case_images: PMC10227521_01
case_images: Timeline of symptoms. ADHD, attention-deficit/hyperactivity disorder; ASD, autism spectrum disorder; OCD, obsessive-compulsive disorder.
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case_images: F1
case_images: Figure 1. Family history of psychiatric conditions included ASD for Alex's younger brother and generalized anxiety disorder for their mother. Please see Figure 1 for a timeline of Alex's symptoms since early childhood.
case_images: Sequence of treatment. ADHD, attention-deficit/hyperactivity disorder; ASD, autism spectrum disorder; CBT-ERP, cognitive-behavioral therapy with exposure and response prevention; OCD, obsessive-compulsive disorder; SSRI, selective serotonin reuptake inhibitor; CY-BOCS, Children's Yale-Brown Obsessive-Compulsive Scale.
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case_images: F2
case_images: Prevention (CBT-ERP): (1) to a multidisciplinary gender clinic for brief family education and ongoing medication management including gender affirming hormone treatment if deemed appropriate and (2) to child and adolescent psychiatry for medication management of ADHD and possibly OCD. Please see Figure 2 for a summary of the services and referrals Alex received.
case_images: Illustration for psychoeducation on behavioral reinforcement of obsessions and compulsions.
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case_images: F3
case_images: For instance, if I smelled smoke in the office right now, my alarm system would turn on (Therapist draws out Figure 3). The first time you thought hard about the germs, you washed your hands and you felt mostly better afterward (Therapist begins to draw Figure 3).
case_images: Illustration for psychoeducation exposure therapy, distress tolerance, and between session habituation.
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case_images: F4
case_images: If we look back at my graphs here, this is what is going to happen (Therapist starts drawing Figure 4).
case_images: Change in OCD symptom severity throughout treatment. OCD, Obsessive-compulsive disorder; CY-BOCS, Children's Yale-Brown Obsessive-Compulsive Scale.
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case_images: F5
case_images: Alex's CY-BOCS scores were higher at session five than at pre-treatment but then decreased gradually over the course of treatment, as expected (see Figure 5). Graphs summarizing Alex's change in CY-BOCS, FAS, and BDI-2 can be found in Figures 5-7, respectively.
case_images: Changes in family accommodation throughout treatment. FAS, Family Accommodation Scale.
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case_images: F6
case_images: Alex's mother's self-reported FAS total scores steadily decreased across sessions (see Figure 6). Graphs summarizing Alex's change in CY-BOCS, FAS, and BDI-2 can be found in Figures 5-7, respectively.
case_images: Changes in depression severity throughout treatment. BDI-2, Beck Depression Inventory - Second Edition.
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case_images: F7
case_images: Graphs summarizing Alex's change in CY-BOCS, FAS, and BDI-2 can be found in Figures 5-7, respectively.