Pediatric OCD is frequently complicated by co-occurrences with ADHD, mood and anxiety disorders. Although each of these disorders is associated with impaired self-regulation, there has been little examination of impaired self-regulation (i.e., dysregulation) in youth with OCD. Dysregulation is characterized by affective, behavioral and cognitive problems, and can be assessed using the Child Behavior Checklist-Dysregulation Profile (CBCL-DP). Dysregulation may help account for the varied yet related findings identified for symptom severity, impairment and treatment outcome in pediatric OCD. This study examined the role of dysregulation on symptom severity, impairment and treatment outcome in a large sample of youth with OCD. A total of 144 youth with primary OCD participated in this study. Clinicians administered the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS), Clinical Global Impression of Severity (CGI-S) and a 13-item scale of family accommodation. Children completed the Multidimensional Anxiety Scale for Children (MASC), and the Child Depression Inventory (CDI). Parents completed the CBCL, with both children and parents completing parallel versions of the Child OCD Impact Scale (COIS-C/P). Within this sample, 97 of these youth received exposure-based CBT and completed the same assessment battery along with the Clinical Global Impression of Improvement (CGI-I) after treatment. Twenty-nine youth (20%) with OCD met categorical criteria for dysregulation. Dysregulated youth had greater obsessive-compulsive symptom severity, depressive mood, and exhibited greater rates of family accommodation and impairment than children without dysregulation. Hierarchical regressions revealed that the level of dysregulation predicted child-and-parent rated impairment, above and beyond obsessive-compulsive severity. Additionally, dysregulation predicted clinician-rated family accommodation above and beyond obsessive-compulsive severity. When examining treatment outcome to exposure-based CBT, a logistic regression indicated that baseline dysregulation did not predict treatment responder status. Although not predicting treatment response, it was found that youth who discontinued treatment (18%) had significantly higher dysregulation than youth who completed treatment (p < .02). For youth who completed exposure-based CBT, a significant decrease in obsessive-compulsive symptom severity and dysregulation was observed (p < .01). Collectively, these findings suggest that youth with OCD and dysregulation experience more severe symptoms and have greater impairment than youth with more regulated functioning. As dysregulation was associated with treatment discontinuation, dysregulated youth with OCD may require more individualized interventions to treat dysregulated behavior prior to receiving exposure-based CBT. For youth who complete treatment, exposure-based CBT reduces obsessive-compulsive symptom severity and its benefits generalize to reductions in dysregulated behaviors as well.

Child sexual abuse (CSA) is a worldwide problem, with two-thirds of all cases going unreported. A wealth of research over the last 30 years demonstrates the negative emotional, cognitive, physical, spiritual, academic, and social effects of CSA. As a result, researchers and mental health professionals frequently attempt to measure the efficacy of treatment modalities in order to assess which treatments lead to better outcomes. However, in order to effectively study treatment outcomes, researchers must be able to track the status of child functioning and symptomology before, during, and after treatment. Because high levels of treatment attrition exist among CSA victims, researchers are unable to effectively study outcomes due to large losses in research participants, loss of statistical power, and threats to external validity (Kazdin, 1990). Moreover, due to the high prevalence of concurrent family violence, caregivers with intimate partner violence are more than twice as likely to have children who are also direct victims of abuse (Kazdin, 1996). Caregivers ultimately make the decisions regarding whether or not a child stays in treatment, and therefore, it is important to examine the influence of both parent factors (e.g., intimate partner violence) and child factors (e.g., traumatization and/or disturbances in cognitive selfdevelopment) on treatment attrition. This two-pronged approach of examining both child and family characteristics simultaneously with attrition patterns offers a more complete picture for the ways concurrent family violence influences treatment than looking at child and caregiver factors separately. The purpose of this study was to investigate the relationships between caregiver intimate partner violence, child posttraumatic stress (Trauma Symptom Checklist for Children [TSCC]; Briere, 1996), child cognitive self-development (Trauma and Attachment Belief Scale [TABS]; iv Pearlman, 2003), and treatment attrition. The statistical analyses in this study included (a) Logistic Regression, (b) Poisson Regression, and (c) Chi-square Test for Independence. Elevated TSCC subscale scores in posttraumatic stress predicted both an increased number of sessions attended and increased number of sessions missed. Elevated TABS subscale scores in self-trust predicted an increased number of sessions attended and decreased number of sessions missed. Elevated TABS subscale scores of other-intimacy and self-control predicted an increased number of sessions missed. Moreover, the presence of past or current caregiver intimate partner violence predicted a decrease in number of sessions attended. While no relationship existed between child posttraumatic stress or cognitive self-development and whether a child graduated or prematurely terminated from treatment, children with parents who confirmed past or current intimate partner violence were 2.5 times more likely to prematurely terminate from treatment.