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Gary R Geffken

Publications and source records attributed to Gary R Geffken.

At least 19 recordsLinked to original sources
PubMed2007

Sequential cognitive-behavioral therapy for children with obsessive-compulsive disorder with an inadequate medication response: a case series of five patients.

Few data have been reported on the efficacy of cognitive-behavioral therapy (CBT) for youth with obsessive-compulsive disorder (OCD) who have not responded to prior treatment with medication. Given this, we report an open trial of CBT for children who have remained symptomatic following medication trials. Five children with OCD who had an inadequate response to psychotropic medications (e.g., limited response and/or unable to be titrated to a complete dose due to side effects) received treatment in a 3-week intensive CBT program. Assessments were conducted at baseline and after treatment. All participants were classified as treatment responders (much improved or very much improved) and the severity of clinician-rated OCD symptoms and impairment significantly decreased after the intervention. Although a number of limitations of this preliminary report exist, this study provides preliminary support for the utility of an intensive intervention for youth with OCD who have had an inadequate response and/or adverse side effects.

Adolescent↗
PubMed2006

Factor-analytic study of the Yale Global Tic Severity Scale.

We report on the factor structure of the Yale Global Tic Severity Scale. Participants were 76 children and adolescents diagnosed with tic disorders. Overall, the model proposed by Leckman et al. [Leckman, J.F., Riddle, M.A., Hardin, M.T., Ort, S.I., Swartz, K.L., Stevenson, J., Cohen, D.J., 1989. The Yale Global Tic Severity Scale: initial testing of a clinician-rated scale of tic severity. Journal of the American Academy of Child and Adolescent Psychiatry 28, 566-573.] represented an adequate fit. The internal consistency of the factors was acceptable and the convergent and divergent validity was supported vis-à-vis correlations with parent ratings of Tourette's Disorder symptoms. These findings support the use of the original scoring structure in assessing pediatric tic severity.

Adolescent↗
PubMed2006

Further psychometric examination of the Tourette's Disorder Scales.

The Tourette's Disorder Scales (Shytle et al., 2003) are parent- (Tourette's Disorder Scales-Parent Rated; TODS-PR) and clinician-rated (Tourette's Disorder Scales-Clinician Rated; TODS-CR) measures that assess tics, obsessions, compulsions, inattention, hyperactivity, aggression, and emotional disturbances among children with tics. Although the TODS-PR/CR are being increasingly used in clinical trials, relatively little psychometric data have been reported. Subjects were 44 children and adolescents recruited in a university tic specialty clinic. Families were administered the TODS-CR and Yale Global Tic Severity Scale. Completion of the TODS-PR and Child Behavior Checklist were counterbalanced. Results indicated adequate to excellent internal consistency for the TODS-PR/CR scores. Excellent inter-rater agreement and convergent and divergent validity was found. These results provide further psychometric support for the TODS-PR and TODS-CR.

Adolescent↗
PubMed2006

Peer victimization, psychosocial adjustment, and physical activity in overweight and at-risk-for-overweight youth.

OBJECTIVE: To examine the relationship between peer victimization and child and parent reports of psychosocial adjustment and physical activity in a clinical sample of at-risk-for-overweight and overweight children and adolescents. METHODS: The Schwartz Peer Victimization Scale, Children's Depression Inventory-Short Form, Multidimensional Anxiety Scale for Children, Social Physique Anxiety Scale, PACE+ Adolescent Physical Activity Measure, and Asher Loneliness Scale were administered to 92 children and adolescents (54 females) aged 8-18 years. The youth's parent/guardian completed the Child Behavior Checklist. RESULTS: Peer victimization was positively related to child-reported depression, anxiety, social physique anxiety, and loneliness, and parent-reported internalizing and externalizing symptoms. Peer victimization was negatively related to physical activity. Depressive symptoms and loneliness mediated the relations between peer victimization and physical activity. CONCLUSION: Recognition of the magnitude of the problem and the means of evaluating for peer victimization is important for clinicians who work with overweight youth. Assessing peer experiences may assist in understanding rates of physical activity and/or past nonadherence to clinician recommendations.

Adolescent↗
PubMed2006

The children's Yale-Brown obsessive-compulsive scale: psychometric properties of child- and parent-report formats.

The children's Yale-Brown obsessive-compulsive scale (CY-BOCS) is a commonly used, psychometrically sound clinician-rated instrument of pediatric obsessive-compulsive disorder (OCD) severity. Given the relatively direct rating format and potential benefits of alternative versions that could be easily administered to patients and parents, we developed and examined the psychometric properties of child- and parent-report formats of the CY-BOCS severity items. A total of 53 children and adolescents (8-17 years old) with OCD and their parents was administered the CY-BOCS, children's Yale-Brown obsessive-compulsive scale-child report (CY-BOCS-CR), children's Yale-Brown obsessive-compulsive scale-parent report (CY-BOCS-PR), and other measures of obsessive-compulsive symptoms, internalizing, and externalizing symptoms. In general, reliability and convergent and divergent validity of the CY-BOCS-CR/PR were satisfactory. Psychometric properties for the CY-BOCS-CR in those children and adolescents with externalizing behavior problems were lower relative to those without externalizing problems. Exploratory factor analyses identified a two-factor structure in both measures comprised of disturbance and severity factors. This study provides preliminary support for the use of child- and parent-report versions of the CY-BOCS.

Adolescent↗
PubMed2006

Clinical predictors of early fluoxetine treatment response in obsessive-compulsive disorder.

Despite wide use, relatively little is known about sociodemographic and clinical characteristics that predict early fluoxetine response. What research has been conducted has produced inconsistent findings, which may be due to the statistical procedures used, and no studies to date have examined predictors of early fluoxetine treatment response. Sixty adults with obsessive-compulsive disorder (OCD) completed an open-label fluoxetine trial for 8 weeks (up to 40 mg) after a 1-week, single-blind, placebo run-in before baseline assessment. The baseline and posttreatment assessment battery included the Yale-Brown Obsessive Compulsive Scale, the Hamilton Rating Scale for Depression, and the Yale Global Tic Severity Scale. Patient characteristics included illness duration, age, age of onset, gender, and pharmacological treatment history. Independent t-tests and multiple logistic regression analysis showed that longer illness duration, older age, and greater symptom severity were associated with nonresponse. Our findings highlight the impact of functional psychiatric impairment on determining those who may respond to treatment. Furthermore, findings suggest early predictors of patients with certain characteristics who may ultimately need adjunctive care to facilitate response.

Adolescent↗
PubMed2006

Bullying, regimen self-management, and metabolic control in youth with type I diabetes.

OBJECTIVE: To determine the association among diabetes-related bullying, diabetes self-management, metabolic control, and depression in children and adolescents with type I diabetes (TID). STUDY DESIGN: Measures of diabetes-related bullying and depression were administered to 167 youth with TID at their regularly scheduled diabetes care visits. Parents were administered a clinician-rated index of their child's diabetes self-management. HbA1c levels were assessed. RESULTS: Diabetes-related bullying was positively related to HbA1c concentration and negatively related to overall self-management and specifically to adherence to glucose testing and dietary tasks. Depressive symptoms partially mediated the relation between diabetes-related bullying and overall self-management. CONCLUSION: Given the associations between diabetes-related bullying and regimen self-management, the issue of illness-related bullying merits serious attention for pediatricians and school personnel.

Adolescent↗
PubMed2006

Home-based behavioral health intervention: Use of a telehealth model to address poor adherence to type-1 diabetes medical regimens.

Youth with insulin-dependent diabetes mellitus face complex treatment regimens and often have difficulty adhering to treatment requirements. Many behavioral-health intervention strategies, such as psychoeducational groups, diabetes summer camps, individual therapy, and residential treatment have been utilized to address this issue. While some have been effective, many barriers exist that limit the number of youth who are able to utilize these treatments. Additionally, the effectiveness of these treatments does not typically generalize to the home environment. Telephone-based, intensive, behavioral-health interventions may address barriers to treatment access by providing lower cost treatment that is easier to access for youth who do not live near a knowledgeable behavioral-health specialist. Additionally, delivery via telephone enables the interventions to take place in the home. This, in combination with parental involvement in the treatment, may increase generalization of the positive treatment outcomes to the home environment. The purpose of this paper is to describe a controlled trial of a telehealth intervention for youth whose diabetes is poorly managed. Preliminary outcome data for the trial are promising. Representative cases from the trial are presented in case-study format.

Adolescent↗
PubMed2006

Cognitive-behavioral therapy for PANDAS-related obsessive-compulsive disorder: findings from a preliminary waitlist controlled open trial.

OBJECTIVE: To provide preliminary estimates of the effectiveness of cognitive-behavioral therapy (CBT) in treating pediatric obsessive-compulsive disorder (OCD) of the pediatric autoimmune neuropsychiatric disorders associated with streptococcus (PANDAS) subtype. METHOD: Seven children with OCD of the PANDAS subtype (range 9-13 years) were treated in a 3-week intensive CBT program conducted at a university clinic. Six of seven children were taking selective serotonin reuptake inhibitor medication(s) upon presentation. Assessments were conducted at four time points: baseline, pretreatment approximately 4 weeks later, posttreatment, and 3-month follow-up. Raters were blind to the nature of the study treatment. RESULTS: Six of seven participants were classified as treatment responders (much or very much improved) at posttreatment, and three of six remained responders at follow-up. Clinician severity ratings, as measured by the Children's Yale-Brown Obsessive-Compulsive Scale and Anxiety Disorder Interview Schedule for DSM-IV Child Interview Schedule-Parent version, decreased significantly following intervention, with effect sizes of 3.38 and 2.29, respectively. Self-reported general anxiety and depression symptoms were not significantly reduced. CONCLUSIONS: This study provides preliminary support for CBT in treating the PANDAS subtype of pediatric OCD. This approach is also considered a safe and minimally invasive treatment approach.

Adolescent↗
PubMed2006

Obsessive-compulsive disorder in Tourette syndrome.

Several lines of evidence suggest a meaningful association between obsessive-compulsive disorder and Tourette syndrome, including comorbidity, phenomenologic overlap, evidence from family and genetic studies, and the possible role of basal ganglia circuitry in both conditions. Obsessive-compulsive behaviors occur frequently in patients who have Tourette syndrome and tend to have a later onset than tics. Despite commonalities, the approaches to treating tics and obsessive-compulsive symptoms are actually quite distinct. A specialized form of cognitive behavior therapy and pharmacotherapy with a potent serotonin reuptake inhibitor are the two established first-line therapies for obsessive-compulsive disorder. An adequate trial of a serotonin reuptake inhibitor is 10 to 12 weeks in duration at doses near the upper end of the recommended range for age and weight. Cases of obsessive-compulsive disorder that do not sufficiently improve with serotonin reuptake inhibitors might benefit from adjunctive low-dose antipsychotic (eg, risperidone) medication whether or not tics are present. Warnings about an increased risk of suicidality among children and adolescents taking antidepressants for pediatric depression extend to those taking the medications for obsessive-compulsive disorder, but the risk-to-benefit ratio is more favorable in this latter population because several serotonin reuptake inhibitors have been shown to be efficacious in obsessive-compulsive disorder.

Adolescent↗
PubMed2006

Peer victimization in children with obsessive-compulsive disorder: relations with symptoms of psychopathology.

This study examined the frequency of peer victimization and psychological symptom correlates among youth with obsessive-compulsive disorder (OCD). The Schwartz Peer Victimization Scale, Children's Depression Inventory, and Asher Loneliness Scale were administered to 52 children and adolescents diagnosed with OCD. The child's parent or guardian completed the Child Behavior Checklist, and a trained clinician administered the Children's Yale-Brown Obsessive-Compulsive Scale (CY- BOCS). Fifty-two healthy controls and 52 children with Type 1 diabetes (T1D) who were administered the Schwartz Peer Victimization Scale as part of another study were included for comparison purposes. Greater rates of peer victimization were reported in youth with OCD relative to healthy controls and children with Type 1 diabetes (T1D). Peer victimization in the OCD sample was positively related to loneliness, child-reported depression, parent-reported internalizing and externalizing symptoms, and clinician-rated OCD severity. Peer victimization fully mediated the relation between OCD severity and both depression and parent reports of child externalizing behaviors and partially mediated the relation between OCD severity and loneliness. Recognition of the magnitude of the problem and contribution problematic peer relations may play in comorbid psychological conditions is important for clinicians who see children with OCD.

Adolescent↗
PubMed2005

Hope and coping in family members of patients with obsessive-compulsive disorder.

Obsessive-compulsive disorder (OCD) affects approximately 2-4% of the adult population. Despite the practical and emotional demands of having a family member with OCD, few systematic attempts have been made to assess the coping strategies used by relatives of individuals with such diagnoses. In this study we examined the relationships between hope, coping strategies, and depressive symptoms in a heterogeneous sample of 67 spouses/primary caregivers of individuals with a history of OCD. In support of our hypotheses, hope was negatively related to depressive symptoms, symptom severity, and denial disengagement coping strategies, and positively related to active reframing and social support coping strategies. Active, Reframing, Social Support, and Religiosity were negatively related to depressive symptoms. Denial/Disengagement was positively associated with depressive symptoms. Coping mediated the relationship between hope and depressive symptoms. Given the importance of family members in treatment, clinical implications of these findings are discussed.

Adaptation, Psychological↗
PubMed2005

Reliability and validity of the Child Behavior Checklist Obsessive-Compulsive Scale.

This study examined the psychometric properties of the Obsessive-Compulsive Scale (OCS) of the Child Behavior Checklist (CBCL). Participants included 48 youth with obsessive-compulsive disorder (OCD), 41 with a non-OCD internalizing disorder, and 101 with an externalizing disorder. Confirmatory factor analysis of the 8-item OCS did not result in an adequate fit. Exploratory factor analysis identified a 1-factor model consisting of 6 items. Adequate internal consistency for the revised OCS (OCS-R) was obtained, and convergent validity was supported by moderate relationships with other OCD indices. The OCS-R had stronger associations with measures of OCD symptoms than with measures of depression and externalizing behaviors. Youth with OCD had significantly higher OCS-R scores than those with internalizing and externalizing disorders. Suggestions for cutoff scores are provided using results from ROC analyses. Overall, these findings suggest that the OCS-R is a reliable and valid instrument for the assessment of pediatric OCD.

Adolescent↗
PubMed2005

The relation between family factors and metabolic control: the role of diabetes adherence.

OBJECTIVES: To examine family factors as predictors of metabolic control in children with type 1 diabetes and determine whether adherence behaviors mediate this relationship. METHOD: Participants were 109 children (ages 8-18) and a parent. Measures of diabetes-specific family functioning and an adherence interview were completed. Glycosylated hemoglobin (HbA1c) was the index of metabolic control. RESULTS: Family functioning and adherence were strongly associated with metabolic control. Combined with demographic information, these constructs accounted for 49% of the variance in metabolic control. Age moderated the relation between aspects of family functioning and HbA1c. Path analyses suggest that adherence mediates the relationship between family functioning and metabolic control. CONCLUSIONS: Family functioning and adherence behaviors are strongly related to a child's health status. Assessment of diabetes-specific family functioning, in addition to adherence, is an important factor in understanding metabolic control.

Adolescent↗
PubMed2005

Peer victimization and the development of obsessive-compulsive disorder in adolescence.

We describe an adolescent boy's experience of peer victimization and its relation with his development of obsessive-compulsive disorder (OCD). Subsequent to being peer victimized, this boy was seen for 20 sessions of cognitive-behavioral therapy over the course of 4 weeks that followed the protocol outlined by March and Mulle in 1998. Standardized post-treatment assessment indicated significant reductions in OCD, depressive, and anxious symptomatology as compared to baseline. This case illustrates how negative peer experiences may be related to the development and maintenance of OCD.

Adolescent↗
PubMed2005

Yale-Brown Obsessive Compulsive Scale: the dimensional structure revisited.

The factor structure of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) has been examined in a number of prior investigations; however, findings have not consistently yielded a stable factor solution. The present study therefore tested the fit of each previously reported factor structure. One hundred thirty-one adults with obsessive-compulsive disorder (OCD) were administered the Y-BOCS; a portion of these participants completed self-report measures of depression and obsessive-compulsive symptoms and were rated on a global impairment index. Consistent with the originally proposed structure, confirmatory factor analyses supported a factor structure comprised of obsession and compulsion factors. Reliability and convergent validity of these factors were generally satisfactory, although divergent validity was not entirely supported. Implications of these findings on scoring the Y-BOCS are discussed.

Adolescent↗