialty Clinicians
Stewart E, Frank H, Benito K, et al. Prof. Psychol.: Res. Pract. 2016 Aug;47(4):303.
This study surveyed specialty clinicians to assess their reported exposure therapy practices and beliefs about underlying mechanisms of change. Results revealed variability in clinicians’ use of exposure techniques, adherence to recommended protocols, and integration of cognitive interventions. While most clinicians endorsed habituation and inhibitory learning as mechanisms, there was inconsistency in how these principles informed practice. Many reported adapting exposures based on client characteristics, and some deviations from evidence-based guidelines were common. Findings highlight a gap between theoretical endorsement of mechanisms and practical application of exposure methods. The authors suggest targeted training to align clinical behavior with empirically supported mechanisms to improve treatment fidelity and outcomes.
Methylation of the Glucocorticoid Receptor in Placenta ...
Sheinkopf SJ, Righi G, Marsit CJ, et al. Front Behav Neurosci. 2016;10:100. Published 2016 Jun 2.
The study examined whether placental DNA methylation of the glucocorticoid receptor gene (NR3C1) is related to acoustic features of newborn cries. Researchers analyzed placental tissue from 120 healthy full‑term infants and detailed cry acoustics captured after birth. They found that higher NR3C1 methylation was linked with lower variation in cry energy and differences in fundamental frequency, especially cries with very high pitch. High pitch in infant cries has been associated with poor vocal tract control and less effective stress regulation. These associations remained significant after adjusting for factors such as birth weight, maternal age, and prenatal tobacco exposure.
Patterns of Change in Response to Prolonged Exposure ...
Clapp JD, Kemp JJ, Cox KS, Tuerk PW. Depress Anxiety. 2016;33(9):807-815.
This study investigates symptom change trajectories during prolonged exposure therapy for PTSD. Results reveal variability in response patterns, with some patients showing early improvement and others gradual progress. Predictors of positive outcomes include adherence to exposure principles and reduction in avoidance behaviors. Findings emphasize the importance of monitoring individual response patterns and adapting treatment strategies to optimize outcomes.
Characteristics of Young Children with OCD ...
Skriner LC, Freeman J, Garcia A, et al. Child Psychiatry Hum Dev. 2016;47(1):83-93.
This study examines baseline characteristics of young children with obsessive-compulsive disorder (OCD) enrolled in the POTS Jr. trial. The sample included children ages 5–8, and assessments focused on symptom severity, comorbid psychiatric conditions, functional impairment, and family factors. Results indicate that early-onset OCD presents with moderate to severe symptom severity, significant impairment in daily functioning, and frequent comorbidity, particularly anxiety and disruptive behavior disorders. Families often experience high levels of stress and accommodation behaviors. Understanding these baseline features highlights the need for early identification and tailored interventions, including family involvement, to improve treatment outcomes in young children with OCD.
Interoceptive Exposure Exercises for Social Anxiety
Dixon LJ, Kemp JJ, Farrell NR, et al. J. Anxiety Disord. 2015;33:25-34
This study examines the use of interoceptive exposure exercises for individuals with social anxiety disorder. These exercises target feared physical sensations (e.g., blushing, sweating) that often accompany social situations. Findings indicate that interoceptive exposure reduces anxiety sensitivity and improves tolerance of bodily sensations, leading to decreased avoidance behaviors. Results support incorporating interoceptive techniques into CBT protocols for social anxiety to enhance treatment efficacy and address physiological fear components.
Assessment of OCD in Young Children: Psychometric Properties of the CY-BOCS
Cook NE, Freeman JB, Garcia AM, et al. J. Psychopathol Behav Assess. 2015;37:432-441.
Similar to paper 7, this study validates the CY-BOCS for young children. Findings confirm strong reliability, internal consistency, and sensitivity to change. The scale captures symptom severity and differentiation, supporting its use in clinical assessment and treatment monitoring. It reinforces the CY-BOCS as a gold-standard measure for early-onset OCD, critical for guiding intervention planning and evaluating therapeutic outcomes.
Modular Approach to Therapy for Anxiety, Depression, Trauma, or Conduct Problems ...
Lucassen MF, Stasiak K, Crengle S, et al. Trials. 2015;16:457. Published 2015 Oct 12.
The Modular Approach to Therapy for Children with Anxiety, Depression, Trauma, or Conduct Problems (MATCH‑ADTC) is a flexible cognitive‑behavioral treatment designed for youth ages 5 to 15 with multiple mental health concerns. Clinicians select from a set of structured modules to tailor treatment to each child’s needs, including psychoeducation, skills training, and caregiver involvement. MATCH‑ADTC aims to reduce symptoms related to anxiety, depression, conduct issues, and traumatic stress while increasing adaptive functioning. Trials show that MATCH can produce faster improvement and greater clinical gains than usual community‑implemented treatments and may require fewer sessions and shorter treatment duration.
Family-Based Treatment of Pediatric OCD
Anderson LM, Freeman JB, Franklin ME, et al. Child Adolesc Psychiatr Clin N Am. 2015;24(3):535-555.
Family-Based Treatment of Pediatric OCD reviews evidence for involving families as central agents in the treatment of obsessive–compulsive disorder in children and adolescents. The article describes family-based cognitive-behavioral therapy with exposure and response prevention, emphasizing parent training to reduce family accommodation and support skill practice. Empirical findings indicate that family involvement improves engagement, adherence, and treatment outcomes, particularly for younger children and severe cases. The review highlights developmental considerations, common barriers, and clinical strategies, concluding that family-based approaches are essential for effective, sustained treatment of pediatric OCD.
A Primer for the Treatment of Tic Disorders in Youth
Selles RR, Freeman JB. Brown Univ Child Adolesc Behav Lett. 2015 Oct;31(10):1-7.
This primer provides an overview of evidence-based treatments for pediatric tic disorders, with a focus on Comprehensive Behavioral Intervention for Tics (CBIT). The paper outlines assessment strategies, core treatment components, and practical considerations for implementation. Emphasis is placed on psychoeducation, habit reversal training, and functional interventions. The primer serves as a clinical guide for practitioners treating youth with tic disorders.
Category Search Speeds Up Face-Selective FMRI Responses ...
Jiang F, Badler JB, Righi G, Rossion B. Cortex. 2015;66:69-80.
This neuroimaging study investigates how category-based search influences face-selective cortical responses. Using fMRI, researchers found that searching for faces accelerates activation in face-processing regions, even within a non-hierarchical network. Results suggest that top-down attentional mechanisms enhance perceptual processing speed for socially relevant stimuli. These findings contribute to understanding visual attention and category-specific modulation in the brain, with implications for models of face perception and disorders involving social cognition deficits.
Screening for Amblyogenic Factors in a Rural State ...
Kemp JJ, Westlake LL, Christensen RD, et al. J.. Vis. Impair. Blind. 2015 Nov;109(6):507-11.
This article describes how Wyoming implemented a statewide vision screening program to identify children with amblyogenic factors, conditions like unequal focus, eye misalignment, and other issues that can lead to amblyopia (lazy eye) if not treated early. Over about 12 years, nearly 62,000 young children were screened through child development centers and volunteer efforts. About 9 percent had one or more risk factors and some were diagnosed with amblyopia after full eye exams. The project showed that large‑scale screening can find children at risk and help connect families with follow‑up care. Researchers highlighted the need for ongoing follow‑up to improve eye health outcomes.
Development of the Pediatric Accommodation Scale
Benito KG, Caporino NE, Frank HE, et al. J. Anxiety Disord. 2015;29:14-24.
This study introduces and validates the Pediatric Accommodation Scale, designed to measure parental and clinician-reported accommodation behaviors in pediatric OCD. Results demonstrate strong reliability and validity across both formats, including internal consistency and sensitivity to treatment-related changes. The scale provides a standardized tool for assessing family accommodation, which is critical for treatment planning and monitoring progress. Findings emphasize the role of accommodation in maintaining OCD symptoms and support the integration of this measure into clinical and research settings.
CBT for Pediatric OCD: Empirical Review and Clinical Recommendations
Franklin ME, Kratz HE, Freeman JB, et al. Psychiatry Res. 2015;227(1):78-92.
This review synthesizes empirical evidence on CBT for pediatric OCD, highlighting its efficacy as a first-line treatment. Key components include exposure and response prevention, family involvement, and cognitive strategies. The paper provides clinical recommendations for tailoring interventions to developmental needs, managing comorbidities, and enhancing adherence. Findings affirm CBT as the gold standard for pediatric OCD and call for broader access and clinician training.
What Do Therapists and Clients Do During Exposures for OCD?
Conelea CA, Freeman JB. J. Obsessive Compuls Relat Disord. 2015 Jul 1;6:144-6.
This paper introduces a framework for analyzing the mechanics of exposure therapy in OCD. It examines therapist and client behaviors, including guidance, reinforcement, and distress management during exposures. Findings underscore the importance of theoretical alignment and fidelity to exposure principles, suggesting that subtle differences in therapist delivery and client engagement can impact outcomes. The article sets the stage for empirical investigations into optimizing exposure therapy techniques.
Depression in Childhood and Early Adolescence
Tompson MC, O Connor EE, Kemp GN, et al. Ann Depress Anxiety. 2015;2(7):1070.
This study investigates the relationship between parental expressed emotion, family functioning, and childhood depression. Findings indicate high criticism and low warmth predict greater depressive symptoms, while positive family functioning serves as a protective factor. Results highlight the importance of family-based interventions in treating youth depression.
Therapeutic Process During Exposure: Habituation Model
Benito KG, Walther M. J. Obsessive Compuls Relat Disord. 2015;6:147-157.
This paper examines the habituation model as a framework for understanding the therapeutic mechanisms underlying exposure-based interventions. The model posits that repeated, prolonged exposure to anxiety-provoking stimuli leads to a reduction in physiological and emotional arousal over time, which in turn facilitates symptom reduction. The authors discuss empirical evidence supporting within-session and between-session habituation as key predictors of treatment outcomes across anxiety and obsessive-compulsive disorders. Clinical implications include structuring exposures to maximize habituation, monitoring subjective units of distress, and ensuring sufficient exposure duration and intensity to promote durable therapeutic gains.
Sensory Over-Responsivity in a Sample of Children Seeking Treatment for Anxiety
Conelea CA, Carter AC, Freeman JB. J. Dev Behav Pediatr. 2014;35(8):510-521.
This study examines sensory over-responsivity (SOR) in children seeking treatment for anxiety disorders. Findings indicate that SOR is prevalent among anxious youth and is associated with heightened avoidance behaviors and functional impairment. Results suggest that sensory processing difficulties may exacerbate anxiety symptoms and complicate treatment. The paper highlights the importance of assessing SOR in clinical evaluations and integrating sensory-focused strategies into anxiety interventions to improve outcomes.
Infants' Experience-Dependent Processing of Male and Female Faces
Righi G, Westerlund A, Congdon EL, et al. Dev Cogn Neurosci. 2014;8:144-152.
This research investigates how infants process male and female faces using eye-tracking and ERP measures. Findings reveal experience-dependent differences, with infants showing enhanced attention and neural responses to faces matching their primary caregivers’ gender. Results highlight the role of early social experience in shaping face perception and have implications for understanding developmental trajectories in social cognition.
Hoarding Behavior Among Young Children with Obsessive Compulsive Disorder
Frank H, Stewart E, Walther M, et al. J. Obsessive Compuls Relat Disord. 2014;3(1):6-11.
This study investigates the prevalence and clinical correlates of hoarding behaviors in young children diagnosed with OCD. Results show that hoarding symptoms are relatively common and associated with earlier onset, greater symptom severity, and increased impairment. Children with hoarding behaviors also demonstrated poorer insight and greater family accommodation. Findings suggest that hoarding represents a distinct and clinically significant presentation within pediatric OCD, underscoring the need for early identification and targeted, family-based interventions to address hoarding-related impairment.
Functional Connectivity in the First Year of Life in Infants at Risk for ASD
Righi G, Tierney AL, Tager-Flusberg H, et al. PLoS One. 2014;9(8):e105176. Published 2014 Aug 20.
Functional Connectivity in the First Year of Life in Infants at Risk for Autism Spectrum Disorder: An EEG Study examines early neural network development in infants with elevated familial risk for ASD. Using longitudinal EEG recordings across the first year of life, the study found atypical patterns of functional connectivity compared with low-risk infants, including altered synchronization across brain regions. These differences emerged early and changed over time, suggesting disrupted neural communication precedes behavioral symptoms of ASD. The findings support EEG functional connectivity as a potential early biomarker for autism risk and highlight the importance of early neurodevelopmental trajectories in ASD.
Is there a Relationship Between Tic Frequency and Physiological Arousal?
Conelea CA, Ramanujam K, Walther MR, et al. Behav Modif. 2014;38(2):217-234.
This study investigates whether tic frequency correlates with physiological arousal in children with co-occurring tic and anxiety disorders. Using measures such as heart rate and skin conductance, results reveal modest associations between heightened arousal and increased tic frequency during stress-inducing tasks. Findings suggest that physiological regulation may play a role in tic expression, informing interventions that target stress management alongside behavioral strategies.
An Examination of the Efficacy of INSIGHTS ...
O'Connor EE, Cappella E, McCormick MP, et al. J. Educ. Psychol. 2014 Nov;106(4):1156.
This research evaluates the INSIGHTS program, a social-emotional learning intervention for early-grade children. The program focuses on temperament-based strategies to improve classroom behavior, emotional regulation, and academic engagement. Using controlled assessments, results indicate significant improvements in student behavior, teacher-student interactions, and academic readiness. The study supports INSIGHTS as an effective, scalable approach for fostering early childhood development, particularly in diverse classroom settings where individualized support enhances both learning outcomes and social-emotional competence.
Family-Based Treatment of Early Childhood OCD: the Pediatric OCD Treatment Study
Freeman J, Sapyta J, Garcia A, et al. JAMA Psychiatry. 2014 Jun;71(6):689-98.
This multisite randomized clinical trial compared family‑based cognitive behavioral therapy (FB‑CBT) with a family‑based relaxation treatment (FB‑RT) for children ages 5 to 8 with obsessive‑compulsive disorder. Families in the FB‑CBT group learned psychoeducation, behavior management skills, and exposure with response prevention, with strong parental involvement. After 14 weeks, more children in FB‑CBT were rated as much or very much improved compared with FB‑RT, and FB‑CBT led to greater reductions in continuous symptom severity on the Children’s Yale‑Brown Obsessive Compulsive Scale. The findings support FB‑CBT as an effective developmentally tailored treatment for early childhood OCD.
Why Do Clinicians Exclude Anxious Clients from Exposure Therapy?
Meyer JM, Farrell NR, Kemp JJ, et al. Behav Res Ther. 2014;54:49-53.
This study investigated reasons clinicians avoid exposure therapy for anxious clients despite strong evidence. Barriers include clinician discomfort, perceived patient resistance, time constraints, and concerns about exacerbating distress. Results suggest that clinician beliefs, training deficits, and systemic pressures hinder implementation. Recommendations include enhanced training, supervision, and organizational support to reduce unnecessary exclusions and increase the use of exposure therapy for eligible youth.
Evidence Base Update for Psychosocial Treatments for Pediatric OCD
Freeman J, Garcia A, Frank H, et al. J. Clin Child Adolesc Psychol. 2014;43(1):7-26.
This review evaluated published studies on psychosocial treatments for obsessive‑compulsive disorder (OCD) in children and adolescents to determine the strength of evidence supporting various approaches. It found consistent evidence that cognitive‑behavioral therapy (CBT) is an effective first‑line psychosocial treatment for pediatric OCD, whether used by itself or with medication. Family‑focused CBT also showed strong support. Other approaches such as group CBT and technology‑assisted CBT showed promise but had weaker evidence. No treatment yet met the highest level of evidence criteria, indicating that more rigorous research and replication are still needed to strengthen the evidence base.
A Qualitative Study of Parenting Stress, Coping, and Discipline Approaches ...
Kistin CJ, Radesky J, Diaz-Linhart Y, et al. J. Dev Behav Pediatr. 2014;35(3):189-196.
This qualitative study examines parenting stress, coping strategies, and discipline practices among low-income mothers with trauma histories. Themes included high levels of stress, reliance on both adaptive and maladaptive coping strategies, and challenges maintaining consistent discipline. Findings highlight systemic stressors and the need for trauma-informed, culturally responsive parenting interventions that address contextual barriers faced by marginalized families.
Tic-Related OCD: Phenomenology and Treatment Outcome in the Pediatric OCD Treatment Study II
Conelea CA, Walther MR, Freeman JB, et al. J. Am Acad Child Adolesc Psychiatry. 2014;53(12):1308-1316.
This study examined whether children and adolescents (ages 7–17) with tic‑related OCD differed from those without tics in clinical features or treatment response within the Pediatric OCD Treatment Study II. Using a broad definition of tic status, tics were present in about 53% of 124 youth with OCD. Those with and without tics showed no significant differences in demographics, OCD severity, impairment, or comorbidity. Importantly, tic status did not affect response to medication management or cognitive‑behavioral therapy (CBT); both groups benefited similarly. Findings support the use of CBT for youth with tic‑related OCD and caution against assumptions that tics signal greater severity or poorer outcomes.
Internet-Delivered, Family-Based Treatment for Early-Onset OCD ...
Comer JS, Furr JM, Cooper-Vince CE, et al. J. of Clinical Child & Adolescent Psychology. 2014 Jan 2;43(1):74-87.
This case series examines the feasibility and preliminary outcomes of delivering family-based cognitive-behavioral therapy (CBT) for early-onset OCD via internet platforms. The intervention emphasizes parental involvement, structured exposure tasks, and therapist guidance through telehealth sessions. Results indicate significant symptom reduction and high caregiver satisfaction, suggesting that remote delivery can maintain treatment integrity while improving accessibility for families facing geographic or logistical barriers. Findings support the potential for scalable, technology-assisted interventions to expand access to evidence-based care for young children with OCD, warranting further research through controlled trials.
Assessing Therapist Reservations about Exposure Therapy for Anxiety ...
Deacon BJ, Farrell NR, Kemp JJ, et al. J. Anxiety Disord. 2013;27(8):772-780.
This study introduces the Therapist Beliefs about Exposure Scale to measure clinicians’ reservations regarding exposure therapy for anxiety disorders. It identifies common concerns, including perceived patient distress, risk of symptom exacerbation, and treatment safety. Findings reveal that therapists with higher reservations are less likely to implement exposure effectively, underscoring the need for targeted training and supervision. Addressing these beliefs can increase adoption of evidence-based treatments, improve patient outcomes, and reduce variability in therapy delivery.
Do Negative Beliefs About Exposure Therapy Cause its Cautious Delivery?
Farrell NR, Deacon BJ, Kemp JJ, et al. Anxiety Disord. 2013 Dec 1;27(8):763-71.
This study examines whether therapists’ negative beliefs about exposure therapy lead to cautious or suboptimal delivery. Results show that clinicians with stronger negative beliefs implement less challenging exposures and avoid high-distress tasks. Findings highlight the importance of addressing therapist attitudes through training and supervision to ensure fidelity and effectiveness of exposure-based treatments.
Evidence-Based Youth PsychoTherapy in the Mental Health Ecosystem
Weisz JR, Ugueto AM, Cheron DM, et al. J. Clin Child Adolesc Psychol. 2013;42(2):274-286.
This paper reviews five decades of research showing that many evidence‑based psychotherapies (EBPs) have been developed for children and adolescents and work well in tightly controlled clinical trials. However, when these therapies are used in real‑world practice settings with clinically referred youths, their benefits often shrink. The authors argue this happens because most research hasn’t accounted for the complexities of the youth mental health ecosystem—including diverse youth needs, family situations, provider constraints, organizations, and broader policy forces. They outline strategies to strengthen EBPs in everyday care, such as testing them in real practice, adapting them, and aligning research with clinical realities.
Family Accommodation in Pediatric Anxiety: Research Update
Grabill Benito K. Brown Univ Child Adolesc Behav Lett. 2013 Jul 1;29(7).
Family accommodation refers to when parents or caregivers change their behavior to help a child avoid or lessen anxiety—for example, taking over tasks, modifying routines, or reassuring excessively. Research shows accommodation is very common across pediatric anxiety disorders and is linked to higher anxiety symptom severity and greater avoidance behaviors in children, as well as lower self‑efficacy (confidence in coping). Higher accommodation also predicts poorer treatment outcomes and slower remission in therapy. Studies increasingly emphasize measuring and reducing accommodation as an important part of anxiety treatment planning.
Maximizing the Efficacy of Interoceptive Exposure by Optimizing Inhibitory Learning
Deacon B, Kemp JJ, Dixon LJ, et al. Behav Res Ther. 2013;51(9):588-596.
This trial evaluates strategies to enhance inhibitory learning during interoceptive exposure for anxiety disorders. Results show that incorporating variability, expectancy violation, and removal of safety behaviors improves fear reduction and generalization. Findings support refining exposure protocols to leverage learning mechanisms for better treatment outcomes.
Effects of a Chemical Imbalance Causal Explanation on Individuals’ Perceptions ...
Kemp JJ, Lickel JJ, Deacon BJ. Behav Res Ther. 2014;56:47-52.
This experiment tested how telling people that their depressive symptoms were caused by a chemical imbalance affected how they viewed their depression. Participants who had experienced depression were randomly given feedback from a bogus but plausible test stating their symptoms were due to a chemical imbalance or not. Being told the chemical imbalance explanation did not reduce self‑blame. It increased pessimism about recovery and lowered confidence in controlling mood. It also made participants see medication as more credible and psychotherapy as less effective. These results suggest that attributing depression to a chemical imbalance may harm perceptions of recovery and treatment.
Does Anxiety Sensitivity Cause Panic Symptoms?
Dixon LJ, Sy JT, Kemp JJ, et al. J. Exp. Psychopathol. 2013 May;4(2):208-23.
Anxiety sensitivity refers to the fear of anxiety‑related sensations, such as a racing heart, because of beliefs that these sensations have harmful consequences. High anxiety sensitivity is strongly linked with panic symptoms and panic attacks and often predicts future panic experiences even after accounting for general anxiety levels. Prospective studies find that people with elevated anxiety sensitivity are more likely to develop panic symptoms or panic attacks over time. Anxiety sensitivity is considered a risk factor or vulnerability factor for panic but not the sole cause, with cognitive interpretations of bodily sensations playing a key role.
A Comparison of Cognitive and Behavioral Approaches for Reducing Cost Bias ...
Possis EA, Kemp JJ, Lickel JJ, et al. J. Cogn Psychother. 2013;27(3):210-220.
This study compares cognitive restructuring and behavioral experiments in reducing cost bias, the tendency to overestimate negative social outcomes, in individuals with social anxiety. Both approaches were effective, but behavioral strategies demonstrated stronger and more durable reductions in cost bias. Results support behavioral interventions as particularly impactful for modifying maladaptive threat appraisals and inform treatment selection within cognitive-behavioral therapy for social anxiety disorder.
Therapist Perceptions and Delivery of Interoceptive Exposure for Panic Disorder
Deacon BJ, Lickel JJ, Farrell NR, et al. J. Anxiety Disord. 2013;27(2):259-264.
This study surveyed clinicians who use interoceptive exposure (IE)—a core cognitive‑behavioral technique for panic disorder that involves inducing feared internal sensations (like rapid heartbeat or dizziness) to reduce fear of those sensations. Results showed big differences in how therapists actually deliver IE in practice. Many clinicians reported using lower doses of IE and adding controlled breathing rather than prolonged, intense exposure. Therapists also commonly worried about possible negative effects, even though they rarely saw such problems in their own clients. These cautious approaches may reflect perceived risks and could influence the effectiveness of treatment.
CBT for Pediatric OCD ...
Franklin ME, Dingfelder HE, Coogan CG, J. Anxiety Disord. 2013;27(8):745-753.
This paper outlines the competencies required for expert-level CBT delivery in pediatric OCD. It discusses training models, supervision strategies, and fidelity monitoring to ensure high-quality implementation. Barriers include limited access to specialized training and variability in therapist skill. Recommendations emphasize scalable training programs and ongoing support to promote dissemination of evidence-based practices.
Child Disruptive Behavior and Parenting Efficacy
O'Connor E, Rodriguez E, Cappella E, et al. J. Community Psychol. 2012;40(5):555-572.
This research compares two models of the INSIGHTS program, designed to improve parenting efficacy and reduce child disruptive behavior. Both models demonstrated positive effects, with improvements in child behavior and parent confidence. Results support temperament-based interventions as effective strategies for promoting adaptive parenting and reducing behavioral problems in early childhood.
CBT Specific Process in Exposure-Based Treatments ...
Benito KG, Conelea C, Garcia AM, et al. J. Obsessive Compuls Relat Disord. 2012;1(2):77-84.
This study investigates specific therapeutic processes during exposure-based CBT for pediatric OCD. It examines mechanisms such as habituation, inhibitory learning, and therapist behaviors that predict treatment outcomes. Results suggest that quality of exposure tasks and therapist adherence to principles significantly influence symptom reduction. Findings inform strategies for optimizing exposure delivery and improving clinical outcomes.
Pots Jr: Developmental Considerations in Rationale, Design, and Methods
Freeman J, Garcia A, Benito K, et al. J. Obsessive Compuls Relat Disord. 2012;1(4):294-300.
This paper outlines the rationale and methodology for the Pediatric OCD Treatment Study Junior (POTS Jr.), a randomized controlled trial evaluating family-based CBT for young children. Developmental adaptations include play-based exposure tasks, simplified language, and active caregiver involvement. The design emphasizes feasibility, engagement, and symptom measurement tailored to early childhood populations.
Recognizing Disguised Faces
Righi G, Peissig JJ, Tarr MJ. Visual Cognition. 2012 Feb 1;20(2):143-69.
Studies of recognizing disguised faces explore how well humans and computer systems can identify people when their appearance is altered by things like hats, wigs, glasses, makeup, or masks. Disguises make face recognition much harder because they change key visual cues, leading to more mistakes by both people and machines. Researchers have built databases of disguised images and tested performance, finding that recognizing disguised faces is far more challenging than normal face identification. Machine algorithms that focus on stable facial regions (or use deep learning) can improve accuracy, but this remains a difficult real‑world problem.
The Pediatric OCD Treatment Study for Young Children (POTS Jr.)
Freeman J, Garcia A, Benito K, et al. J. Obsessive Compuls Relat Disord. 2012;1(4):294-300.
The POTS Jr. study was a multi‑site randomized controlled trial designed to compare family‑based cognitive‑behavioral therapy (CBT) with family‑based relaxation therapy for young children (ages 5–8) with obsessive‑compulsive disorder (OCD). It included 127 participants and focused on reducing OCD symptoms, improving functioning, and enhancing quality of life. The paper describes how the trial’s design, assessment methods, and treatment procedures were adapted for developmental needs of young children—such as parent involvement, simplified assessment tools, age‑appropriate exposures, and tailored psychoeducation—to ensure valid measurement and effective treatment for this age group.
Maternal and Child Expressed Emotion as Predictors of Treatment Response ...
Przeworski A, Zoellner LA, Franklin ME, et al. Child Psychiatry Hum Dev. 2012;43(3):337-353
This study examined whether levels of expressed emotion (EE) from mothers and children predicted how youth with obsessive‑compulsive disorder (OCD) responded to treatment. EE is a measure of attitudes such as criticism or emotional overinvolvement expressed toward a family member. High EE was mainly driven by criticism rather than overinvolvement. High maternal and child criticism were linked with greater OCD severity before treatment. Although high criticism did not predict reduction in core OCD symptoms after treatment, it was associated with poorer functioning in school and social domains after treatment. These results suggest that family emotional climate may influence broader treatment outcomes in pediatric OCD.
Integrating Behavioral Theory with OCD Assessment Using the Y-BOCS/CY-BOCS Symptom Checklist
Conelea CA, Freeman JB, Garcia AM. J. Obsessive Compuls Relat Disord. 2012 Apr 1;1(2):112-8.
This paper proposes integrating behavioral theory into OCD assessment by leveraging the Y-BOCS/CY-BOCS symptom checklist. The approach emphasizes functional analysis of symptoms, identifying maintaining factors such as avoidance and reinforcement. Findings suggest that incorporating behavioral principles enhances assessment utility, informs individualized treatment planning, and improves alignment between symptom measurement and intervention strategies.
The Children's Yale-Brown Obsessive Compulsive Scale ...
Freeman J, Flessner CA, Garcia A. J. Abnorm Child Psychol. 2011;39(6):877-883.
This study tested whether the Children’s Yale‑Brown Obsessive Compulsive Scale (CY‑BOCS), the gold‑standard clinician‑rated measure of OCD symptom severity, works well for younger children aged 5–8 with obsessive‑compulsive disorder. Forty‑two children were assessed, and results showed that the total CY‑BOCS score had good reliability and validity and was sensitive to change during treatment. However, the obsessions subscale alone showed questionable reliability, while the compulsions subscale and total score were stronger. The authors concluded that the total CY‑BOCS score can be useful in early childhood OCD, but caution is advised when using only the obsession items.
CBT Augmentation of PharmacoTherapy in Pediatric OCD ...
Franklin ME, Sapyta J, Freeman JB, et al. JAMA. 2011;306(11):1224-1232.
This trial evaluates whether adding CBT to medication improves outcomes for pediatric OCD patients with partial response to pharmacotherapy. Results demonstrate that combined treatment significantly reduces symptom severity compared to medication alone. CBT focused on exposure and response prevention, delivered in structured sessions. Findings support integrated treatment approaches for optimizing outcomes in youth with OCD, emphasizing the importance of CBT even when medication is already in use.
Predictors of Parental Accommodation in Pediatric OCD...
Flessner CA, Freeman JB, Sapyta J, et al. J. Am Acad Child Adolesc Psychiatry. 2011;50(7):716-725.
The study examined which child‑ and parent‑level factors predict how much parents accommodate their child’s obsessive‑compulsive symptoms using the Family Accommodation Scale‑Parent Report in 96 youth with OCD. Parental accommodation was very common. Higher child compulsion severity, more oppositional behavior, and more frequent washing/contamination symptoms predicted greater overall accommodation. Parent anxiety symptoms also predicted higher accommodation. Compulsion severity and parent anxiety together explained a meaningful portion of accommodation levels. Child oppositional behavior and washing symptoms were especially linked with parents’ involvement in rituals. These predictors may influence treatment adherence and outcomes in pediatric OCD.
Pediatric Anxiety: How family Accommodation May Hinder Treatment
Benito KG, Freeman J. Brown Univ Child Adolesc Behav Lett. 2011 Mar 1;27(3).
This article reviews the impact of family accommodation on pediatric anxiety treatment. Accommodation behaviors, such as enabling avoidance or providing reassurance, are linked to symptom maintenance and poorer treatment outcomes. The paper advocates for parent-focused interventions that reduce accommodation, enhance exposure adherence, and promote child independence. Recommendations include psychoeducation and structured strategies for managing parental involvement.
Face Categorization in Visual Scenes May Start in a Higher Order Area ...
Jiang F, Dricot L, Weber J, et al. J. Neurophysiol. 2011;106(5):2720-2736.
This study used functional MRI to investigate how the brain quickly identifies faces in complex visual scenes. Participants viewed images of scenes that gradually emerged from visual noise and were asked to press a button when they detected a face or a car. Results showed that the right fusiform face area (FFA)—a higher‑level visual area in the right fusiform gyrus—showed differences in activity between faces and cars before another face‑related region (the occipital face area). This suggests that initial face categorization may occur in this higher‑order region and then spread to other parts of the face‑processing network.
CBT Augmentation of PharmacoTherapy in Pediatric OCD ...
Franklin ME, Sapyta J, Freeman JB, et al. JAMA. 2011;306(11):1224-1232.
The POTS II trial evaluated whether adding cognitive-behavioral therapy (CBT) to medication improves outcomes for pediatric OCD patients with partial response to pharmacotherapy. Results showed that combined treatment significantly reduced symptom severity compared to medication alone. CBT focused on exposure and response prevention, delivered in structured sessions. Findings support integrated treatment approaches for optimizing outcomes in youth with OCD, emphasizing the importance of CBT even when medication is already in use.
Still Struggling: Characteristics of Youth with OCD Who are Partial Responders ...
Freeman J, Sapyta J, Garcia A, et al. Child Psychiatry Hum Dev. 2011;42(4):424-441.
The paper describes 124 youth ages 7 to 17 with obsessive‑compulsive disorder (OCD) who remained clinically symptomatic after an adequate trial of serotonin reuptake inhibitor (SRI) medication. These youth tended to be older adolescents, were mostly White, and came from middle to upper income families with extensive past treatment history. Despite medication trials, they showed moderate to severe OCD symptoms, high ratings of impairment, and significant psychiatric comorbidity including social phobia, ADHD, and anxiety disorders. Functioning was impaired and family functioning scores were poor. The findings highlight the need for effective augmentation strategies beyond medication for this group of youth with OCD.
Kernels vs. Ears, and Other Questions for a Science of Treatment Dissemination
Weisz JR, Ugueto AM, Herren J, et al. Clin. Psychol.: Sci. Pract.
This conceptual paper discusses strategies for disseminating evidence-based treatments, using metaphors like “kernels” (core components) and “ears” (adaptations for context). It argues for identifying essential treatment elements while allowing flexibility for cultural and systemic adaptation. Recommendations include scalable training, fidelity monitoring, and research on implementation science to bridge gaps between efficacy and real-world practice.
Examining the Psychometric Properties of the Family Accommodation Scale ...
Flessner CA, Sapyta J, Garcia A, et al. J. Psychopathol Behav Assess. 2009;31(1):38-46.
This study evaluated the Family Accommodation Scale-Parent Report (FAS-PR), a questionnaire that asks parents how much they help a child avoid or reduce anxiety or OCD symptoms, such as participating in rituals or changing routines. Data from 96 children with obsessive-compulsive disorder showed that the FAS-PR is a reliable and valid measure. The scale divides into two meaningful parts: Avoidance of Triggers and Involvement in Compulsions. Scores on the FAS-PR were related to symptom severity and functional impairment, supporting its use in both research and clinical work.
Assessment of OCD: Review and Future Directions
Benito K, Storch EA. Expert Rev Neurother. 2011;11(2):287-298.
This paper reviews current assessment practices for OCD, highlighting advances in structured interviews, rating scales, and dimensional approaches. It emphasizes integrating developmental considerations, comorbidities, and functional impairment into evaluations. Future directions include improving cross-cultural validity, leveraging digital assessment tools, and enhancing precision in measuring symptom trajectories and treatment responses. The review advocates for evidence-based, individualized assessment strategies to optimize clinical care and research.
Preface: Cognitive-Behavioral Therapy in Youth
Peters TE, Freeman JB. Child and Adolescent Psychiatric Clinics. 2011 Apr 1;20(2):xv-i.
The preface introduces the special issue on Cognitive‑Behavioral Therapy (CBT) for youth, describing CBT as a leading, evidence‑based approach for treating psychological difficulties in children and adolescents. It highlights how CBT integrates behavioral and cognitive strategies to help young people understand and change thoughts, emotions, and behaviors that contribute to problems. The editors emphasize CBT’s developmental adaptations for youth, its broad application across disorders like anxiety and OCD, and the importance of connecting clinical research with real‑world practice. Overall, the preface sets the stage for in‑depth articles on CBT methods and outcomes for young people.
Assessment Scales for OCD
Storch EA, Benito K, Goodman W. Neuropsychiatry. 2011 Jun 1;1(3):243.
This paper reviews various OCD assessment scales, comparing their reliability, validity, and clinical utility. It examines tools such as self-report inventories, clinician-administered interviews, and dimensional rating scales. The review identifies best practices for scale selection based on patient age, symptom severity, and research or clinical objectives. Emphasis is placed on standardized assessments to guide diagnosis, track treatment progress, and inform evidence-based interventions, while highlighting areas for improvement in psychometric precision and cultural sensitivity.
Neural Systems Underlying Lexical Competition: An Eye Tracking and FMRI Study
Righi G, Blumstein SE, Mertus J, et al. J. Cogn Neurosci. 2010;22(2):213-224
The study used eye tracking and functional magnetic resonance imaging (fMRI) to investigate how the brain processes phonological onset competition when people hear a spoken word and see multiple object pictures, one of which shares the beginning sounds with the target word. Participants looked more at objects that shared sounds with the spoken word than unrelated items. Brain imaging showed that left inferior frontal gyrus and left supramarginal gyrus extending into posterior superior temporal gyrus were more active during competition trials than non‑competition trials. These findings show that both frontal and posterior language regions are involved in resolving competition among similar sounding words.
Testing Tic Suppression: Comparing the effects ...
Lyon GJ, Samar SM, Conelea C, et al. J. Child Adolesc Psychopharmacol. 2010;20(4):283-289.
The study tested whether a single dose of immediate‑release dexmethylphenidate (dMPH) affects tic suppression in children and adolescents with attention‑deficit/hyperactivity disorder (ADHD) and Tourette’s disorder. Ten participants completed both medication and no‑medication conditions in a randomized crossover design using a standard tic suppression paradigm. Overall tic frequency was lower on the dMPH day compared to no medication, and behavioral reinforcement reduced tics relative to baseline. However, dexmethylphenidate did not significantly improve the ability to suppress tics beyond the behavioral reinforcement effect. The findings suggest acute dMPH did not enhance tic suppressibility in this small sample.
Behavior Therapy for Pediatric Trichotillomania ...
Franklin ME, Edson AL, Freeman JB. Child Adolesc Psychiatry Ment Health. 2010;4:18. Published 2010 Jun 28.
This study examines how age impacts response to behavioral therapy for pediatric trichotillomania. Using clinical outcomes, it finds differential effectiveness, with younger children often showing quicker gains, though older children demonstrate sustained improvements. Findings underscore the need for age-adapted interventions, tailored strategies for motivation and adherence, and early identification to optimize treatment efficacy for hair-pulling disorders.
Family Accommodation in Pediatric Obsessive-Compulsive Disorder
Storch EA, Geffken GR, Merlo LJ, et al. J. Clin Child Adolesc Psychol. 2007;36(2):207-216.
Family accommodation refers to ways parents or family members help a child avoid or reduce distress from OCD symptoms—for example, participating in rituals, providing reassurance, changing routines, or avoiding triggers. It is very common in pediatric OCD and occurs daily in many families. Although done with good intentions, accommodation can maintain or worsen OCD symptoms, make treatment like exposure therapy less effective, and is linked to higher symptom severity and greater impairment in daily life. Reducing accommodation and teaching families adaptive responses are important parts of effective assessment and treatment planning.
Predictors and Moderators of Treatment Outcome in the Pediatric OCD Study
Garcia AM, Sapyta JJ, Moore PS, et al. J. Am Acad Child Adolesc Psychiatry. 2010;49(10):1024-1086.
This study identifies predictors and moderators of CBT outcomes for pediatric OCD in the POTS I trial. Key predictors include baseline symptom severity, comorbidities, and family accommodation. Moderators such as age and treatment adherence influenced response variability. Findings emphasize the importance of individualized treatment planning and highlight factors that may guide clinicians in tailoring interventions for optimal outcomes.
Family Functioning and Adherence in Youth with Type-1 Diabetes ...
Grabill KM, Geffken GR, Duke D, et al. J. Children's Health Care. 2010 Oct 20;39(4):279-95.
This study examined how family dynamics relate to adherence to diabetes care and blood sugar control (HbA1c) over two years in 224 children with type‑1 diabetes and their parents. Researchers measured family functioning (such as disagreements about who is responsible for diabetes tasks, critical parenting, parental guidance, and warmth), adherence to the treatment regimen, and HbA1c at baseline, year 1, and year 2. Using a growth model, they found that family factors influenced children’s initial HbA1c levels through adherence, especially when parenting was more critical. However, family functioning did not predict changes in HbA1c over time. Overall, family behavior plays an important role in adherence and glycemic control in youth.
The Impact of Neuropsychological Functioning on Treatment Outcome in Pediatric OCD
Flessner CA, Allgair A, Garcia A, et al. Depress Anxiety. 2010;27(4):365-371.
This study looked at whether children’s cognitive abilities before treatment relate to how well they respond to therapy for pediatric OCD. Sixty‑three young people completed tests like the Rey‑Osterrieth Complex Figure and parts of an IQ test before treatment. Results showed that poorer performance on certain memory and organizational tasks—especially tests involving recall—was linked with less improvement in treatment, particularly for those receiving CBT alone. These findings suggest that executive functioning abilities (like memory and strategy use) may influence how well a child benefits from therapy, and that treatment may need to be tailored for those with cognitive challenges
Phenomenology of Early Onset Obsessive-Compulsive Disorder
Garcia AM, Freeman JB, Himle MB, et al. J. Psychopathol Behav Assess. 2009;31(2):104-111.
This research describes the clinical features of obsessive‑compulsive disorder in children who first developed symptoms before age eight. Fifty‑eight children ages four to eight were evaluated using structured interviews and symptom rating scales. The average age when symptoms began was about five and severity tended to be moderately high. Common obsessions involved contamination and fears of harm while common compulsions included washing and checking. Many children also had other psychiatric diagnoses and a family history of OCD was frequent. Early childhood onset cases shared many core features with later‑onset pediatric OCD but showed some differences in gender ratio and depressive comorbidity.
The Development of Stimulus Control Over Tics ...
Woods DW, Walther MR, Bauer CC, et al. Behav Res Ther. 2009;47(1):41-47.
This study explored why tics in Tourette syndrome can vary depending on the situation. Researchers trained 10 children with tic disorders to suppress tics in the presence of a specific visual cue (a purple light) by giving rewards when tics were absent. Later, without instructions or rewards, tics were still reduced when the purple light was shown, suggesting that the environment itself had gained control over tic expression. This supports the idea that a person’s history of reinforcement in different settings may help explain why tics are more frequent or less frequent in certain contexts.
Symptom Profiles in Pediatric OCD: The Effects of Comorbid Grooming Conditions
Flessner CA, Berman N, Garcia A, et al. J. Anxiety Disord. 2009;23(6):753-759.
This study analyzes symptom patterns in pediatric OCD with comorbid grooming disorders (e.g., trichotillomania). Findings indicate that grooming comorbidity is associated with distinct symptom clusters, greater functional impairment, and treatment complexity. Results underscore the importance of comprehensive assessment and integrated interventions addressing both OCD and grooming behaviors.
Just Say No: Sequential Parent Management Training and CBT ...
Lehmkuhl HD, Storch EA, Rahman O, et al. Clinical Case Studies. 2009 Feb;8(1):48-58.
This case study describes a sequential treatment approach combining parent management training (PMT) and CBT for a child with comorbid disruptive behavior and OCD. PMT addressed behavioral noncompliance and improved family dynamics, creating a foundation for effective CBT targeting OCD symptoms. Results demonstrate symptom reduction across both domains, highlighting the value of integrated, staged interventions for complex comorbid presentations.
The Pediatric OCD Treatment Study II: Rationale, Design, and Methods
Freeman JB, Choate-Summers ML, Garcia AM, et al. Child Adolesc Psychiatry Ment Health. 2009;3(1):4.
The paper outlines the Pediatric Obsessive‑Compulsive Disorder Treatment Study II, a randomized clinical trial evaluating two cognitive‑behavioral therapy augmentation strategies for children and adolescents (ages 7–17) with OCD who partially responded to serotonin reuptake inhibitor medication. It compares standard medication management alone with medication plus either traditional “dual‑doctor” CBT or a briefer, psychiatrist‑delivered “single‑doctor” instructional CBT. The study balances efficacy and real‑world effectiveness, aiming to test whether a disseminable CBT protocol delivered by psychiatrists can improve outcomes. Independent evaluators assess participants during 12 weeks of treatment and through one‑year follow‑up.
Somatic Symptoms in Children and Adolescents with OCD ..
Storch EA, Merlo LJ, Keeley ML, et al. Behav. & Cogn. Psychother. 2008 May;36(3):283-97.
This study explores somatic symptoms (e.g., headaches, stomachaches) in youth with OCD and their impact on treatment. Results show that somatic complaints are frequent and correlate with higher symptom severity and functional impairment. However, CBT remains effective regardless of somatic symptom presence. Findings underscore the need for clinicians to address somatic concerns during treatment planning to enhance engagement and adherence.
Juvenile-Onset OCD: Clinical Features of Children, Adolescents, and Adults
Mancebo MC, Garcia AM, Pinto A, et al. Acta Psychiatr Scand. 2008;118(2):149-159.
This paper examines clinical characteristics of juvenile-onset OCD across developmental stages. Findings indicate early onset is associated with higher symptom severity, chronicity, and comorbidities such as tics and anxiety. Adults with juvenile-onset OCD often exhibit persistent symptoms and functional impairment. Results underscore the importance of early detection and intervention to improve long-term outcomes.
Early Childhood OCD: Preliminary Findings ...
Freeman JB, Garcia AM, Coyne L, et al. J. Am Acad Child Adolesc Psychiatry. 2008;47(5):593-602.
This randomized trial assessed a family‑based cognitive behavioral therapy (CBT) for young children ages 5 to 8 with obsessive‑compulsive disorder (OCD). Forty‑two children were randomly assigned to receive 12 sessions of family‑based CBT or family‑based relaxation treatment. Independent evaluators measured symptom severity before and after treatment. The CBT group showed larger reductions in OCD symptoms and higher remission rates than the relaxation group. In the intent‑to‑treat sample, half of the CBT participants achieved remission compared with 20 percent in the control group. Among treatment completers, nearly 70 percent in the CBT group achieved remission. The results support the effectiveness of developmentally tailored CBT for early‑onset OCD.
Assessment of OCD: A Review
Grabill K, Merlo L, Duke D, et al. J. Anxiety Disord. 2008 Jan 1;22(1):1-7.
This review synthesizes current methods for assessing OCD across age groups, including clinical interviews, self-report scales, and behavioral observations. It evaluates reliability, validity, and utility of various tools while discussing challenges such as symptom heterogeneity and comorbidity. The paper emphasizes the importance of standardized assessments for accurate diagnosis, treatment planning, and outcome measurement, while also identifying gaps for future research in both pediatric and adult populations.
Clinical Considerations When Tailoring CBT for Young Children with OCD
Choate-Summers ML, Freeman JB, Garcia AM, et al. Educ. Treat. Child. 2008;31(3):395-416.
This clinical guide discusses ways to adapt cognitive behavioral therapy (CBT) to meet the developmental needs of young children with obsessive‑compulsive disorder. Young children may have limited ability to identify internal thoughts and motivations, so therapists use more concrete, child‑friendly examples and metaphors to explain core CBT concepts. Treatment often involves parents to help implement exposure and response prevention at home and to reduce family accommodation of symptoms. Developmental level also guides the balance between behavioral and cognitive techniques, with emphasis on play, rewards, and simple language for younger children. These adaptations aim to make CBT more understandable and effective for early childhood OCD.
CBT for Young Children with OCD
Freeman JB, Choate-Summers ML, Moore PS, et al. Biol Psychiatry. 2007;61(3):337-343.
The paper reviews evidence on cognitive behavioral therapy (CBT) for very young children with obsessive‑compulsive disorder (OCD), noting that OCD can begin as early as age four and cause major impairment in daily functioning. It highlights that CBT shows promise for reducing symptoms and improving functioning in youth but that the research base for treating very young children was limited at the time. The authors review existing child CBT studies, identify gaps in knowledge, and propose a research agenda to better understand effective, developmentally appropriate CBT interventions for early childhood OCD.
Associations Between Miscellaneous Symptoms and Symptom Subtypes ...
Storch EA, Lack C, Merlo LJ, et al. Behav. Res. Ther. 2007 Nov 1;45(11):2593-603.
This study investigates the relationships between diverse symptom presentations and established OCD subtypes in children. It explores how symptoms cluster, overlap, or predict functional outcomes. Findings indicate that certain “miscellaneous” behaviors correlate with specific subtypes, providing insight into underlying mechanisms and potential treatment targets. The research supports nuanced symptom assessment to guide personalized interventions and highlights the complexity of pediatric OCD presentation.
Family-Based CBT for Pediatric OCD: Comparison of Intensive and Weekly Approaches
Storch EA, Geffken GR, Merlo LJ, et al. J. Am Acad Child Adolesc Psychiatry. 2007;46(4):469-478.
This randomized study compared intensive vs. weekly family‑based CBT for children and adolescents (ages 7–17) with OCD. Both formats,14 sessions of daily intensive therapy and 14 weekly sessions, produced significant reductions in OCD symptoms. Immediately posttreatment, the intensive group showed slightly greater clinical improvement and higher remission rates (75% vs. 50%), but by 3‑month follow‑up outcomes were similar across groups. These findings suggest that both weekly and intensive CBT, incorporating family involvement with exposure and response prevention components, are efficacious for pediatric OCD, with intensive treatment offering modest short‑term advantages.
Tics Moderate Treatment Outcome with Sertraline but Not CBT in Pediatric OCD
March JS, Franklin ME, Leonard H, et al. Biol Psychiatry. 2007;61(3):344-347.
This study analyzed whether comorbid tic disorders influenced treatment outcomes in children and adolescents with obsessive‑compulsive disorder (OCD) from the Pediatric OCD Treatment Study (POTS). Results showed that tics significantly moderated response to sertraline (an SSRI): in youth with tics, sertraline did not outperform placebo in reducing OCD symptoms, whereas in those without tics it did. In contrast, cognitive‑behavioral therapy (CBT) outcomes were not affected by the presence of tics—CBT remained effective regardless of tic status. Combined CBT and sertraline remained most effective overall. Findings suggest starting treatment with CBT (with or without sertraline) for tic‑related pediatric OCD.
Innovations in CBT Interventions for Anxious Youth
Grabill K, Storch EA, Geffken GR. The Behavior Therapist. 2007;30(1):19
This article reviews intensive CBT formats for pediatric OCD, which involve condensed treatment schedules to accelerate symptom reduction. Evidence indicates that intensive CBT is highly effective, particularly for severe cases or when rapid improvement is needed. The paper discusses practical considerations, including family involvement and therapist training, and advocates for broader implementation of intensive models to improve access and outcomes.
Further Psychometric Examination of the Tourette’s Disorder Scales
Storch EA, Merlo LJ, Lehmkuhl H, et al. Child Psychiatry Hum Dev. 2007;38(2):89-98
Further Psychometric Examination of the Tourette’s Disorder Scales evaluates the reliability and validity of commonly used measures for assessing tic severity and related symptoms in individuals with Tourette’s disorder. Using clinical samples, the study examines internal consistency, interrater reliability, and convergent validity with established clinical ratings. Results support strong psychometric properties for the scales, while also identifying areas for refinement and improved sensitivity to change. The findings reinforce the utility of these instruments for both clinical assessment and research, and provide guidance for accurate measurement of tic severity and treatment outcomes.
Gender and Study Behavior: How Social Perception, Social Norm Adherence ...
Grabill KM, Lasane TP, Povitsky WT, et al. North American J of Psychology. 2005 Apr 1;7(1).
This paper examines how gender influences academic behaviors through social and perceptual factors. The study found that gender predicted differences in structured study habits, adherence to social norms, and sensitivity to social evaluation. These behaviors were shaped in part by social expectations regarding appropriate academic conduct. Results suggest that gender-related socialization contributes to how students organize, regulate, and engage in their academic work, with implications for designing study-skills interventions that account for social perception and normative pressures.
Obsessive-Compulsive Disorder
Leonard HL, Ale CM, Freeman JB, et al. Child Adolesc Psychiatr Clin N Am. 2005;14(4):727-viii.
This review provides an overview of OCD in children and adolescents, covering epidemiology, symptom presentation, comorbidities, and treatment approaches. CBT with ERP is highlighted as the gold standard, with pharmacotherapy as an adjunct for severe cases. The paper emphasizes early intervention and family involvement.
Psychiatric Diagnoses and Comorbidity in Relation to Suicidal Behavior ...
D'Eramo KS, Prinstein MJ, Freeman J, et al. Child Psychiatry Hum Dev. 2004;35(1):21-35.
This research looked at 12‑ to 17‑year‑old adolescents admitted to a psychiatric hospital and grouped them by history of suicidal behavior including ideation only, single attempt, and multiple attempts. The severity of suicidal thoughts rose with the seriousness of suicidal behavior. Teenagers with multiple suicide attempts were more often female and more likely to have at least one externalizing disorder, especially substance use disorder. They also had more comorbid psychiatric diagnoses compared with adolescents who had no suicidal behavior or only ideation. The findings highlight that multiple attempts signal high risk that clinicians should closely monitor.
CBT, Sertraline, and Their Combination for Children and Adolescents with OCD
Pediatric OCD Treatment Study POTS Team, Jama. 2004 Oct 27;292(16):1969-76.
This landmark study compares the efficacy of CBT, sertraline, and their combination in treating pediatric OCD. Results show all treatments reduce symptoms, but combined therapy yields the greatest improvement. CBT alone was highly effective, reinforcing its role as a first-line intervention. Findings highlight the benefits of multimodal approaches for severe cases and inform clinical guidelines for treatment sequencing and integration.
Family-Based Treatment of Early-Onset OCD
Freeman JB, Garcia AM, Fucci C, et al. J. Child Adolesc Psychopharmacol. 2003;13 Suppl 1:S71-S80.
Family-Based Treatment of Early-Onset OCD describes an adaptation of cognitive-behavioral therapy for young children with obsessive–compulsive disorder that actively involves parents. The approach emphasizes psychoeducation, parent coaching, and reducing family accommodation while implementing developmentally appropriate exposure and response prevention. Parents are trained to support exposures, manage anxiety-driven behaviors, and reinforce skill use at home. Findings from clinical trials reviewed in this supplement indicate that family-based CBT is feasible, well tolerated, and effective in reducing OCD symptoms in young children. The paper highlights the importance of early intervention and parent involvement to improve outcomes and prevent chronicity.
A Preliminary Examination of Treatment for PTSD ...
Shipherd JC, Beck JG, Hamblen JL, et al. J. Trauma Stress. 2003;16(5):451-457.
This case study explores the application of trauma-focused treatment for a patient with comorbid PTSD and chronic pain. Treatment was associated with reductions in PTSD symptoms and improvements in pain-related functioning. Results suggest that addressing trauma symptoms may positively impact chronic pain outcomes and support the feasibility of integrating PTSD treatment within pain management settings.
Specificity of Stroop Interference in Patients with Pain and PTSD
Beck JG, Freeman JB, Shipherd JC, et al. J. Abnorm Psychol. 2001;110(4):536-543.
This study investigates Stroop interference patterns in individuals with chronic pain and PTSD. Results indicate that trauma-related and pain-related words produce greater interference compared to neutral words, suggesting heightened attentional bias. Findings highlight shared cognitive mechanisms underlying both conditions and support interventions targeting attentional control to reduce symptom burden.
Cognitive Interference for Trauma Cues in Sexually Abused Adolescent Girls with PTSD
Freeman JB, Beck JG. J Clin Child Psychol. 2000;29(2):245-256.
This study examines cognitive interference in adolescent girls with PTSD following sexual abuse. Using experimental tasks, researchers assessed how trauma-related cues disrupt attention and cognitive processing. Results revealed significant interference effects, indicating heightened sensitivity to trauma cues and impaired cognitive control. Findings underscore the role of attentional biases in PTSD maintenance and suggest that interventions targeting cognitive flexibility and trauma-related attentional control may improve treatment outcomes for this population.
Sexual Obsessions in OCD
Freeman JB, Leonard HL. J. Am Acad Child Adolesc Psychiatry. 2000 Feb 1;39(2):141-2.
This paper reviews the phenomenology and clinical implications of sexual obsessions in OCD. These intrusive thoughts often involve taboo or inappropriate sexual content, causing significant distress and shame. Findings emphasize that sexual obsessions are common yet underreported due to stigma, leading to diagnostic delays. The study advocates for clinician awareness, sensitive assessment, and tailored CBT approaches, including exposure and response prevention, to address these symptoms effectively.
Rush to Judgment? Child Protective Services and Allegations of Sexual Abuse
Levine M, Doueck HJ, Freeman JB, et al. Am J. Orthopsychiatry. 1998;68(1):101-107.
This research examined 293 child protection cases from a large county to test whether sexual abuse allegations get treated more urgently than other types of maltreatment by Child Protective Services (CPS). Contrary to critics’ concerns that agencies might hastily prioritize or over‑investigate sexual abuse reports, the study found that sexual abuse allegations were not investigated more intensively, were substantiated at a lower rate, and were not linked to more services compared with other maltreatment cases. These findings suggest CPS does not automatically rush to action on sexual abuse allegations more than on other serious child welfare concerns.
Child Age and Caseworker Attention in Child Protective Services Investigations
Freeman JB, Levine M, Doueck HJ. Child Abuse Negl. 1996;20(10):907-920.
The study examined whether a child’s age influences the amount of attention and services provided during child protective services investigations. Using a sample of 293 child abuse and neglect reports, researchers found that younger children receive more overall casework services and more caseworker activity such as home visits and contacts compared to older children. Child age was linked with the level of caseworker engagement after a case was substantiated, but age did not significantly affect the initial decision to substantiate the report. The gender of the alleged perpetrator did not reliably predict how much attention a case received.
African American Families and Child Protection
Levine M, Doueck HJ, Freeman JB, et al. Child Youth Serv. Rev. 1996 Jan 1;18(8):693-711.
This paper explores the interactions between African American families and child protection systems. It investigates the impact of systemic bias, socio-economic factors, and cultural misunderstandings on family experiences. The study highlights disparities in reporting, intervention, and outcomes compared with other populations. Findings underscore the need for culturally responsive practices, anti-bias training for practitioners, and community-informed policies to improve trust, reduce disproportionality, and support family preservation while maintaining child safety.
Maltreatment-Related Fatalities: Issues of Policy and Prevention
Levine M, Freeman J, Compaan C. Law & Policy. 1994 Oct;16(4):449-71.
This article reviews policy challenges and prevention strategies related to child maltreatment fatalities. It highlights systemic gaps in reporting, risk assessment, and interagency coordination. Recommendations include improved data collection, mandatory training for professionals, and community-based prevention programs. Findings stress the need for proactive measures to reduce fatalities and enhance child protection systems.
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