Impacts of Adolescents Emotional and Behavioral Concerns and Soc
OCD in children and adolescents: A cognitive-behavioral treatment manual
1
© 1999 WILEY-LISS, INC. DEPRESSION AND ANXIETY 9:149 (1999) OCD IN CHILDREN AND ADOLESCENTS: A COGNITIVE-BEHAVIORAL TREATMENT MANUAL, by John S. March and Karen Mulle, Guilford Press, New York, 1998, 298 pp., $32.00. This important new manual signals the “coming age” of cognitive behavioral therapy as an important mode of treatment for individuals 18 years of age and under with obsessive-compulsive disorder (OCD). Highly comprehensive, yet remarkably well organized, optimistic while retaining a healthy scientific skepti- cism, this cognitive behavioral treatment manual has a number of unique features. Simply put, this is the best cognitive behavioral treatment manual, adult or child, which I have ever read. Dr. March and his colleagues are to be commended for their unique approach. This manual will not only as- sist those using it to employ state-of-the-art techniques but equally importantly avoid unwitting missteps. OCD is a severe, highly prevalent, and often chronically dis- abling illness that has its onset in childhood or adoles- cence in as many as 80% of all cases. A common mistake in diagnosing and treating childhood neuropsychiatric disorders has been to copy the identical paradigms uti- lized in adults and extrapolate them to children with the intent of verifying the finding or treatment effect. In the process, the developmental process is often lost, or I sus- pect in some cases not even taken into consideration. We are learning that this is a crucial mistake, and that, as the pediatricians have told us for years, children are not sim- ply “little adults.” We now recognize the folly of an ap- proach that does not put developmental considerations at the forefront in the diagnosis and treatment of child- hood onset neuropsychiatric disorders. For example, tri- cyclic antidepressants, a recognized effective treatment in depressed adults has never been shown to be effective in childhood and adolescent depression. Dr. March and Ms. Mulle prove especially adept at delineating different ap- proaches when implementing cognitive behavioral ther- apy in younger children, early and late adolescents vs. adults, as well as the importance of taking into account a child’s individual developmental maturation level. The manual is organized into three parts. The intro- duction provides an excellent overview of pediatric OCD and how it is assessed and treated. The authors then launch into the pragmatic part most relevant to clinicians in the trenches with a session-by-session treatment program. The final section is on troubleshooting. The session-by-session treatment program is helped enor- mously by effective use of figures and tables that facili- tate mastery of difficult concepts and allows their implementation. I found the chapter on establishing a neurobehavioral framework especially intriguing and likely to be helpful for parents and children in combating OCD. This section is also quite helpful in assisting the health care professional in recognizing and defining appropriate roles for parents, children, therapists, etc. While the novice unacquainted with cognitive behav- ioral therapy will find this manual especially helpful even sophisticated readers are likely to find pearls for implementing successful cognitive behavioral therapy, particularly in the chapters on mapping OCD, putting exposure/response prevention into action, and the family sections. In contrast to adults who bring them- selves into treatment, children are most often brought into treatment by parents, necessitating a family sys- tem approach as well as incorporating schools when obsessive-compulsive behaviors are interfering with work. The chapter “Working with Schools,” with Gail Adams, is the most pragmatic and comprehensive guide I have ever read for children with this illness and will help clinicians, parents, and teachers tackle the treatment of this debilitating illness. In fact, this chapter and the chapter for working with families have become mandatory reading for all health care profes- sionals in our pediatric OCD program. Dr. March and his colleagues also discuss a particularly difficult topic, namely, the use of combined treatment, when to use combination medication and behavioral treatment, the treatments individually, etc. This is often difficult, particularly given concern by parents and clini- cians over potential and unknown developmental effects of CNS active medications. As the manual emphasizes, there has been no controlled study in this area—an area desperately needing research attention. Where limited information is available, the authors offer practical rec- ommendations on how to safely initiate treatment tai- lored to pediatric populations. It is also noteworthy that the authors specifically avoid a “cookbook approach” and emphasize the need to individualize treatment to each child and family. This is the definitive manual on clinical and cognitive behavioral therapy for pediatric OCD. It is a must have for child psychiatrists, behavioral pediatricians, psycholo- gists, social workers, and really anyone working with children. I also think residents, child and adult, could benefit greatly from this manual. Cognitive behavioral therapy is commonly a neglected area for residency training; such a manual would be especially helpful for residents in the trenches with practical, hands on strate- gies for implementing cognitive behavioral therapy. In summary, this is an amazingly comprehensive work that will become for many child health care professionals the definitive clinical cognitive behavioral therapy refer- ence work in OCD. It is an outstanding contribution to our field, and I highly recommend this book for child psychiatrists, psychologists, social workers, and therapists at all levels of training and practice. David Rosenberg Director, Obsessive-Compulsive Disorder Program Anxiety Disorders Clinical Research Division Wayne State University, Detroit, Michigan Book Review
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Transcript of OCD in children and adolescents: A cognitive-behavioral treatment manual
© 1999 WILEY-LISS, INC.
DEPRESSION AND ANXIETY 9:149 (1999)
OCD IN CHILDREN AND ADOLESCENTS: ACOGNITIVE-BEHAVIORAL TREATMENTMANUAL, by John S. March and Karen Mulle,Guilford Press, New York, 1998, 298 pp., $32.00.
This important new manual signals the “comingage” of cognitive behavioral therapy as an importantmode of treatment for individuals 18 years of age andunder with obsessive-compulsive disorder (OCD).Highly comprehensive, yet remarkably well organized,optimistic while retaining a healthy scientific skepti-cism, this cognitive behavioral treatment manual has anumber of unique features. Simply put, this is the bestcognitive behavioral treatment manual, adult or child,which I have ever read.
Dr. March and his colleagues are to be commendedfor their unique approach. This manual will not only as-sist those using it to employ state-of-the-art techniquesbut equally importantly avoid unwitting missteps. OCDis a severe, highly prevalent, and often chronically dis-abling illness that has its onset in childhood or adoles-cence in as many as 80% of all cases. A common mistakein diagnosing and treating childhood neuropsychiatricdisorders has been to copy the identical paradigms uti-lized in adults and extrapolate them to children with theintent of verifying the finding or treatment effect. In theprocess, the developmental process is often lost, or I sus-pect in some cases not even taken into consideration. Weare learning that this is a crucial mistake, and that, as thepediatricians have told us for years, children are not sim-ply “little adults.” We now recognize the folly of an ap-proach that does not put developmental considerationsat the forefront in the diagnosis and treatment of child-hood onset neuropsychiatric disorders. For example, tri-cyclic antidepressants, a recognized effective treatment indepressed adults has never been shown to be effective inchildhood and adolescent depression. Dr. March and Ms.Mulle prove especially adept at delineating different ap-proaches when implementing cognitive behavioral ther-apy in younger children, early and late adolescents vs.adults, as well as the importance of taking into account achild’s individual developmental maturation level.
The manual is organized into three parts. The intro-duction provides an excellent overview of pediatric OCDand how it is assessed and treated. The authors thenlaunch into the pragmatic part most relevant to cliniciansin the trenches with a session-by-session treatmentprogram. The final section is on troubleshooting. Thesession-by-session treatment program is helped enor-mously by effective use of figures and tables that facili-tate mastery of difficult concepts and allows theirimplementation. I found the chapter on establishing aneurobehavioral framework especially intriguing andlikely to be helpful for parents and children in combating
OCD. This section is also quite helpful in assisting thehealth care professional in recognizing and definingappropriate roles for parents, children, therapists, etc.While the novice unacquainted with cognitive behav-ioral therapy will find this manual especially helpfuleven sophisticated readers are likely to find pearls forimplementing successful cognitive behavioral therapy,particularly in the chapters on mapping OCD, puttingexposure/response prevention into action, and thefamily sections. In contrast to adults who bring them-selves into treatment, children are most often broughtinto treatment by parents, necessitating a family sys-tem approach as well as incorporating schools whenobsessive-compulsive behaviors are interfering withwork. The chapter “Working with Schools,” with GailAdams, is the most pragmatic and comprehensiveguide I have ever read for children with this illnessand will help clinicians, parents, and teachers tacklethe treatment of this debilitating illness. In fact, thischapter and the chapter for working with families havebecome mandatory reading for all health care profes-sionals in our pediatric OCD program.
Dr. March and his colleagues also discuss a particularlydifficult topic, namely, the use of combined treatment,when to use combination medication and behavioraltreatment, the treatments individually, etc. This is oftendifficult, particularly given concern by parents and clini-cians over potential and unknown developmental effectsof CNS active medications. As the manual emphasizes,there has been no controlled study in this area—an areadesperately needing research attention. Where limitedinformation is available, the authors offer practical rec-ommendations on how to safely initiate treatment tai-lored to pediatric populations. It is also noteworthy thatthe authors specifically avoid a “cookbook approach” andemphasize the need to individualize treatment to eachchild and family.
This is the definitive manual on clinical and cognitivebehavioral therapy for pediatric OCD. It is a must havefor child psychiatrists, behavioral pediatricians, psycholo-gists, social workers, and really anyone working withchildren. I also think residents, child and adult, couldbenefit greatly from this manual. Cognitive behavioraltherapy is commonly a neglected area for residencytraining; such a manual would be especially helpful forresidents in the trenches with practical, hands on strate-gies for implementing cognitive behavioral therapy.
In summary, this is an amazingly comprehensive workthat will become for many child health care professionalsthe definitive clinical cognitive behavioral therapy refer-ence work in OCD. It is an outstanding contribution toour field, and I highly recommend this book for childpsychiatrists, psychologists, social workers, and therapistsat all levels of training and practice.
David RosenbergDirector, Obsessive-Compulsive Disorder ProgramAnxiety Disorders Clinical Research DivisionWayne State University, Detroit, Michigan
Book Review
