Main characteristics of both basins.
\r\n\t
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During medical school, she also completed a fellowship in Epidemiology at the Centers for Disease Control and Prevention at the National Center for Birth Defects and Developmental Disabilities. She completed her Obstetrics and Gynecology residency at Emory University and REI fellowship at the University of Michigan. Dr. Marsh\\'s research focuses on improving fertility outcomes. 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Venkateswarlu",coverURL:"https://cdn.intechopen.com/books/images_new/371.jpg",editedByType:"Edited by",editors:[{id:"58592",title:"Dr.",name:"Arun",surname:"Shanker",slug:"arun-shanker",fullName:"Arun Shanker"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"878",title:"Phytochemicals",subtitle:"A Global Perspective of Their Role in Nutrition and Health",isOpenForSubmission:!1,hash:"ec77671f63975ef2d16192897deb6835",slug:"phytochemicals-a-global-perspective-of-their-role-in-nutrition-and-health",bookSignature:"Venketeshwer Rao",coverURL:"https://cdn.intechopen.com/books/images_new/878.jpg",editedByType:"Edited by",editors:[{id:"82663",title:"Dr.",name:"Venketeshwer",surname:"Rao",slug:"venketeshwer-rao",fullName:"Venketeshwer Rao"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},chapter:{item:{type:"chapter",id:"37578",title:"Soil Erosion After Wildfires in Portugal: What Happens When Heavy Rainfall Events Occur?",doi:"10.5772/50447",slug:"soil-erosion-after-wildfires-in-portugal-what-happens-when-heavy-rainfall-events-occur-",body:'\n\t\tIn Portugal, as well as in other Mediterranean countries, wildfires and burnt areas have increased significantly since 1970. This rising trend, although encompassing some periods of lower burnt areas, distinguishes Portugal from other southern European States with the highest number of ignitions and the greatest proportion of burnt areas, particularly in the central and northern regions (Nunes, 2012). Forest fires therefore constitute one of the most significant environmental problems (Moreno, 1989; Vallejo, 1997) and are frequently considered the major cause of soil degradation and desertification (Rubio, 1987).
\n\t\t\tWildfires can considerably change hydrological processes and the landscape’s vulnerability to major flooding and erosion events (Shakesby and Doerr, 2006; Stoof et al., 2012). Post-fire mudflows and flash floods represent a particularly acute problem in mountainous regions (Tryhorn et al., 2007). In fact, vegetation cover is an important factor in determining runoff and erosion risk (Nunes, 2011). Its removal by fire increases the raindrop impact on the bare soil and reduces the storage of rainfall in the canopy, thus increasing the amount of effective rainfall. Burned catchments are therefore at increased hydrological risk and respond faster to rainfall than unburned catchments (Meyer et al. 1995; Cannon et al. 1998; Wilson, 1999; Stoof et al., 2012). Wildfires also affect the hydrogeological response of catchments by altering certain physical and chemical characteristics of the soils, including their water repellent conditions (Conedera et al. 1998; DeBano et al. 1998; Letey 2001; Martin and Moody 2001; Shakesby and Doerr 2006). Increased runoff can lower the intensity threshold and the amount of precipitation needed to cause a flood event and also exacerbate the impact of precipitation. Combined with steep slopes, this can create the potential for flash floods.
\n\t\t\tVarious studies in different parts of the world, including Portugal, have shown strong and sometimes extreme responses in runoff generation and soil loss following fires, especially during the earlier stages of the so-called “window-of-disturbance” (Shakesby, 2011).
\n\t\t\tIn general, the first 4–6 months after a fire is often the period of greatest vulnerability to erosion because of the maximum fire potential in summer (July–August) and the likelihood of intense post-wildfire rainfall the following autumn–winter (November–January) (Sala et al., 1994; Andreu et al., 2001). However, soil erosion may reach its peak during the first year after a wildfire and subsequently decline, or in some situations be delayed until later, (much later in some cases) during the window of disturbance, in the third or even the fifth year after a fire (Mayor et al., 2007; Llovet et al., 2009). As noted by Ferreira et al. (2009), since the greatest effects of fire on hydrology and erosion generally occur shortly after a fire, data analysis and discussion is limited to the short-term (±1 yr) effects.
\n\t\t\tPost wildfire hydrological and erosional responses have been assessed at plot and hill slope level in various parts of the world, especially in the Mediterranean region, under natural rainfall conditions (Lourenço, 1989; Sala et al., 1994; Ferreira et al., 1997; Andreu et al., 2001¸ Coelho et al., 2004; Shakesby and Doerr, 2006).
\n\t\t\tThe hydrogeomorphic responses to wildfire at catchment level have received much less attention than those on smaller scales in locations worldwide, mainly because of the greater practical difficulties and expense involved in monitoring on this scale, and the large chance factor involved in the wildfire burning even a small catchment completely (Shakesby and Doerr, 2006; Shakesby et al., 2006; Shakesby, 2011).
\n\t\t\tDespite the high rate of occurrences of fires in the European Mediterranean area (Moreira et al., 2001; Pausas, 2004), catchment-scale wildfire studies have mostly been carried out in the USA (Moody et, 2008; Moody and Martin, 2001; Gottfried et al., 2003; Meixner and Wohlgemuth, 2003; Nasseri, 1989; Seibert et al., 2010), South Africa (Scott and Van Wyk, 1990; Scott, 1993, 1997) and Australia (Brown, 1972; Langford, 1976; Prosser and Williams, 1998), and in only a few locations in the European Mediterranean area (Lavabre et al., 1993; Mayor et al., 2007; Ferreira et al, 2008; Stoof et al., 2012). In addition, post-fire monitoring is generally comparatively brief (usually 2–3 years) due to logistical and financial constraints, meaning that infrequent severe storms may be missed and the full recovery to pre-fire conditions may not be monitored.
\n\t\t\tTherefore, the impact of burned areas on peak flow and sediment transport in large river catchments has not been fully studied, although it is of the utmost importance to understand the off-site impacts of forest fires (Ferreira et al., 2008). A better understanding of the hydrogeomorphic impacts of fire at catchment level can improve our ability to understand, and therefore possibly predict, the risk of flooding and erosion in burned areas. In fact, when a precipitation event follows a large, high-severity fire, the impacts can cause various kinds of damage on- and off-site including high sediment inputs, downstream flooding, destruction of the aquatic habitat, and damage to human infrastructures.
\n\t\t\tMoreover, in the Mediterranean region precipitation patterns are highly variable in terms of time, space, amount and duration of events (Durão et al., 2010). The occurrence of heavy, often localised, precipitation can cause severe post-fire erosion and increase the risk of flash flooding and debris flow.
\n\t\t\tThe main objective of this work was to evaluate the impact of fire at catchment level, with particular reference to the implications of the off-site hydrological response and erosional processes after severe rainstorms (involving one occurrence in June 2006 and another in July 2006). In fact, the growing probability of catastrophic wildfires in Portugal and elsewhere in the world has increased the need to understand the flood risk and the erosion and depositional responses of burned watersheds.
\n\t\tTwo catchments (the Pomares and Piodão basins), both located in the mountains of central Portugal, were studied (Figure 1). The study area has a high annual precipitation rate, with an average of 1600/1700 mm yr-1. The rainfall is generally concentrated during the period from October to May, whereas July and August are dry months. According to the Köppen climate classification, it has a Mediterranean Csb type climate.
\n\t\t\tLocation of the study basins and the areas affected by forest fire of 2005.
Both catchments lie on Precambrian schist and have shallow, stony, umbric leptosol soils. Both rivers are tributaries of River Alva and, according to the Strahler classification, are five-order streams. Some of the characteristics of both basins are presented in Table I. The Piodão and Pomares basins have areas of 34.3 and 44.7 km2 respectively and both have a high elevation gradient of over 1,000 metres. In general, both are surrounded by steep slopes with a top convexity and no basal concavity. More than 90% of the basin areas have slopes of over 20% and in the Piodão river more than a half of the watershed has slopes of over 50%. A comparative analysis shows the basin ruggedness and coefficient of torrentiality to be slightly higher in the Pomares basin.
\n\t\t\t\n\t\t\t\t\t\t | \n\t\t\t\t\t\tPiodão river | \n\t\t\t\t\t\tPomares river | \n\t\t\t\t\t
Basin area (km2) | \n\t\t\t\t\t\t34.3 | \n\t\t\t\t\t\t44.7 | \n\t\t\t\t\t
Basin gradient (m) | \n\t\t\t\t\t\t1047 (295-1342) | \n\t\t\t\t\t\t1069 (211-1280) | \n\t\t\t\t\t
Basin ruggedness1\n\t\t\t\t\t\t | \n\t\t\t\t\t\t1.13 | \n\t\t\t\t\t\t1.84 | \n\t\t\t\t\t
Drainage density2 (km /km2) | \n\t\t\t\t\t\t4.13 | \n\t\t\t\t\t\t4.42 | \n\t\t\t\t\t
Coefficient of torrentiality | \n\t\t\t\t\t\t29.48 | \n\t\t\t\t\t\t41.39 | \n\t\t\t\t\t
Basin area with slopes greater than 20 percent Basin area with slopes greater than 50 percent | \n\t\t\t\t\t\t43.9 52.4 | \n\t\t\t\t\t\t54.7 38.6 | \n\t\t\t\t\t
Burnt area, June 2005 (in%) | \n\t\t\t\t\t\t100 | \n\t\t\t\t\t\t60 | \n\t\t\t\t\t
Main characteristics of both basins.
1. maximum change in elevation within a basin, divided by the square root of the basin area (Melton, 1965);
2. the total length of all channels within a basin, divided by the basin area, (Horton, 1945)
Important demographic and socio-economic changes have affected the mountain areas of Portugal for at least the last five to six decades. The population of the mountain areas decreased substantially during the second half of the 20th century, leading to the abandonment of agricultural land and a reduction in the size of herds and the amount of forest fuels consumed by grazing and the collection of firewood (Rego, 1992; Moreira et al., 2011; Lourenço, 1996, Nunes, 2012).
\n\t\t\tConsequently, the landscape has been drastically modified due to the sequential abandonment of traditional land use throughout the second half of the 20th century. The increase in uncultivated land has led to a secondary vegetation succession and modification of the vegetation structure, favouring horizontal and vertical fuel continuity and a consequent increase in flammable biomass. The unmanaged accumulation of large quantities of fuel and the exclusion of fires from forest management has led to a dramatic increase in the magnitude and frequency of forest fires (Carvalho et al., 2002; Moreira et al., 2011).
\n\t\t\tIn addition, afforestation has focused primarily on highly inflammable species, mainly pines (predominantly Pinus pinaster) which also favours the proliferation of forest fires (Shakesby et al., 1996). Once fires break out under these highly dangerous conditions, they spread more easily and cannot be stopped. The low population density, delays in detecting fires, and difficulties in gaining access to the sites where fires tend to start, due to the rugged topography, are other factors that explain the large burnt areas in the central mountain area of Portugal.
\n\t\t\tThe Mediterranean characteristics of the Portuguese climate (warm, dry summers and relatively wet winters) make it prone to wildfires and post-fire soil erosion. In Portugal, the major fires occur in summer, essentially in July and August. At this time of year, several factors combine to create the right conditions for the onset and propagation of wildfires. It is the driest time of year as well as the season for tourism, which includes camping and picnicking, and it is also the time when agricultural refuse and slash are traditionally cleaned and burned after crops have been harvested.
\n\t\t\tConsequently, as in other Mediterranean countries, Portugal’s burnt area has increased significantly in recent decades. In the past three decades, the number of forest fires exceeded half a million ignitions and the total burnt area was approximately 3,236,890 ha, representing more than a third of the surface area of mainland Portugal (Nunes, 2012). Within the last 30 years (1981-2010), 2003 and 2005 were the worst fire seasons in Portugal, resulting in the burning of almost 430,000 hectares and 325.000 hectares respectively of forest land, shrub land and crops.
\n\t\t\tThe Pomares and Piodão catchments have been severely affected by wildfires since the 1970s. Two large wildfires have affected the greater part of the area of both catchments: the first, between 13th and 20th September 1987, burnt a total of 10,900 hectares, and the second, occurring eighteen years later between 19th and 24th July 2005, affected an area of 17,450 hectares (Lourenço, 2006a\n\t\t\t\tb, 2007). Figure 1 shows the burnt area associated with both wildfires.
\n\t\tThe post-wildfire hydrological and erosional responses are based on intensive post-event fieldwork to determine the geomorphological impacts and socio-economic implications by collating, collecting and analysing data from field studies that was essential to understanding the meteorology, hydrology and hydraulics of the event.
\n\t\t\tThe meteorological characteristics of the storms that affected the basins were determined using data from a rain gauge installed in the Piodão basin. Daily and 30-minute rainfall intensity measures (I30) were chosen for each event, since rainfall frequency studies (Hershfield, 1961; Miller et al., 1973) indicate that in mountainous terrain 79% of the hourly rainfall occurs within 30 minutes and this type of storm has a short duration, lasting between 10 and 60 minutes (Moody and Martin, 2001).
\n\t\t\tThe fieldwork took place a few days after the events occurred and was based on identifying certain variables:
\n\t\t\tIndicators of the peak discharge values, mainly cross-section surveys based on flood marks, in addition to signs of flow velocity (witness observations and water super-elevations in river bends or in front of obstacles). High water marks on channel banks, mostly indicated by the deposition of vegetation fragments and silt, were visible in the sites. These marks are very important and provide approximate estimates for reconstructing peak discharges for ungauged cross-sections of rivers affected by floods.
Sediment transfer processes (erosion and deposition on slopes and in river beds, hyperconcentrated mud or debris flow), which may give an indication of local runoff generation processes and flow energy and velocity.
The post-wildfire hydrological and erosional research benefited from the cooperation of local authorities and organisations that knew the area and had information about the catchment and the event. They provided useful information on the rainfall runoff processes (observation of surface runoff, origin of the runoff) and the local flow characteristics (type of flow – i.e. flood water, hyperconcentrated or debris flow, the presence of woody debris in the flow, approximate surface water flow velocities, blockages formed during the flood and their possible breakup, time and the effect of the collapse of bridges or dykes). The local authorities also provided important information on previous floods, which was relevant in assessing the return period of the flood.
\n\t\t\tAfter compiling the information using a Geographical Information System (GIS), detailed information was produced (mainly in the form of maps) which identified the areas heavily affected by water erosion (splash, rill and gully erosion) and sedimentation, as well as the areas affected by flash floods.
\n\t\tA rain gauge installed in the Piodão basin registered high levels of precipitation roughly one year after the July 2005 wildfire for two main events on 16th June and 14th July 2006. Figure 2 shows the 24 hour precipitation registered by the rain gauge during the month of June, totalling 58mm, distributed over 5 days (Figure 2).
\n\t\t\t\tDaily distribution of rainfall in June and bi-hourly distribution on 16th June.
However, around 50% of the total rainfall was concentrated on 16th June. A more detailed analysis of the hourly distribution of rainfall on that day shows that 22 mm were recorded between 5 pm and 6 pm.
\n\t\t\t\t\n\t\t\t\tThis event was caused by a high altitude cyclone in the southwest of the Iberian Peninsula which affected the weather in the Portuguese mainland during this period. In mid-latitudes, a ‘cyclone’ refers to the low pressure centres formed by baroclinic instability, with a typical scale in the order of 1000 km. However, cyclones or cyclonic centres also include any kind of surface depression, even small, weak, shallow low centres of orographic or thermal origin.
\n\t\t\t\t\n\t\t\t\tFollowing the high concentration of precipitation recorded on 16th June, several areas in both basins were affected by flash floods, soil erosion and sedimentation processes. Figure 3 summarises the areas worst affected by these processes.
\n\t\t\t\t\n\t\t\t\tEffects of the intense rainfall after the wildfires.
The figures 4 and 5 confirm the super-elevation of the flow at the Pomares Bridge (in the Pomares river basin) as well as the flooding of the right bank of the river. In fact, the stream flow created a 2.5 meter waterfront, although the floodgates were open. The impossibility of draining off the volume of water that had accumulated during the intense rainfall, as well as the power of the runoff and stream flow to transport materials obstructed the flow of the water and enlarged the flood area. Figure 5 simulates the peak discharge level and shows the tonnes of material, mainly branches of trees and shrubs, carried downstream, which created a blockage at the bridge.
\n\t\t\t\t\n\t\t\t\tThe super-elevation of the flow at Pomares Bridge and the flooding of the right bank of the river.
Simulation of maximum peak discharge and the blocked organic and sediment debris (Pomares Bridge).
Upstream, at the of Sobral Magro and Soito da Ruiva river beaches the flood marks were also evident, as can be seen in figures and 6, 7 and 8. At Soito da Ruiva, the stream overflowed on both banks (Figure 6). In the Piodão basin the hydrological effects were also visible, particularly affecting the Piodão, Foz da Égua and Vide river beaches, where flash floods were recorded (Figure 3).
\n\t\t\t\t\n\t\t\t\tSimulation of the peak bank flood at Soita da Ruiva in the Pomares basin.
Deposition of sediment at Soito da Ruiva, in the Pomares basin.
During reconnaissance of the watersheds, widespread geomorphological consequences of the event were identified. In fact, high volume discharges have great erosional energy and the natural and man-made structures (dykes and bridges) along the rivers created obstacles to the transport of sediment and led to deposition throughout the main river channel and tributaries. However, the volume of off-site eroded sediment after a wildfire is difficult to assess because its response to rainstorms and runoff has different characteristics. The debris that was transported was mainly sediment from the thalwegs of tributaries that had been loosened by daily weathering and erosion, but could only be moved by large events.
\n\t\t\t\t\n\t\t\t\t\tFigures 7 and 8 show a plan of the debris flow deposition area caused by the inability of the drainage ditches to cope with the increased run-off generated in the upstream areas and the soil erosion, which led to flooding and the accumulation of large boulders and woody debris.
\n\t\t\t\t\n\t\t\t\t\n\t\t\t\tWood accumulation following the wildfire at Sobral Magro, in the Pomares basin.
In July, the precipitation was higher than the precipitation recorded in June, totalling 95 mm (Figure 9). This second event also registered very intensive rainfall. In fact, about 70mm fell in two days, on 13th and 14th July, registering 30mm and 39mm, respectively. The rainfall recorded on 14th July was concentrated in one single event that occurred between 4 pm and 5 pm. The total precipitation in the first half hour was 14mm, followed by 24mm in the next 30 minutes.
\n\t\t\t\tAccording to the Portuguese Meteorological Services, the heavy rainfall in several areas of inland Portugal was associated with “high atmospheric instability” related to the formation of a thermal low in the interior of the Iberian Peninsula, typical of the summer months. The summer heat in the Iberian Peninsula causes the surface pressure low (Alonso et al., 1994). If the Iberian thermal low draws air from the Atlantic rather than Africa, incursive winds can become humid, conditions become unstable, and intense thunderstorms may occur (Linés, 1977), sometimes leading to torrential rain.
\n\t\t\t\tAccording to Jarrett (2001), convective thunderstorms are known to have sharp rainfall gradients and rainfall intensities and vary in size, so that entire watersheds are not necessarily subjected to the same rainfall intensity.
\n\t\t\t\tThe natural consequence of these precipitation patterns, which are relatively common in this climate, is that neighbouring watersheds receive different amounts of rainfall and therefore respond differently to the event. In fact, this event was more localised in comparison with the event of 16th June, mainly affecting the headwaters of the Piodão stream. The heavy rainfall significantly increased the amount of streamflow, resulting in a stronger and faster response and generating downstream floods and serious damage due to sediment transport. In addition to the substantial damage to human infrastructures, one death was recorded.
\n\t\t\t\tDaily distribution of rainfall in July and bi-hourly distribution on 14th July.
\n\t\t\t\t\tFigure 10, provided by a local resident and showing the volume of accumulated water, demonstrate that the peak discharge was higher during this event than the previous one. The flood marks on the house used to estimate the peak discharge level show that the ground floor was not flooded in the 16th June event, whereas during this flash flood the building was flooded to a depth of 1 metre.
\n\t\t\t\tThe diagram in Figure 11 shows the longitudinal profile and different cross-sections of the Piodão river upstream of the village of Piodão, defines the stream bed and simulates the flood bed on the basis of flood marks, for the event of 14th July. Overall, the stream overflowed its banks and doubled in size in comparison to the “normal” bed. Immediately upstream of the village of Piodão, the flooded area was triple the size of the stream bed. This expansion of the flooded area was associated with a man-made structure designed as a channel for the bed stream. The inability to drain off the flow of water led to an increase in the flooded area, with profound geomorphologic consequences. The force of the water demolished a bridge which a tourist was crossing at the time, leading to his death. A car park was partially destroyed by the water, causing a landslide, as can be seen in figure 12.
\n\t\t\t\tSimulation of the maximum peak discharge in the 16th june (above) and in the 14th July (below). Comparative analysis.
In fact, intense rainfall increases the erosive power of overland flow, resulting in deeply incised channels, such as rills and gullies (figure 13), and accelerates the removal of material from hill slopes. Increased runoff can also erode significant volumes of material from channels. The net result of rainfall on burned basins is the transport and deposition of large volumes of sediment, both within and downstream of the burned areas. The following photographs illustrate its powerful capacity to transport materials along the main channel and its highly destructive force (Figures 14 and 15). In figure 14 a large block can be observed abandoned in the river bed. In figure 15 a trout pond is crammed with material transported by the flood. The power of the stream affected sediment transport processes during the flood, also influencing the morphology of the river.
\n\t\t\tWildfire is an important, and sometimes the most important, driving force behind landscape degradation in the Mediterranean region (e.g. Naveh, 1975; Andreu et al., 2001; Dimitrakopoulos and Seilopoulos, 2002; Alloza and Vallejo, 2006; Mayor et al., 2007). In fact, wildfire can have profound effects on a watershed. Burned catchments are at increased hydrological risk and respond faster to rainfall than unburned catchments (Meyer et al. 1995; Cannon et al. 1998; Ferreira et al. 2008; Stoof, 2012). Therefore, flooding and soil erosion also represent some of the most significant off-site impacts of wildfires, causing serious damage to public infrastructures and private property, as well as increased psychological stress for the affected population.
\n\t\t\tWildfire alters the hydrological response of watersheds, including the peak discharge resulting from subsequent rainfall.
\n\t\t\tPeak discharge is also directly related to flood damage, and it is therefore important to understand the relationship between rainfall and peak discharge. The analysis of rainfall-runoff relations suggests that in the case of burned watersheds a rainfall intensity threshold exists, implying a critical change in the behaviour of the hydrological response. This threshold has been estimated at around 10 mm h_1 (Krammes & Rice, 1963; Doehring, 1968; Mackay and Cornish, 1982; Moody and Martin, 2001). One of the main reasons for the existence of a critical threshold intensity could be the hill slope infiltration rate. Infiltration rates have been shown to decrease by a factor of two to seven after wildfires (Cerdà, 1998; Martin & Moody, 2001), meaning that post-fire rainfall intensities that exceed this infiltration rate and cause runoff may be lower than the pre-fire intensities required to produce a comparable runoff. Below approximately 10 mm h_1 the rainfall intensity may be below the average watershed infiltration rate, meaning that most of the rainfall infiltrates, with some transient runoff (Ronan, 1986) and some subsurface flow, which may either cause quickflow (Hewlett and Hibbert, 1967) in the channel or a lagged response. Above 10 mm h_1 the rainfall intensity may exceed the average watershed infiltration rate, so that the runoff is dominated by sheet flow, which produces flash floods. As an example, Martin and Moody (2001), consider if the rainfall intensity is 20 mm h_1, the unit-area peak discharge response would be 27 times greater than the response if the rainfall-runoff relation had not exceeded the 10 mm h_1 threshold. The same authors consider that if the rainfall intensity is 55 mm h_1 the response will be 700 times greater.
\n\t\t\tThe consumption of the rainfall-intercepting canopy and soil-mantling litter and duff, intensive drying up of the soil, combustion of soil-binding organic matter, and enhancement or formation of water-repellent soils are factors that reduce rainfall infiltration into the soil and significantly increase overland flow and runoff in channels. The removal of obstructions to flow, such as live and downed timber and plant stems, due to wildfire can increase the erosive power of the overland flow, accelerating the removal of material from hill slopes. Increased runoff can also erode significant amounts of material from channels. The net result of rainfall on burned basins is often the transport and deposition of large volumes of sediment, both within and downstream of the burned areas (Cannon et al., 2008; Cannon 2005).
\n\t\t\tProfile and different cross-sections of the Piodão river upstream of the village of Piodão and normal and flooded area in the event of 14th July.
A car park partially destroyed by the water, causing a landslide.
Rills and gullies erosion as a consequence of the intense rainfall.
Post-fire debris flows are generally triggered by one of two processes: surface erosion caused by rainfall runoff, and landslides caused by the infiltration of rainfall into the ground. Runoff-dominated processes are by far the most common, since fires usually reduce the infiltration capacity of soils, which increases runoff and erosion. Infiltration processes are much less common, but prolonged heavy rain may increase soil moisture even after a wildfire. The wet soil may then collapse, producing infiltration-triggered landslides (Johnson, 2005).
\n\t\t\t\n\t\t\tAccording to (Johnson, 2005), although debris flows can occur in areas lying on almost any rock type, the areas most likely to produce debris flows are those lying on sedimentary or metamorphic rocks with more than around 65% of the area moderately or severely burned. In addition, debris flows are most frequently produced from steep (> 20 ), tightly confined drainage basins with an abundance of accumulated material, and are unlikely to extend beyond the mouths of basins larger than about 25 square kilometres (Johnson, 2005). The numerous instances of debris flows found in the study area suggest that the bedrock must have been highly fractured and weathered in order to be transported by the flow.
\n\t\t\tThe powerful capacity to transport materials along the main channel during the event of 14th July.
A trout pond is crammed with material transported by the flood.
Despite the fact that the events studied occurred one year after the wildfires, it would be expected that the stream flow and erosion response would be much lower after vegetation re-growth and the removal of some of the sediment by relatively smaller storms in the following autumn and winter. Nevertheless, post-fire threshold conditions change over time even though the sediment supplies are depleted and the vegetation recovers, and the net result of intense rainfall on these burned basins was flash flooding in several areas and the transport and deposition of large volumes of sediment, both within and downstream of the burned areas. DeBano (2000) and Loaiciga (2001) consider that wildfires increase the magnitude of runoff and erosion and alter the hydrological response of watersheds resulting from subsequent rainfall, creating a risk for downstream communities that lasts for 1-3 years after a fire. Several other authors (Rowe et al., 1954; Doehring, 1968; Scott and Williams, 1978; Wells et al., 1979; Helvey, 1980; Robichaud et al., 2000) extend the “window of disturbance” to a much longer period of 3–10 years.
\n\t\tThe hydrogeomorphic consequences of the 2006 events were identified during the field survey and it was found that there were widespread effects in the valleys of the watershed as well as in the main river channel and tributaries. In the Piodão and Pomares river basins, there were many instances of bed lowering, channel widening, avulsion and deposition. In several valleys there were flood marks, shallow landslides, slope failures and erosion gullies due to the intense rainstorm registered in both events. There were several instances of damage to infrastructures and buildings and one human life was lost.
\n\t\t\tFires, floods and intensive erosion are a regular part of the landscape in mountainous regions around the world (Tryhorn et al., 2007) and are particularly significant in the Mediterranean basin, where forest fires have been increasing (JRC, 2005) and the climate is characterised by intense rainfall as a consequence of strong cyclogenesis (Kostopoulou, 2003). However, this intense rainfall has also been associated with factors other than cyclogenesis. Estrela et al. (2000) show that orographically induced thunderstorms caused by the Iberian thermal low can produce large volumes of precipitation. Post-fire floods may be associated with several different meteorological mechanisms and may either occur immediately after the fire or be delayed by several weeks or even years. Delayed floods are more likely to be caused by surface modifications that reduce infiltration, with precipitation due either to a large-scale drought break or localised thunderstorms. In combination, these processes can create a greater potential for severe flooding and intense erosive processes. A single intense rainstorm can generate peak flows which produce 75% of the sediment eroded during a longer (7-year) period of study (Shakesby, 2011).
\n\t\t\tIn Portugal, several mountain areas have been affected by flash floods and landslides after forest fires. As an example, about 2 decades previously a major fire, which occurred in September 1987 and burnt an area of 10900 ha, affected most of the Pomares and Piodão basin area (Lourenço, 1988; 2006a\n\t\t\t\tb). A storm with similar characteristics to those in this study occurred in 2006, generating flash floods and severe erosion. Lourenço (1994) also studied a landslide which occurred in the Serra da Estrela mountains (in granitic lithology), after a severe rainfall event in October 1993, in an area burnt in August 1991. In the northern region of Portugal, Pedrosa et al. (2001) also studied a landslide that destroyed the great part of village of Frades (Arcos de Valdevez). This landslide also occurred in a granitic soil and was linked with a fire that occurred a few months before and destroyed the plant cover.
\n\t\t\tThere is therefore a need to develop tools and methods to identify and quantify the potential hazards posed by flash floods and landslides generated by burned watersheds. An analysis of data collected from studies of flash flooding and debris flows following wildfires can answer many of the questions that are fundamental to post-fire hazard assessment—what and why, where, when, how big, and how often?
\n\t\t\tIn fact, it is necessary to improve predictions of the magnitude and recurrence of the flooding that follows wildfires, due to the increased human population at risk in the wildland–urban interface. By understanding the magnitude of the runoff response and the erosion and deposition responses of recent wildfires, we can minimise loss of life and damage to property and provide data for landscape evolution in areas prone to wildfire. Moreover, watershed-scale predictions of erosion and deposition caused by these natural disasters can be used by land managers to prioritise forestry measures based on the erosion potential before and after wildfires.
\n\t\tObsessive-compulsive disorder (OCD) has been exhibited in children as early as age 3 and all the way through adolescence and into adulthood [1]. If untreated, OCD can greatly impact children’s and adolescents’ abilities to thrive and participate in their lives. Functional impairment for children is frequently exhibited across various life domains including scholastic, family, social, and recreational realms [2]. Additionally, symptoms often remain or intensify as children develop. A thorough understanding of pediatric OCD symptoms and treatment recommendations can help ensure that children are appropriately screened, assessed, and provided with effective treatment and resources.
About 1–3% of children are estimated to carry an OCD diagnosis [3, 4]. Several studies have found that males are overrepresented in pediatric OCD populations, while females hold the majority in adult cases [5]. Male’s age of onset of OCD tends to be between the ages of 5 and 15 years, while women have a bimodal distribution, either developing it during childhood or during pregnancy [6].
While there are many similarities between childhood-onset OCD and adult-onset OCD, several distinguishing factors are noted. Individuals with OCD onset in childhood and early adolescence are more likely to exhibit a gradual increase in symptoms and less likely to attribute triggering events, whereas individuals who develop OCD in adulthood are likely to identify possible environmental factors such as pregnancy or job loss as well as a sudden onset of symptoms [7]. Studies have also revealed individuals with early-onset OCD are likely to have a strong family history of OCD [8, 9].
Certain clinical features such as magical thinking, tapping/rubbing, and collecting compulsions as well as motor and vocal tics are more common in childhood OCD [7]. Comorbidity patterns may differ as well with children more often presenting with ADHD and tic disorders, while adults tend to present with mood-related difficulties [10]. Symptom clusters appear to manifest somewhat differently within pediatric and adult populations. Research has indicated five common symptom dimension groups in adults through factor analysis of the Yale-Brown Obsessive Compulsive Scale (YBOCS) (cleaning, symmetry, forbidden thoughts, harm, and hoarding) and about three groups in children based on Children’s Yale-Brown Obsessive Compulsive Scale (harm/sexual, symmetry/hoarding, and contamination/cleaning) [11, 12].
Children may also not necessarily recognize the irrational nature of their OCD symptoms and may not describe their symptoms as distressing. Abstract thinking and hypothesis testing are still developing during childhood so the ability to draw conclusions or make connections between symptoms and restrictions on daily living is limited. In fact, a study exploring insight in 71 youths with OCD who were part of a larger treatment trial found significant differences in insight between age groups [13]. About 48% of preadolescents (ages 8–10) were categorized as high insight, while close to 72% of younger adolescents (ages 11–13) and 79% of older adolescents (ages 14–17) were categorized as high insight [13]. Thus, younger children may have a hard time addressing their symptoms due to the potential lack of understanding of the impact of OCD. Lower insight in children has been linked to greater OCD severity, higher parent-reported OCD-related impairments, and higher family accommodation [14]. A thorough assessment of insight in children is recommended; should a child appear to have poor insight, increased involvement of family members is likely warranted.
It may also be that children do not report beliefs around their compulsions, while adults do because the beliefs may be explanations adults give to their compulsions. In other words, if you have an urge to perform a particular task, you experience a feeling (e.g., anxiety) and you perform the motor act. Then you give in to the urge and try to explain why you performed a motor act. Adults usually try to explain their behaviors and have the language as well as the associations formed between certain behaviors and learned explanations, for example, we wash our hands to be clean, we look things over to be thorough and avoid mistakes, we even things up because symmetry is aesthetically pleasing, etc. It may be worth investigating at what point do children begin to explain their behaviors. As for pure obsessions, they are spontaneous thoughts over which neither children nor adults have any control except for their reaction to the thought.
Most children who have OCD also suffer from additional mental health issues similar to their adult counterparts. Comorbidity with OCD presents considerable challenges including greater symptom severity, worse functional impairment, and poorer treatment response [2]. While studies tend to vary on percentages of comorbid conditions, they consistently demonstrate that anxiety, depression, ADHD, tic disorder, and oppositional defiant disorder are typical concerns for the pediatric OCD population [15, 16].
A recent study of 322 children with a primary diagnosis of OCD found that almost two-thirds of the sample met criteria for at least one additional diagnosis beyond OCD, with a number of comorbidities ranging up to six mental health diagnoses [16]. Only 34% of the sample presented solely with OCD. Similar to other studies, anxiety was the most common comorbidity (50%), followed by externalizing disorders including ADHD and ODD (16%), followed by depression (12%), and followed by tic disorder (11%). Adolescents (ages 14–17) in particular were most likely to have comorbid difficulties compared to preadolescents (ages 10–13) and children (ages 7–9) in particular depression, which was six times more likely [16].
Since most children who present in OCD specialty clinics will likely have co-occurring conditions, it is important that pediatric OCD assessments address the presence and impact of potential comorbidities. Decisions about treatment alterations related to comorbidities often come up as well. For example, if a child meets criteria for depression and OCD, is it necessary to have stages of treatment that address each issue separately or is it possible that CBT for OCD will address both? In fact, some studies have suggested that depressive disorders are often secondary to OCD and treating OCD as usual will typically lead to improvements in depression [15]. It is also possible that symptoms from another condition can interfere with a child’s ability to absorb or tolerate therapy as usual; a child with ADHD may have trouble concentrating during sessions, whereas a child with ODD may act out during sessions. In these cases, it is particularly important to continue assessment in initial treatment stages so that any possible issues can be identified and addressed as necessary.
Before discussing various disorders that need to be differentiated from OCD, it is important to recognize that within normal development there are rituals that would not be considered dysfunctional.
Young children often seek out and find comfort in routines, for example, reading the same bedtime story every night, playing with the same toys each time at the library, or requesting the same afternoon snack every day. While these behaviors may appear ritualistic on the surface, they would not be classified as compulsions if they do not cause significant impairment or are excessively time-consuming; additionally, interruption of these rituals typically would not cause severe distress in the child [17]. Generally, children will gradually reduce their reliance and preference for these rituals as they age with little issue. These routines are to be distinguished from the presence of obsessions and compulsions, which often involve repetitive behavior, however, typically at a higher frequency and intensity and with the addition of high anxiety and distress when rituals are interrupted. Notably, children do not customarily just “grow out” of OCD so it is important that parents address the issue and provide appropriate treatment rather than minimize the impact of the symptoms or accommodate as a short-term fix [18, 19].
Obsessive compulsive disorder involves intrusive and anxiety-provoking thoughts, images, and/or impulses (obsessions) and repetitive mental or behavioral actions intended to reduce anxiety and prevent feared negative consequences (compulsions), which cause distress, are time consuming, and cause functional impairment [20]. The content of obsessions and compulsions often varies such that OCD can appear quite heterogeneous across cases: one child may repeatedly wash their hands throughout the day in an effort to prevent life-threatening illnesses, while another child repeats certain phrases to ensure “bad” thoughts do not lead to the occurrence of “bad” events. Additionally, two children may wash hands repeatedly and display similar compulsions for entirely different obsessional themes (for example, one child may fear germs, whereas another child seeks a “just right” feeling). The Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS) is considered the gold standard for assessment of OCD and includes a clinician-rated checklist of common obsessions and compulsions, which allows for specificity and clarity of symptoms [21].
Diagnosing OCD is complicated as it manifests quite differently across cases and symptoms can appear similar to other disorders [22]. Children and adolescents may attempt to hide their symptoms due to shame or embarrassment about having “bad” or irrational thoughts or unusual behaviors, which may cause parents or clinicians to miss or overlook dysfunction [17]. As children are still developing with regard to verbal communication abilities, they may not articulate clear obsessions. Similarly, mental rituals may go undetected. Also, as discussed above, children with OCD may have comorbid conditions, which can lead to challenges in distinguishing symptoms between diagnoses. Symptoms of different conditions can look quite similar in presentation; that is, does a child who repeatedly asks for reassurance and checks for physical ailments related to fear of throwing up have a separate phobia or is the fear of vomiting considered another manifestation of OCD? Certain tics can also manifest quite similarly to behavioral compulsions related to symmetry or “just right” feeling. Differential diagnosis must be carefully conducted particularly in situations where treatment recommendations would differ. Below are some disorders that need to be considered in differential diagnosis.
“Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections” (PANDAS) refers to a particular subtype of pediatric OCD with abrupt onset, episodic course of illness, and a number of distinctive features [23, 24]. The original diagnostic criteria for PANDAS included (1) the presence of OCD and/or a tic disorder, (2) onset of these symptoms prior to puberty, (3) abrupt onset of symptoms, and (4) association with autoimmune infection group A streptococcus (GAS) [24]. The autoimmune response in PANDAS contributes to inflammation of the basal ganglia and subsequent dysfunction of the brain structure [24]. Researchers began investigating PANDAS when they identified a subset of pediatric individuals who had an unusual course of OCD symptoms: a sudden dramatic onset followed by a gradual reduction over several months [23, 24]. They noted similarities to individuals with Sydenham’s chorea (a type of rheumatic fever) and, upon further investigation, noted that numerous patients with chorea also had obsessive compulsive symptoms as well.
PANDAS symptoms are documented as early as age 3 and intensification of symptoms can occur within mere days [24]. An investigation of 50 clinical case studies identified average age of onset for PANDAS with obsessive compulsive symptoms at 7.4 and with tic symptoms at 6.3 [24]. To be classified as PANDAS, the symptoms must be temporally related to GAS infection such as a positive throat culture or elevated anti-GAS antibody titers. Patients also often exhibit neurological irregularities such as motor hyperactivity and tics though these may wax and wane during periods of remission. Other symptoms associated with PANDAS include impulsivity, distractibility, emotional lability, separation anxiety, age-inappropriate behavior, bedwetting, and handwriting disabilities [24, 25]. Of note, PANDAS-like symptoms have been exhibited in response to other bacterial and viral infections including influenza, varicella, mycoplasma infections, and chronic Lyme disease [26].
Recently, researchers noted potential challenges with the original diagnostic criteria of PANDAS (such as difficulty establishing temporal association with GAS infection as well as difficulty distinguishing between PANDAS and non-PANDAS cases). Thus, researchers have reviewed the original diagnostic criteria and available data to establish PANS: pediatric acute-onset neuropsychiatric syndrome [26]. PANDAS is now considered under the rubric of PANS. Diagnostic criteria for PANS include (1) abrupt, dramatic onset of obsessive compulsive disorder, (2) severely restricted food intake, (3) concurrent presence of additional neuropsychiatric symptoms from at least two of the following seven categories: anxiety; emotional lability and/or depression; irritability or aggression; behavioral regression; reduced school performance; motor abnormalities; somatic symptoms including sleep disturbance, enuresis, or urinary frequency, and (4) symptoms are not better explained by a neurological or medical disorder [26]. PANS is conceptualized as a broader clinical entity that can be related to a preceding infection; however, it also refers to acute-onset symptoms without apparent immune disturbance [26]. If a child does exhibit the clinical criteria of PANS, the possibility of PANDAS should be explored and appropriate laboratory studies conducted to determine any association to GAS or other infectious triggers.
Treatment for PANS includes standard OCD treatments including exposure and response prevention as well as psychotropic medications (selective serotonin reuptake inhibitors, SSRIs) [27]. Additional treatment options specific to PANDAS that are being explored include antibiotics, tonsillectomy, nonsteroidal anti-inflammatory drugs (NSAIDS), therapeutic plasma exchange (TPE), intravenous immunoglobulin (IVIG), and anti-CD20 monoclonal antibodies (rituximab) [27].
A child who has difficulty controlling worries about everyday issues would likely be exhibiting symptoms of generalized anxiety disorder (GAD). GAD involves excessive worry about real-life concerns, while OCD centers on irrational fears that are unrealistic and beyond the scope of daily life problems [22, 28]. At times, these disorders can be clearly distinguished, for example, when one child worries excessively about an upcoming math test while another is overwhelmingly concerned about receiving a deadly illness from germs or turning into an animal by the power of their thoughts. Sometimes, however, the differential diagnosis may be less clear-cut; for example, a child’s concern about his mother flying on an airplane could be categorized as a worry about his mother’s well-being (GAD) or irrational fear of harm toward loved ones (OCD). Furthermore, pathological worry may function similarly to mental compulsions as both are self-initiated and aimed at reducing distress [28]. It has been suggested that compulsions can be distinguished from pathological worry by its frequency (compulsions will likely have a higher number of repetitions), rigidity (a child with OCD is more likely to seek the same answer over and over, whereas a child with GAD may ask numerous questions about different risks), quality (compulsions are likely to be more illogical such as tapping an object repeatedly to prevent harm to a loved one), and function (compulsions for OCD often seek to reduce distress related to thought of future negative events, whereas pathological worry seeks to reduce occurrence of future negative event but as no compulsions or acts involved in preventing the outcome) [28].
Tics refer to sudden, repetitive, stereotyped movements or sounds. While tics are often perceived as involuntary, they usually are accompanied by premonitory sensory urges [29]. Simple tics include eye blinking, neck jerking, shoulder shrugging, or throat clearing. Complex tics can involve facial gestures, touching, smelling objects, or repeating words or phrases; often complex tics involve repeating certain actions until it feels right. Simple tics are more easily distinguished from compulsions due to their brevity, lack of purpose, and seemingly involuntary nature, while complex tics can present quite similarly to compulsions [29]. A behavior that functions to reduce distress or anxiety (e.g., repeatedly tapping the sidewalk to prevent a feared consequence) is likely to be related to OCD, while a behavior that functions to relieve somatic discomfort or tension (e.g., repeatedly moving arm in certain way in response to discomfort) [22]. Additionally, clinicians can ask if withholding the behavior would result in anxiety or physical discomfort. Looking at the symptom in context of the child’s history can be helpful as well depending on if the child has presented with anxiety and/or distinct obsessions or compulsions vs. simple tics with minimal anxiety [22].
Individuals with autism spectrum disorders often display rigid interests and repetitive behaviors, which can appear similar to obsessions and compulsions. Common repetitive behaviors associated with autism disorder include repetitive motor mannerisms, preference for sameness, distressing reactions to change, and perseveration on a restricted range of interests [30]. It has been suggested that repetitive behavior in autism is a source of pleasure rather than a reaction to anxiety [30]. Querying about developmental history may help differentiate between OCD and autism such as screening for history of language delays and difficulties with social interactions. Additionally, fixed interests in autism are typically experienced as ego-syntonic and even enjoyable, while symptoms in OCD are often distressing and experienced as ego-dystonic [22].
Patients with eating disorders (EDs), similar to OCD, experience intrusive thoughts that contribute to maintenance of dysfunctional behaviors. Intrusive thoughts in ED typically center on food, diet, physical exercise, and appearance [31]. These intrusions trigger negative affect, which leads to engagement in behaviors to alleviate discomfort such as checking weight, compulsive exercise, binge eating, purging, or restricting food intake. Thus, both ED and OCD involve intrusive thoughts related to feared negative outcomes, which are linked to compensatory behaviors intended to reduce emotional distress [31]. OCD can present similarly to ED (for example, severe weight loss from contamination-focused OCD due to fears that food is dirty); eating only certain foods that are perceived to keep in good health for those with health-related OCD. Also the reverse can be true where patients with ED may appear to be OCD; for example, avoid having oils around due to fear of contamination of the food with fats; counting the number of bites of a piece of food; cutting the food into a certain number of pieces, etc. Studies that have assessed frequency of obsessions and compulsions in OCD and ED (particularly anorexia nervosa) patients have found symmetry obsessions and ordering compulsions to be most common for ED, while OCD patients tend to have more variety of symptoms [32].
Depression is often comorbid with OCD and may be treated differently whether it is secondary and occurring in response to the stress caused by OCD or it is a primary condition that is separate from the OCD. Comorbid depression is associated with increased OCD symptom severity and increased functional impairment [14, 33]. Screening for depression is important to ensure treatment is effective and taking into account a person’s overall well-being. Notably, several studies have revealed that treating OCD through exposure and response prevention can lead to a decrease in comorbid depression and that treatment outcomes are not worsened by the presence of depression [15, 34, 35]. Distinguishing whether depression is primary or secondary to OCD can guide treatment decisions whether to begin with exposure and response prevention or to begin with CBT targeting depression. Assessing the content of depressive cognitions can provide information on whether depressive thoughts center on impairment or quality of life issues related to OCD. Additionally, obtaining a timeline of symptoms (such as whether depression preceded OCD or began afterward) can assist with identifying if depression is reactionary to OCD or a distinct condition.
While OCD has frequently been described as a debilitating and chronic illness whose symptoms wax and wane over time, less is known about the course of the disorder for children and adolescents specifically. In fact, research demonstrates potential differences regarding the course of illness between pediatric and adult populations. A study that compared pediatric and adult treatment-seeking individuals with OCD over a 3-year time period found that children had a significantly higher remission rate (53%) compared to adults (34%) [36]. Better psychosocial functioning as well as engaging in treatment earlier in the course of illness was related to shorter time to remission for children with OCD. These findings suggest a better prognosis for pediatric OCD and additionally emphasize the importance of early recognition and intervention for children with OCD [36].
Additionally, clinical presentation of OCD may vary across the life span between children, adolescents, and adults. Youth diagnosed with OCD at an earlier age tend to have higher rates of ADHD and anxiety disorders [1, 37]. As children with OCD age into adolescence, they are more likely to experience mood disorders such as depression [1, 16, 37]. These developmental trends are exemplified by a study that investigated differences in clinical presentation between 46 children, 55 adolescents, and 60 adults with OCD. Results revealed that ADHD and tic disorder rates were inversely related to age such that the children had the highest prevalence followed by adolescents and then adults [37]. Conversely, adults had the highest rates of depression followed by adolescents and then children with the lowest rates of depression [37]. Similarly, another study that examined the prevalence of comorbidity in pediatric OCD demonstrated adolescents had a six times greater likelihood of having a co-occurring depressive disorder compared to younger children [16].
OCD pathogenesis involves neuroanatomy, biochemical, genetic, and environmental factors. Brain structures that are associated with obsessive compulsive disorder include the orbitofrontal cortex, striatum, thalamus, and the basal ganglia, which are all involved in the cortical-striatal circuit [38]. MRI and fMRI scans have demonstrated structural abnormalities for individuals with OCD. Biochemical factors that have been identified to play a role include neurotransmitters like serotonin [38, 39], and in fact, serotonin changes have been shown to change purely with an intensive exposure and response prevention treatment [40]. Genetic factors also appear to have a strong influence on the development of early-onset OCD. Children with OCD are likely to have other first-degree relatives that also have OCD as well as anxiety, mood, ADHD, and tic disorders [9]. Numerous studies have demonstrated elevated rates of OCD in parents of children with early onset of the disorder, including a study that found a quarter of fathers and almost 10% of mothers meeting criteria for OCD [41]. For a subset of individuals, the pathogenesis of OCD is related to an autoimmune infectious disease known as autoimmune neuropsychiatric disorders associated with Streptococcus (PANDAS), which is also implicated in Tourette’s disorder. It has been suggested this year that PANDAS be renamed to encephalitis autoimmune disorder poststreptococci.
With regard to environmental factors, family environment has been identified as a likely contributor to OCD development in children [42]. Social learning is theorized to play an important role in the development of childhood anxiety disorders. Children learn from seeing how their parents function in the world and how their parents cope with their own anxiety and emotional distress. Additionally, parent communication style and relationship quality impacts child development of psychopathology. Authoritarian parenting style (low warmth, high behavioral control) has been linked to higher incidences of obsessive compulsive symptoms and obsessive compulsive beliefs (such as regarding the importance of thoughts and personal responsibility) [43]. This finding is consistent with other studies that have demonstrated an association between parental control and higher rates of child anxiety [44]. Family factors are therefore important to address in the treatment of pediatric OCD.
Children’s OCD symptoms affect and are affected by family dynamics and the family environment. As children are heavily reliant on their parents for activities of daily living and general well-being, parents often bear the brunt of their child’s OCD severity and impairment. Extensive research demonstrates the importance of accounting for family factors in the treatment of pediatric OCD [45, 46, 47, 48]. In fact, family-based therapy has demonstrated effectiveness and is highly encouraged, especially in the case of younger children [45, 49].
A parent of a child with OCD is faced with many challenges on a daily basis. Children may delay family activities due to involvement in rituals or may refuse to partake in activities or gatherings altogether due to their OCD symptoms. When children become distressed by their obsessions and compulsions, it is typically family members who deal with the resulting temper tantrums, crying, reassurance seeking, or avoidance of situations and activities. Children may request or demand their parents adjust their behavior to assist with rituals or prevent feared negative consequences related to obsessional fears (e.g., expecting a parent to hand-wash excessively after a parent touches something the child considers dirty). Parents are faced with difficult questions such as how to cope effectively with their children’s emotional distress, whether to assist in rituals or provide reassurance, and how to respond when children avoid or refuse to participate in activities. In addition, parents often have to deal with the poor interpersonal relations these children exhibit [50].
A child, age 8, becomes tearful after accidentally touching something in a public area due to worries of becoming severely ill. She cries and asks her mother repeatedly “Am I going to be sick and die?” The child’s mother answers the question, “No, that’s not possible, you aren’t going to become sick from that”; however, the girl appears unsatisfied and continues to ask similar questions. When her mother eventually tells her she already answered the question and attempts to end the conversation, the daughter throws herself onto the floor and begs her mother to answer again. The mother knows from past experience that when she answers her daughter, she is likely to calm down sooner and experience relief. However, she has also observed that her daughter seems to ask more frequently for reassurance and seems to want her mother to repeat the answer more times. What is this mother’s best choice in this situation?
It is common for pediatric and adult individuals with OCD to involve close family members in OCD-related behaviors in some capacity [51, 52]. Accommodation refers to family members’ modification of their own behavior in order to assist in their child’s OCD-related rituals [53, 54, 55]. This may occur in a variety of forms including participating in rituals themselves (e.g., washing their hands excessively at their child’s request or listening to repeated confessions of their child), facilitating avoidance of situations (e.g., picking child up early from school or removing knives in home if child has aggressive obsessions), and providing reassurance (e.g., saying nothing bad is going to happen in response to child asking about a harm-related fear).
Research suggests that the majority of families engage in accommodation on a regular basis. An analysis of the Pediatric OCD Treatment Study (POTS) explored the prevalence of family accommodation as well as whether there are child or parent factors that are related to a tendency toward accommodation. The POTS is a randomized controlled trial that investigated the effectiveness of cognitive behavioral therapy alone, medication alone, and the combination of therapy and medication, compared to a placebo control condition in children (ages 7–17) with OCD and their families [56]. In a subset of 96 individuals who completed the Family Accommodation Scale Parent Report (FAS-PR), 99% of parents reported engaging in at least one accommodating behavior to some extent and 77.1% reported engaging in at least one accommodating behavior daily [53]. More than half of parents reassured their child (63.5%), while about a third participated in their child’s OCD rituals (32.33%) and assisted in avoiding triggering situations (33.3%) on a daily basis [53]. These results are comparable to other studies that have explored the prevalence of accommodation in pediatric OCD [46, 57].
Parents typically accommodate with their child’s best interests at heart in hopes of alleviating distress, assisting with management of OCD symptoms, and/or improving family functioning. Accommodation often does result in short-term relief and can appear helpful when, for example, a child ceases tantruming after receiving reassurance. In reality, OCD symptoms are actually maintained as rituals are negatively reinforced and the child learns they cannot handle their fears without compulsions. Family accommodation has been shown to be associated with symptom severity pretreatment for children and adolescents with OCD, further evidence that this practice actually worsens rather than solves the problem [46, 57, 58]. Yet, children eventually come to expect family participation in rituals and become agitated when family members attempt to change the system. Thus, parents can often feel powerless to intervene and feel compelled to continue accommodation even if they realize it may exacerbate symptoms over time.
In an effort to understanding the family processes that contribute to accommodation, researchers have explored the correlates and predictors of this phenomenon. Within the 96 families involved in the POTS cited above, more severe rituals, oppositional behavior, and higher frequency of washing symptoms in children contributed to increased parental accommodation. Parental anxiety was also identified as a relevant factor, which suggests that as parents’ anxiety increases, they may have a harder time setting boundaries and disengaging from requests to participate in rituals [53]. A study of 65 children and their families (ages 8–17) also demonstrated that child symptom severity as well as parent anxiety, parent hostility, and parent psychopathology correlate with accommodation. Additionally, higher family conflict was associated with more accommodation-related distress and worse consequences when not accommodating while higher family organization was associated with the less accommodation-related distress [57]. Thus, without addressing family or parent-related factors, cognitive behavioral therapy can be compromised and lead to less beneficial outcomes. A prospective, longitudinal study found that parental accommodation (measured at intake) was the strongest predictor of OCD symptom severity at intake and 2-year follow-up, again demonstrating the impact of family factors on pediatric OCD [54]. This study analyzed data from an ongoing, prospective study, the Brown Longitudinal Obsessive Compulsive Disorder Study (BROWNS), to examine the predictive value of parental accommodation (assessed at intake) on OCD symptom severity at intake and 2 years after intake after controlling for factors such as child age, anxiety, and depression [59]. Results revealed, as discussed above, that parental accommodation at a single point in time may have a strong influence on predicting future OCD symptom severity. Potentially, family accommodation patterns become so entrenched that they are maintained over time due to the potential short-term effects of sudden accommodation changes (child becoming agitated and expressing distress). Thus, unless intervention directly targets family factors, one may expect parental accommodation to remain a strong predictor of future OCD symptoms and outcome.
Addressing family accommodation in treatment can substantially impact treatment outcomes in children with OCD [46, 58]. In a study of 50 youth and families who participated in family-based cognitive behavioral therapy, family accommodation was common among the participants and was associated with symptom severity before treatment [46]. Decreases in family accommodation during treatment predicted treatment outcome even when controlling for pretreatment OCD severity. Accordingly, treatment protocols for OCD are increasingly emphasizing reduction of family accommodation as an important therapeutic factor.
The 2012 evidence-based practice parameters published by the American Academy of Child Adolescent Psychiatry detail assessment recommendations for pediatric OCD symptoms [17]. Routine screening of obsessions and compulsions is recommended during all psychiatric evaluations of children and adolescents, regardless of whether OCD is part of the presenting complaint. Screening can be conducted via several brief questions such as “Do you have worries that just won’t go away or get stuck” and “Do you do things over and over or have habits you can’t stop?” [17]. For individuals who exhibit OCD symptoms and meet DSM criteria for the disorder, a comprehensive evaluation of possible comorbid psychiatric disorders is recommended as well as a thorough medical, developmental, family, and school history [17]. As discussed in comorbidity section above, children are likely to present with multiple diagnoses, which may impact their treatment needs and ability to participate effectively in OCD treatment. With regard to family history, inquiries should focus on family mental health history, activities of daily living, general family dynamics, and lifestyle factors. Medical history questions may also provide helpful information regarding differential diagnosis of PANDAS/PANS. Additionally, gathering information about a child’s academic performance over time also allows for an understanding of functional impairment and symptom severity outside of the child’s home [17].
Evidence-based treatment modalities for pediatric obsessive compulsive disorder comprise cognitive behavior therapy (CBT), specifically exposure and response prevention (ERP), as well as psychiatric medication (selective serotonin reuptake inhibitors, SSRIs) [17, 45, 60, 61]. CBT is recommended as the first-line treatment for mild-to-moderate cases of OCD in children [17]. A combination of psychotropic medication and CBT is recommended for moderate-to-severe OCD in children, with serotonin reuptake inhibitors considered the first-line medication [62]. Additionally, medication can be helpful in cases where children are having difficulties engaging in treatment or have co-occurring disorders that cause additional functional impairment. Medication augmentation may also be considered for individuals with treatment resistance (i.e., nonresponsive to empirically based interventions) who experience persistent OCD symptoms despite adequate treatment interventions.
Exposure and response prevention (ERP) involves prolonged, repeated contact with feared stimuli that trigger obsessions (exposure) without engagement in compulsive or avoidant behaviors (ritual prevention) [63, 64]. Treatment will usually start with psychoeducation to orient the child and family to the cognitive behavioral model and expectations for therapy. The therapist, child, and often family members will then collaborate to create a list of situations that trigger anxiety and rate them from lowest to highest intensity (i.e., treatment hierarchy). Exposures will typically begin with situations that trigger mild anxiety and proceed in a graded fashion as the child habituates (experiences a reduction in anxiety) and/or increases their willingness to remain in the situations despite anxiety. Simultaneously, the child does not engage in rituals before, during, or after exposure to block negative reinforcement and to allow the anxiety to decline naturally. For example, a child who worries about contracting a serious illness and engages in excessive handwashing and avoidance of germs would not only touch objects that are associated with germs but also refrain from handwashing for the exposure exercise.
Family-based CBT programs have been recommended for early childhood OCD (approximately ages 5–8) and have demonstrated success in randomized control trials [45, 61]. Parent participation is particularly important for younger children who have unique developmental needs and rely heavily on their caretakers. The Pediatric Obsessive-Compulsive Disorder Treatment Study for Young Children (POTS JR) evaluated the efficacy of a family-based CBT protocol (FB-CBT) for young children who addressed cognitive, socioemotional, and family factors compared to a family-based relaxation training protocol [45]. This 14-week randomized clinical trial involved 127 pediatric outpatients with OCD aged 5–8 years at three academic medical centers. Results revealed that the FB-CBT led to significant reductions in OCD symptoms and functional impairment; young children with OCD were able to benefit from exposure and response prevention with parental support [45].
Family-based CBT incorporates parent tools such as behavior management skills training; parents are trained in behavioral strategies such as implementing reward systems, modeling, and ignoring behaviors that are reinforced by attention [45]. As children may lack insight into their symptoms and/or resist voluntary contact with triggers, they may be more likely to participate in treatment with the addition of external reinforcers. Additionally, parents can be actively involved during in-session and home-based exposure exercises and provide helpful support to their child. Therapists teach parents how to act as a coach between sessions, which ensures increased likelihood of children practicing and adhering to CBT principles between sessions [45]. Parents who are included in the treatment process are less likely to accommodate their child’s OCD, which can greatly enhance treatment outcomes [14].
While outpatient therapy often involves a weekly schedule, the possibility of more intensive treatment can be considered depending on the child’s clinical presentation and circumstances. Studies have demonstrated that daily sessions offer comparable results to weekly sessions and even provide slight advantages immediately posttreatment though there appear to be no group differences at later follow-ups [48, 49]. While weekly treatment allows for children to maintain their routines and remain in school and other activities, intensive treatment can also be considered as an option when children have a limited time frame and/or require a faster response rate. Many of our children receive intensive treatment during holidays or during the summer months. In addition, children who are unable to attend school may be considered for intensive outpatient programs.
Children are encouraged to externalize the OCD as separate from themselves [64, 65]. Therapists often describe OCD as a “bully” or “worry monster” that puts “silly worries” or “scary thoughts” into the children and “commands” or “bullies” the children to repeat certain behaviors. Children externalize their OCD by giving their OCD a name of their choice (e.g., Mr. Wrong, Meanie, Silly Sam, etc.) and “bossing back” or fighting OCD by not listening to its commands and doing the opposite of what OCD says (i.e., exposures).
Psychoeducation can involve using examples from other areas of the child’s life to build motivation for facing fears as a way of overcoming them (e.g., learning to ride a bike or swim). Depending on child’s age or developmental level, therapists may measure level of anxiety in a variety of ways: a fear thermometer or using objects of different sizes that symbolize anxiety levels (e.g., three cups of different sizes). When possible and applicable, therapists can make exposure into a game (e.g., doing silly things in the presence of feared trigger, who can touch the dirty pen first, passing a pen between their toes and race with the therapist) to increase children’s willingness to participate and match their developmental level. Additionally, including parents in the “game” or exposure activity may help children feel more comfortable and open to engage.
Factors associated with poorer treatment response in children with OCD include lower insight, higher family accommodation, comorbid disorders, and greater symptom severity [48, 49, 61]. Researchers are exploring ways to improve the efficacy and accessibility of OCD treatments. Potentially, strategies aimed at enhancing readiness in children may facilitate increased engagement in therapy such as motivational interviewing strategies [66]. In fact, a pilot study explored the usefulness of adjunctive motivational interviewing sessions (MI) compared to adjunctive psychoeducation sessions; results indicated the MI condition led to faster reduction in symptoms (though scores posttreatment were not significantly different from the control condition), and on average, treatment was completed three sessions earlier than those in the control group [46]. Incorporating technology may allow CBT researchers and clinicians to reach a wider audience of individuals who otherwise may not have access to treatment due to location and other logistics (e.g., childcare for other siblings, transportation availability). One pilot study found significant treatment outcomes for a web-based CBT intervention, leading to the suggestion that web-based CBT may be considered in cases where in-person sessions are not feasible [67]. Additionally, as discussed above in prior sections, family members are increasingly being included and targeted in standard CBT therapy protocols for children with OCD with substantially positive outcomes [46, 58].
This is a brief overview of the main steps involved in publishing with IntechOpen Compacts, Monographs and Edited Books. Once you submit your proposal you will be appointed a Author Service Manager who will be your single point of contact and lead you through all the described steps below.
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