Adverse childhood experiences (ACEs) may be important etiological factors in the onset and maintenance of psychiatric illness in youth. Youth who experience ACEs have poorer physical and mental health outcomes and exhibit more high-risk health behaviors, but have been understudied among those with OCD. We examined the frequency of ACEs in youth with OCD and the extent to which ACEs are associated with clinical correlates.
Primary caregivers of 142 youth with primary OCD completed a demographic survey assessing exposure to ACEs and age of exposure. Subjects received 10 CBT sessions and were administered the K-SADS-PL, the CYBOCS, and the OBQ-44 to assess comorbidites, OC symptom severity, and negative thinking patterns, respectively. ANCOVA was used to compare mean CYBOCS scores in ACE+ and ACE- subjects. Longitudinal changes in CYBOCS scores from visit 1 to visit 12 were examined via multilevel modeling with time as a linear and quadratic effect and baseline comorbidity as a covariate. The ACEs sum was included as a main effect at baseline and in interactions with linear and quadratic time.
Visit 1 CYBOCS scores were significantly greater for patients who experienced family financial problems (p<.05) or school problems (p<.01) and visit 1 OBQ scores were significantly greater (p<.01) for patients who experienced family financial problems compared to those who had not. There were significant linear and quadratic declines in CYBOCS scores over time. ACEs were not related to CYBOCS scores at visit 1, but were associated with linear changes in CYBOCS scores. Patients who were 1 SD below the mean sum of ACEs at baseline showed greater improvement in CYBOCS scores over time compared to patients who were at the mean or were 1 SD above the mean.
These findings extend prior research by exploring the relationship between ACEs, severity of OCD, and negative thinking patterns, and the impact of ACEs on response to CBT. These data suggest that financial stress in families is a factor for OC symptoms and negative thinking in children, and that CBT response may be modified by children’s experiences with adverse events.