Developmental Considerations in Obsessive Compulsive Disorder: Comparing Pediatric and Adult-Onset Cases

Are the Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents as Effective for OCD as for Anxiety and Depression?

Background: Obsessive-compulsive disorder (OCD) in youth commonly co-occurs with other affective disorders (e.g., anxiety, depression). Exposure and response prevention (ERP) is the front-line treatment for OCD but may require significant adaptation to treat co-occurring symptoms or complex comorbidity patterns. Preliminary evidence suggests that the Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents (UP-C/A) are effective in reducing OCD symptoms. Still, it is not yet known if the UP-C/A are comparably effective to treat OCD as they are for anxiety and depression, the disorders for which there is the most robust empirical support. Methods: This study compared trajectories of OCD, anxiety, and depression symptom change among 388 youth who received UP-C/A treatment (M = 15 sessions) at a university-based research clinic. We also examined whether youth with (n = 60) and without (n = 328) an OCD diagnosis demonstrated comparable improvements in anxiety, depression, and transdiagnostic treatment targets (i.e., anxiety sensitivity, cognitive flexibility, and distress tolerance). Results: OCD symptoms improved at a slower rate than anxiety and depression symptoms during the first half of UP-C/A treatment but at a comparable rate to anxiety and depression symptoms during the second half of treatment. Youth with and without OCD exhibited comparable improvements in anxiety, depression, anxiety sensitivity, cognitive flexibility, and distress tolerance across the treatment course. Conclusions: Findings support the efficacy of UP-C/A treatment for co-occurring OCD and affective disorders but suggest that initiating exposure earlier in the treatment course may confer additional benefits.

McLean OCD Institute for Children and Adolescents: Overview, Rationale, and Description of Symptomatology and Functional Impairment

BACKGROUND/OBJECTIVES

Residential treatment represents an important level of care for adolescents with severe and/or treatment-refractory obsessive-compulsive disorder (OCD). Despite accumulating evidence supporting the treatment efficacy and cost-effectiveness of insurance-based intensive OCD treatment in residential settings, few data exist that characterize the population of adolescent patients utilizing this level of care. As a result, residential treatment may be poorly understood by patients, their families, and referring providers, which may delay appropriate treatment for adolescents with OCD. Here, we characterize the patient population at an intensive residential treatment center (RTC) and partial hospitalization program (PHP) for adolescents (Mage = 15.23) with a primary diagnosis of OCD.

METHODS

We examine quantitative data collected from 168 adolescents admitted to the McLean OCD Institute for Children and Adolescents for the treatment of primary OCD or a related disorder over a three-year period. We also conduct analyses on a subset of patients (n = 120) who participated in the Child and Adolescent Routine Evaluation (CARE) Initiative (McLean Child Division-Wide Measurement-Based Care Program) to further characterize this patient population with a lens toward additional comorbidities and factors impacting prognosis.

RESULTS

The current paper describes the severity of symptom presentation, comorbidities, psychotropic medication profiles, and disruption to personal and family functioning. Analyses also include the prevalence of OCD subtypes and co-occurrence among varied presentations.

CONCLUSIONS

In addition to identifying common clinical presentations in an RTC/PHP, this paper further aims to detail best practices and clinical rationale guiding a specialty RTC/PHP to inform families, providers, and payors about the individuals that most benefit from this level of care.

Evaluating the diagnostic validity of CBCL-OCS in Chinese children and adolescents with OCD

BACKGROUND AND OBJECTIVES

Obsessive-compulsive disorder (OCD) is recognized globally as a serious mental health concern among children and adolescents. Accurate early diagnosis and intervention are crucial for effective management and improving patient outcomes. The primary objective of this study was to evaluate the diagnostic validity of the Child Behavior Checklist-Obsessive Compulsive Scale (CBCL-OCS) in Chinese children and adolescents, ensuring its cultural adaptability. The secondary objective was to explore the clinical characteristics of OCD, including prevalence, symptom severity, and comorbidities.

METHODS

A cross-sectional epidemiological survey was conducted among 8,595 middle school students in Liaoning Province, China. The CBCL-OCS was employed as the primary screening tool. The optimal cutoff value for OCD screening was determined through receiver operating characteristic (ROC) curve analysis.

RESULTS

The study found an OCD prevalence of 1.710%, which was consistent with the global estimation. ROC analysis determined a cutoff score of 2.5 for CBCL-OCS, with a sensitivity of 0.789 and a specificity of 0.899. Furthermore, adolescents exhibited significantly higher CBCL-OCS scores compared to younger children, suggesting an increase in OCD severity with age. Significant associations were also found between OCD symptoms and comorbid emotional disorders, behavioral problems, and anxiety symptoms.

CONCLUSIONS

This study confirms the utility of CBCL-OCS as an effective early screening tool for OCD in Chinese middle school students, highlighting its sensitivity and specificity, and cultural adaptability. Results contributed valuable insights to the epidemiology of OCD among children and adolescents, underscoring the need for targeted interventions during critical developmental periods, especially in adolescence.

Clinical Characteristics of Cognitive Subgroups of Obsessive Compulsive Disorder

INTRODUCTION

Obsessive-compulsive disorder (OCD) is a clinically heterogeneous disorder. The results of symptom-based classification studies are inconsistent in resolving this heterogeneity. The aim of this study was to investigate clinical differences between clusters created according to neurocognitive performance.

METHODS

This study combined data sets from three previously published studies. A total of 135 outpatients diagnosed with OCD, and 106 healthy controls (HCs) were evaluated using the 17-Item Hamilton Depression Rating Scale (HDRS-17) and a comprehensive neuropsychological battery. Patients were also administered the Yale-Brown Obsessive Compulsive Scale (Y-BOCS).

RESULTS

Two neurocognitive subgroups were identified by k-means cluster analysis: globally impaired (GI, n = 42) and cognitively intact (CI, n = 93). The GI subgroup performed worse than the HC and CI groups on all neurocognitive tests. There was no difference between the CI group and HC in any cognitive domains. Compulsive symptom severity [t(133) = -2.45, p = 0.015], Y-BOCS total score [t(133) = -2.09, p = 0.038], and age of onset were higher in the GI group than in the CI group [t(132) = -4.24, p < 0.001]. Years of education were higher in the CI and HC groups than in the GI group [F(238) = 35.27, p < 0.001]. There was no difference in symptom profile between the CI and GI groups.

CONCLUSION

The identified cognitive clusters may indicate subtypes with different neurobiological bases. A better dissection of the cognitive structure of OCD could potentially facilitate genetic and neuroimaging studies.

Moderating Effects of Age and Gender on the Relationship Between Pediatric Obsessive-Compulsive Symptoms and Parental Accommodation

Parental accommodation is a well-established anxiogenic parenting practice that is ubiquitous among parents of youth with obsessive-compulsive symptoms (OCS). Accommodation is associated with heightened symptom severity (i.e., high levels of accommodation reinforce and maintain OCS). The present study sought to evaluate whether child age and gender moderated the relationship between parental accommodation and symptom severity. Participants included parents of children with a broad range of psychiatric disorders, as well as some youth with no psychiatric disorder (N = 61, children ages 7-17). Parents completed questionnaires related to their accommodation practices and their child's obsessive-compulsive symptoms. Age significantly moderated the relationship between accommodation and symptom severity, such that the relationship was stronger among older children. Gender significantly moderated the relationship between accommodation and symptom severity, such that the relationship was stronger among boys. Additional research is needed to further delineate the impact of age and gender on parental accommodation and OCS.

Evaluating the effectiveness of a collaborative care digital mental health intervention on obsessive-compulsive symptoms in adolescents: A retrospective study

Objective

Obsessive-compulsive (OC) symptoms, characterized by distressing and repetitive thoughts and behaviors, frequently onset during adolescence for individuals with obsessive-compulsive disorder or anxiety disorders. Digital mental health interventions (DMHIs) offer a promising platform to deliver mental health treatment, which may address OC symptoms. The purpose of this retrospective study was to determine the effects of a DMHI, Bend Health, on various domains of OC symptoms, including contamination, responsibility (for harm), unwanted thoughts, and symmetry, in adolescents.

Methods

OC symptoms were assessed at baseline (before beginning care) and monthly in adolescents engaged in different care programs involving coaching and/or therapy with the DMHI. Retrospective analyses were used to identify characteristics associated with OC symptoms (N = 2151) and to characterize treatment responsiveness of adolescents with elevated OC symptoms (n = 553).

Results

Adolescents with elevated OC symptoms (32.2%; n = 693 of 2151) were more likely than those with non-elevated OC symptoms to be female (p < .001), to have comorbid symptoms (e.g. anxiety and depression; p < .001), and participate in therapy (p < .001). Further, their caregivers had higher rates of sleep problems and burnout (p < .05). OC symptoms improved for 87.7% (n = 485 of 532) of adolescents during care with the DMHI, and 46.6% (n = 249 of 534) reported clinically substantive improvement. Scores decreased significantly over months in care (t1187 = -8.06, p < .001). Improvements were also identified for OC symptom dimensions (contamination, responsibility (for harm), unwanted thoughts, and symmetry).

Conclusions

Our results deliver compelling preliminary evidence that participation in coaching and therapy with a DMHI may mitigate a variety of OC symptoms for adolescents. Improvements were observed across different OC symptom types, demonstrating the broad applicability of the DMHI to address various presentations and complexities of OC symptoms.

A coordinate-based meta-analysis of grey matter volume differences between adults with obsessive-compulsive disorder (OCD) and healthy controls

According to the cortico-striato-thalamo-cortical (CSTC) model of obsessive-compulsive disorder (OCD), the striatum plays a primary role in its neuropathophysiology. Hypothesising that volumetric alterations are more pronounced in subcortical areas of patients within the CSTC circuit compared to healthy controls (HCs), we conducted a coordinate-based meta-analysis of magnetic resonance imaging (MRI) studies. We included 26 whole-brain MRI studies, comprising 3,010 subjects: 1,508 patients (788 men, 720 women; mean age: 30.26 years, SD = 8.16) and 1,502 HCs (801 men, 701 women; mean age: 29.47 years, SD = 7.88). This meta-analysis demonstrated significant grey matter volume increases in the bilateral putamen, lateral globus pallidus, left parietal cortex, right pulvinar, and left cerebellum in adults with OCD, alongside decreases in the right hippocampus/caudate, bilateral medial frontal gyri, and other cortical regions. Volume increases were predominantly observed in subcortical areas, with the exception of the left parietal cortex and cerebellar dentate, while volume decreases were primarily cortical, aside from the right hippocampus/caudate. Further exploration of these neuropathophysiological correlates could inform specific prevention and treatment strategies, advancing precision mental health in clinical applications.

Data resource profile: the ORIGINS project databank: a collaborative data resource for investigating the developmental origins of health and disease

Introduction

The ORIGINS Project ("ORIGINS") is a longitudinal, population-level birth cohort with data and biosample collections that aim to facilitate research to reduce non-communicable diseases (NCDs) and encourage 'a healthy start to life'. ORIGINS has gathered millions of datapoints and over 400,000 biosamples over 15 timepoints, antenatally through to five years of age, from mothers, non-birthing partners and the child, across four health and wellness domains: 'Growth and development', 'Medical, biological and genetic', 'Biopsychosocial and cognitive', 'Lifestyle, environment and nutrition'.

Methods

Mothers, non-birthing partners and their offspring were recruited antenatally (between 18 and 38 weeks' gestation) from the Joondalup and Wanneroo communities of Perth, Western Australia from 2017 to 2024. Data come from several sources, including routine hospital antenatal and birthing data, ORIGINS clinical appointments, and online self-completed surveys comprising several standardised measures. Data are merged using the Medical Record Number (MRN), the ORIGINS Unique Identifier and the ORIGINS Pregnancy Number, as well as additional demographic data (e.g. name and date of birth) when necessary.

Results

The data are held on an integrated data platform that extracts, links, ingests, integrates and stores ORIGINS' data on an Amazon Web Services (AWS) cloud-based data warehouse. Data are linked, transformed for cleaning and coding, and catalogued, ready to provide to sub-projects (independent researchers that apply to use ORIGINS data) to prepare for their own analyses. ORIGINS maximises data quality by checking and replacing missing and erroneous data across the various data sources.

Conclusion

As a wide array of data across several different domains and timepoints has been collected, the options for future research and utilisation of the data and biosamples are broad. As ORIGINS aims to extend into middle childhood, researchers can examine which antenatal and early childhood factors predict middle childhood outcomes. ORIGINS also aims to link to State and Commonwealth data sets (e.g. Medicare, the National Assessment Program - Literacy and Numeracy, the Pharmaceutical Benefits Scheme) which will cater to a wide array of research questions.

Hand Washing: When Ritual Behavior Protects! Covid-19 Experience in Children and Adolescents with (and without) Obsessive-Compulsive Disorder

No abstract present.

Atypical neurocognitive functioning in children and adolescents with obsessive-compulsive disorder (OCD)

Atypical neurocognitive functioning has been found in adult patients with obsessive-compulsive disorder (OCD). However, little work has been done in children and adolescents with OCD. In this study, we investigated neurocognitive functioning in a large and representative sample of newly diagnosed children and adolescents with OCD compared to non-psychiatric controls. Children and adolescents with OCD (n = 119) and non-psychiatric controls (n = 90) underwent psychopathological assessment, intelligence testing, and a neurocognitive test battery spanning cognitive flexibility, planning and decision-making, working memory, fluency, and processing speed. The MANOVA main effect revealed that children and adolescents with OCD performed significantly worse than the control group (p < .001, η p 2 = 0.256). Atypical patient performance was particularly found for indices of cognitive flexibility, decision-making, working memory, and processing speed. We found no evidence of differences in planning or fluency. Moreover, we found no significant associations between neurocognitive performance and OCD symptom severity or comorbidity status. Our results indicate that children and adolescents with OCD show selective atypical neurocognitive functioning. These difficulties do not appear to drive their OCD symptoms. However, they may contribute to lifespan difficulties and interfere with treatment efficacy, an objective of our research currently.

Beliefs, compulsive behavior and reduced confidence in control

OCD has been conceptualized as a disorder arising from dysfunctional beliefs, such as overestimating threats or pathological doubts. Yet, how these beliefs lead to compulsions and obsessions remains unclear. Here, we develop a computational model to examine the specific beliefs that trigger and sustain compulsive behavior in a simple symptom-provoking scenario. Our results demonstrate that a single belief disturbance-a lack of confidence in the effectiveness of one's preventive (harm-avoiding) actions-can trigger and maintain compulsions and is directly linked to compulsion severity. This distrust can further explain a number of seemingly unrelated phenomena in OCD, including the role of not-just-right feelings, the link to intolerance to uncertainty, perfectionism, and overestimation of threat, and deficits in reversal and state learning. Our simulations shed new light on which underlying beliefs drive compulsive behavior and highlight the important role of perceived ability to exert control for OCD.

Inflammation in obsessive-compulsive disorder: A literature review and hypothesis-based potential of transcranial photobiomodulation

Obsessive-compulsive disorder (OCD) is a disabling neuropsychiatric disorder that affects about 2%-3% of the global population. Despite the availability of several treatments, many patients with OCD do not respond adequately, highlighting the need for new therapeutic approaches. Recent studies have associated various inflammatory processes with the pathogenesis of OCD, including alterations in peripheral immune cells, alterations in cytokine levels, and neuroinflammation. These findings suggest that inflammation could be a promising target for intervention. Transcranial photobiomodulation (t-PBM) with near-infrared light is a noninvasive neuromodulation technique that has shown potential for several neuropsychiatric disorders. However, its efficacy in OCD remains to be fully explored. This study aimed to review the literature on inflammation in OCD, detailing associations with T-cell populations, monocytes, NLRP3 inflammasome components, microglial activation, and elevated proinflammatory cytokines such as TNF-α, CRP, IL-1β, and IL-6. We also examined the hypothesis-based potential of t-PBM in targeting these inflammatory pathways of OCD, focusing on mechanisms such as modulation of oxidative stress, regulation of immune cell function, reduction of proinflammatory cytokine levels, deactivation of neurotoxic microglia, and upregulation of BDNF gene expression. Our review suggests that t-PBM could be a promising, noninvasive intervention for OCD, with the potential to modulate underlying inflammatory processes. Future research should focus on randomized clinical trials to assess t-PBM's efficacy and optimal treatment parameters in OCD. Biomarker analyses and neuroimaging studies will be important in understanding the relationship between inflammatory modulation and OCD symptom improvement following t-PBM sessions.

Transdiagnostic risk identification: A validation study of the Clinical High At Risk Mental State (CHARMS) criteria

A set of clinical criteria, the Clinical High At-Risk Mental State (CHARMS) criteria, have been developed to identify symptomatic young people who are at-risk of disorder progression. The current study aimed to validate the CHARMS criteria by testing whether they prospectively identify individuals at-risk of progressing from attenuated symptomatology to a first episode of serious mental disorder, namely first episode psychosis, first episode mania, severe major depression, and borderline personality disorder. 121 young people completed clinical evaluations at baseline, 6- and 12-month follow-up. The Kaplan-Meier method was used to assess transition rates. Cox regression and LASSO were used to examine baseline clinical predictors of transition. Linear mixed effects modelling was used to examine symptom severity. 28 % of CHARMS+ individuals transitioned to a Stage 2 disorder by 12-month follow-up. The CHARMS+ group had more severe symptoms at follow-up than the CHARMS- group. 96 % of Stage 2 transitions were initially to severe depression. Meeting criteria for multiple CHARMS subgroups was associated with higher transition risk: meeting one at-risk group = 24 %; meeting two at-risk groups = 17 %, meeting three at-risk groups = 55 %, meeting four at-risk groups = 50 %. The strongest baseline predictor of transition was severity of depressive symptoms. The CHARMS criteria identified a group of individuals at-risk of imminent onset of severe mental disorder, particularly severe depression. Larger scale studies and longer follow-up periods are required to validate and extend these findings.

A clinical investigation of psychotic vulnerability in early-onset Obsessive-Compulsive Disorder through Cognitive-Perceptive basic symptoms

Childhood-onset Obsessive-Compulsive Disorder (OCD) shows distinct comorbidity patterns and developmental pathways, as well as an increased risk of psychosis with respect to adult-onset forms. Nevertheless, little is known about the prodromal symptoms of psychosis in children and adolescents with a primary diagnosis of OCD. The present study was aimed at evaluating the occurrence of Cognitive-Perceptual basic symptoms (COPER) and high- risk criterion Cognitive Disturbances (COGDIS) in pediatric and adults OCD patients, verifying if they might vary according to the age of onset of OCD. The study included 90 outpatients with a primary diagnosis of obsessive-compulsive disorder. The study sample was collapsed into three groups according to the age at onset: 1) very early onset group (< 10 years); 2) early onset group (11-18 years); 3) adult-onset group (> 18 years). All patients were administered the Yale-Brown Obsessive- Compulsive Scale (Y-BOCS) and its Child version (CY-BOCS), the Schizophrenia Proneness Instrument-Adult (SPIA) and its Child and Adolescent version (SPI-CY) and the Social and Occupational Functioning Assessment Scale (SOFAS). COPER and COGDIS symptoms were positively associated with OCD severity and detectable, respectively, in 28.9 and 26.7% of our study sample. The very early onset group significantly had higher COPER and COGDIS symptoms than the adult-onset group. Our data suggest that COPER and COGDIS symptoms are frequent in obsessive patients, in particular in those with earlier onset; therefore, their detection in childhood-onset OCD may represent an early and specific indicator of psychotic vulnerability.

The Relationship between Childhood Trauma Experiences and Psychotic Vulnerability in Obsessive Compulsive Disorder: An Italian Cross-Sectional Study

People with obsessive compulsive disorder (OCD) are at increased risk of developing psychotic disorders; yet little is known about specific clinical features which might hint at this vulnerability. The present study was aimed at elucidating the pathophysiological mechanism linking OCD to psychosis through the investigation of childhood trauma experiences in adolescents and adults with OCD. One hundred outpatients, aged between 12 and 65 years old, were administered the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and its Child version (CY-BOCS), as well as the Childhood Trauma Questionnaire (CTQ); Cognitive-Perceptual basic symptoms (COPER) and high-risk criterion Cognitive Disturbances (COGDIS) were assessed in the study sample. Greater childhood trauma experiences were found to predict psychotic vulnerability (p = 0.018), as well as more severe OCD symptoms (p = 0.010) and an earlier age of OCD onset (p = 0.050). Participants with psychotic vulnerability reported higher scores on childhood trauma experiences (p = 0.02), specifically in the emotional neglect domain (p = 0.01). In turn, emotional neglect and psychotic vulnerability were found higher in the pediatric group than in the adult group (p = 0.01). Our findings suggest that childhood trauma in people with OCD may represent an indicator of psychotic vulnerability, especially in those with an earlier OCD onset. Research on the pathogenic pathways linking trauma, OCD, and psychosis is needed.

Life-threatening obsessive-compulsive disorder precipitated by the COVID-19 pandemic in an adolescent

The COVID-19 pandemic starting in 2020 has had massive mental health consequences worldwide. It has caused generalised fear and anxiety about catching, spreading and suffering from the virus. This article describes a fictionalised patient's presentation of life-threatening obsessive-compulsive disorder (OCD) associated with fears of catching COVID-19. The fears resulted in refusal to eat and drink, with subsequent weight loss that required paediatric admission. The scenario portrays the association between COVID-19 and life-threatening OCD symptoms and goes on to illustrate the patient's good response to standard OCD treatments.

Closing the Gap for Children with OCD: A Staged-Care Model of Cognitive Behavioural Therapy with Exposure and Response Prevention

Childhood obsessive-compulsive disorder (OCD) is among the most prevalent and disabling mental health conditions affecting children and adolescents. Although the distress and burden associated with childhood OCD are well documented and empirically supported treatments are available, there remains an unacceptable "treatment gap" and "quality gap" in the provision of services for youth suffering from OCD. The treatment gap represents the large number of children who never receive mental health services for OCD, while the quality gap refers to the children and young people who do access services, but do not receive evidence-based, cognitive behavioural therapy with exposure and response prevention (CBT-ERP). We propose a novel staged-care model of CBT-ERP that aims to improve the treatment access to high-quality CBT-ERP, as well as enhance the treatment outcomes for youth. In staged care, patients receive hierarchically arranged service packages that vary according to the intensity, duration, and mix of treatment options, with provision of care from prevention, early intervention, through to first and second-line treatments. Based on a comprehensive review of the literature on treatment outcomes and predictors of treatments response, we propose a preliminary staging algorithm to determine the level of clinical care, informed by three key determinants: severity of illness, comorbidity, and prior treatment history. The proposed clinical staging model for paediatric OCD prioritises high-quality care for children at all stages and levels of illness, utilising empirically supported CBT-ERP, across multiple modalities, combined with evidence-informed, clinical decision-making heuristics. While informed by evidence, the proposed staging model requires empirical validation before it is ready for prime time.

Understanding the support needs of parents of children with obsessive-compulsive disorder: a qualitative descriptive study in the UK

INTRODUCTION

Caring for a child with obsessive-compulsive disorder (OCD) can be extremely difficult, yet evidence-based support strategies for parents/carers are limited. A detailed understanding of parent support needs is an important first step in intervention development and qualitative research with this focus is currently lacking. In this study, the viewpoints of parents and professionals were used to understand support needs and preferences when caring for a child with OCD. This qualitative descriptive study formed part of a wider UK-based project aimed at developing better support for parents of children with OCD.

METHOD

Individual semi-structured interviews (and an optional one-week journal) with a purposive sample of parents of children and young people (CYP) with OCD, aged 8-18, and focus groups (or individual interviews where preferred) with a purposive sample of professionals supporting CYP with OCD. Data comprised transcripts of audio-recorded interviews and focus groups, and text from journals. Analysis was informed by the Framework approach involving inductive and deductive coding, supported by NVivo 12.0 software. Co-production methods were adopted throughout the research process, including the involvement of a parent co-researcher and charity collaborators.

RESULTS

Interviews were undertaken with 20 parents, of which 16 completed a journal. Twenty-five professionals took part in a focus group or interview. Five key themes relating to parent support challenges and support needs/preferences were identified (1) Coping with the impact of OCD; (2) Getting help for my child; (3) Understanding parents' role; (4) Making sense of OCD; (5) Joined-up care.

CONCLUSION

Parents caring for children with OCD have clear caregiver support needs which are currently not being met. Through triangulation of parent and professional accounts, this study has identified parent support challenges (e.g., emotional impact of OCD, visibility of caring role, misunderstanding about OCD) and support needs/ preferences (e.g., headspace/respite, compassion/sensitivity, guidance on accommodation) to lay the vital foundations for the development of effective parent support interventions. There is now an urgent need to develop and test an intervention to support parents in their caregiving role, with the aim of preventing and/or reducing their levels of burden and distress and ultimately, improving their quality of life.

Error-related brain activity: A time-domain and time-frequency investigation in pediatric obsessive-compulsive disorder

Increased error-related negativity (ERN), a measure of error monitoring, has been suggested as a biomarker of obsessive-compulsive disorder (OCD). Additional insight into error monitoring is possible using time-frequency decomposition of electroencephalographic (EEG) data, as it allows disentangling the brain's parallel processing of information. Greater error-related theta is thought to reflect an error detection signal, while delta activity may reflect more elaborative post-detection processes (i.e., strategic adjustments). Recent investigations show that decreased error-related alpha may index attentional engagement following errors; additionally, increases and decreases in error-related beta could reflect motor inhibition and motor preparation, respectively. However, time-frequency dynamics of error monitoring in OCD are largely unknown. The present study examined time-frequency theta, delta, alpha and beta power in early adolescents with OCD using a data-driven, cluster-based approach. The aim was to explore electrocortical measures of error monitoring in early adolescents with (n = 27, 15 females) and without OCD (n = 27, 14 females) during an arrowhead version of the flanker task while EEG activity was recorded. Results indicated that the OCD group was characterized by increased ERN and error-related theta, as well as reduced error-related beta power decrease (i.e., greater power) compared to participants without OCD. Greater error-related beta explained variance in OCD over and above the ERN and error-related theta. By examining separate time-frequency measures, the present study provides novel insights into the dynamics of error monitoring, suggesting that pediatric OCD may be characterized by enhanced error monitoring (i.e., greater theta power) and post-error inhibition (i.e., reduced beta power decrease).

Childhood Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD) frequently affects children and adolescents, with most cases beginning during this time. Symptoms of OCD in youth may present as exaggerated developmental concerns and excessive ritualistic behavior beyond what is part of normal development, yet low levels of insight may prevent recognition. Affected youth commonly have comorbid neurodevelopmental diagnoses, especially males. Early detection and intervention are critical to recovery and remission, as well as family involvement in treatment. Cognitive behavioral therapy and serotonin reuptake inhibitors are first-line treatments.

Screen Time and Obsessive-Compulsive Disorder Among Children 9-10 Years Old: A Prospective Cohort Study

PURPOSE

The aim of this study is to determine the prospective associations between baseline screen time and obsessive-compulsive disorder (OCD) at 2-year follow-up in a national (United States) cohort of 9- to 10-year-old children.

METHODS

We analyzed prospective cohort data from the Adolescent Brain Cognitive Development study (n = 9,208). Logistic regression analyses were used to determine the associations between baseline self-reported screen time (exposure) and OCD, based on the Kiddie Schedule for Affective Disorders and Schizophrenia (outcome), at 2-year-follow-up, adjusting for race/ethnicity, sex, household income, parent education, family history of psychopathology, and study site, excluding participants with baseline OCD.

RESULTS

The sample was 48.9% female and racially and ethnically diverse (43.5% non-White). Each additional hour of total screen time was prospectively associated with 1.05 higher odds of OCD at 2-year follow-up (95% confidence interval [CI] 1.01-1.09). For specific screen time modalities, each additional hour of playing video games (adjusted odds ratio 1.15, 95% CI 1.03-1.28) and watching videos (adjusted odds ratio 1.11, 95% CI 1.01-1.23) was associated with a subsequent OCD diagnosis.

CONCLUSION

Video games and watching videos are prospectively associated with new-onset OCD in early adolescents. Future research should examine mechanisms linking these specific screen modalities to OCD development to inform future prevention and intervention efforts.

Dysfunctional Beliefs and Cognitive Performance across Symptom Dimensions in Childhood and Adolescent OCD

Although etiological and maintenance cognitive factors have proved effective in predicting the disease course in youths with OCD, their contribution to symptom severity and specific OCD dimensions has been scarcely examined. In a cohort of children and adolescents with OCD (N = 41; mean age = 14; age range = 10-18 yrs.), we investigated whether certain dysfunctional beliefs and cognitive traits could predict symptom severity, and whether they were differentially associated with specific symptom dimensions. We found that self-oriented and socially prescribed perfectionism and intolerance to uncertainty were associated with higher obsession severity, which was not uniquely related to any neuropsychological variable. Greater severity of obsessions and compulsions about harm due to aggression/injury/violence/natural disasters was predicted by excessive concerns with the expectations of other people. Severity in this dimension was additionally predicted by decreasing accuracy in performing a problem-solving, non-verbal reasoning task, which was also a significant predictor of severity of obsessions about symmetry and compulsions to count or order/arrange. Apart from corroborating both the belief-based and neuropsychological models of OCD, our findings substantiate for the first time the specificity of certain dysfunctional beliefs and cognitive traits in two definite symptom dimensions in youth. This bears important clinical implications for developing treatment strategies to deal with unique dysfunctional core beliefs, and possibly for preventing illness chronicity.

Suicidal Ideation and Obsessive-Compulsive Disorder: Links and Knowledge

Suicidal ideation (SI) is understudied in obsessive-compulsive disorder (OCD). Nonetheless, evidence suggests increased risk for SI in individuals with OCD compared to the general population. Understanding the relationship between SI and OCD involves investigating risk factors associated with SI. Furthering knowledge of links is essential for enhancing outcomes and decreasing experiences of SI through improving treatment interventions. Additionally, increasing awareness of factors that lead SI to suicide attempts (SA) is vital. To best illustrate the current state of knowledge, this scoping review examines risk factors for SI, including symptom profiles or phenotypes, comorbid diagnoses, sociodemographic and lifestyle factors, childhood trauma, and genetic and familial contributions. Important treatment considerations for targeting SI within the context of OCD are detailed with respect to the current evidence for psychotherapy, pharmacology, brain stimulation, and neurosurgery. Gaps in the literature and future directions are identified, broadly with respect to studies examining the treatment of SI within the context of OCD, particular OCD phenotypes, and factors influencing SI in pediatric OCD. Due to the relative novelty of this area of exploration, many unknowns persist regarding onset of SI in OCD, factors contributing to the maintenance of SI in OCD, and relevant treatment protocols. Findings suggest that individuals with previous SI or SA, history of childhood trauma, significant life stress, and psychiatric comorbidities, particularly depression, should be closely monitored and screened for SI.

Symptom improvement and remission in untreated adults seeking treatment for obsessive-compulsive disorder: A systematic review and meta-analysis

Obsessive-compulsive disorder (OCD) is a common psychiatric condition that results in significant distress and impairment, and high societal costs. OCD is widely considered to be a chronic condition, however, our understanding of the chronicity of the disorder, and the incidence of spontaneous remission, has largely relied on longitudinal studies of individuals who have received treatment. The aim of the current study is to examine symptom improvement and rate of spontaneous remission in individuals with OCD who were assigned to a no-treatment control group within a randomized controlled trial using a meta-analytic approach. Twelve studies (n = 282; mean age = 35.52; 60.03 % female) were included in the meta-analysis. The pooled within-group effect size was negligible (g = -0.14; 95 % CI [-0.25, -0.04]) and only 4 % of participants demonstrated spontaneous remission across an average of 10.92 weeks (event rate = 0.04; [95 % CI: 0.01, 0.11]). Sample size and duration of OCD symptoms significantly moderated the effect size for symptom change. No moderators were found for symptom remission. The findings add to the small body of literature demonstrating that OCD has a chronic and unremitting course without treatment.

Inhibitory control in obsessive compulsive disorder: A systematic review and activation likelihood estimation meta-analysis of functional magnetic resonance imaging studies

BACKGROUND

Patients with obsessive compulsive disorder (OCD) often show deficits in inhibitory control, which may underlie poor control over obsessions and compulsions. Several functional magnetic resonance imaging (fMRI) experiments utilizing a variety of tasks have investigated the neural correlates of inhibitory control in OCD. Evidence from existing meta-analyses suggests aberrant activation of regions in fronto-striatal circuits during inhibitory control. However, new fMRI articles have since been published, and a more rigorous methodology for neuroimaging meta-analyses is now available.

OBJECTIVES

First, to reevaluate the evidence for abnormal brain activation during performance of inhibitory control tasks in OCD while adhering to current best practices for meta-analyses, and second, to extend previous findings by separately assessing different subprocesses of inhibitory control.

METHOD

We systematically searched Web of Knowledge, ScienceDirect, Scopus, PubMed and the functional BrainMap database for fMRI articles that compared activation during performance of inhibitory control tasks in patients with OCD and healthy control (HC) subjects. Thirty-five experiments from 21 articles met our criteria for inclusion. We first performed activation-likelihood-estimation meta-analyses to elucidate brain areas in which case-control activation differences converged across articles and tasks. We then aimed to extend previous work by separately evaluating experiments requiring inhibition of a prepotent response without execution of an alternative response (i.e., response inhibition) and experiments requiring inhibition of a prepotent response and execution of an alternative response (i.e., cognitive inhibition).

RESULTS

The 35 experiments included a total of 394 patients and 410 controls. We did not find evidence of abnormal brain activation in OCD during inhibitory control when pooling data from all experiments. Analysis restricted to cognitive inhibition experiments showed abnormal activation of the dorsal anterior cingulate cortex (dACC; P = .04, cluster-level familywise error-corrected, cluster volume of 824 mm³). We did not have sufficient data to evaluate response inhibition experiments separately.

CONCLUSION

Findings of abnormal brain activation in OCD from different inhibitory control tasks do not appear to converge on the same brain regions, but the dACC may be implicated in abnormal cognitive inhibition. Our findings highlight a need for experiments that specifically target subprocesses of inhibitory control to achieve a more differentiated understanding of the neural correlates for impaired inhibitory control in OCD.

The global assessment of OCD

Obsessive Compulsive Disorder (OCD) is a common mental disorder that often causes great sufferance, with substantial impairment in social functioning and quality of life and affects family and significant relationships. Notwithstanding its severity, OCD is often not adequately diagnosed, or it is diagnosed with delay, leading often to a long latency between onset of the OCD symptoms and the start of adequate treatments. Several factors contribute to the complexity of OCD's clinical picture: early age of onset, chronic course, heterogeneity of symptoms, high rate of comorbidity with other psychiatric disorders, slow or partial response to therapy. Therefore, it is of primary importance for clinicians involved in diagnosing OCD, to assess all aspects of the disorder. This narrative review focuses on the global assessment of OCD, highlighting crucial areas to explore, pointing out the clinical features which are relevant for the treatment of the disorder, and giving an overview of the psychometric tools that can be useful during the screening procedure.

Convergence mechanism of mindfulness intervention in treating attention deficit hyperactivity disorder: Clues from current evidence

This paper reviews the underlying evidence for various aspects of the convergence mechanism of mindfulness intervention in attention deficit hyperactivity disorder (ADHD). There may be compatibility among various ADHD remission models and the therapeutic mechanism of mindfulness intervention in ADHD may be mainly via the convergence mechanism. However, neuroimaging-based analysis of the mechanisms of mindfulness intervention in treating ADHD is lacking. Differences in the efficacy of various subtypes of mindfulness intervention, and corresponding specific imaging changes need further investigation. Future research may focus on the neuroimaging features of specific mindfulness intervention subtypes.

Provider perceptions of telehealth and in-person exposure and response prevention for obsessive-compulsive disorder

Until recently, psychotherapies, including exposure and response prevention (ERP) for obsessive-compulsive disorder (OCD), have primarily been delivered in-person. The COVID-19 pandemic required OCD providers delivering ERP to quickly transition to telehealth services. While evidence supports telehealth ERP delivery, limited research has examined OCD provider perceptions about patient characteristics that are most appropriate for this modality, as well as provider abilities to identify and address factors interfering with effective telehealth ERP. In the present study, OCD therapists (N = 113) rated the feasibility of delivering telehealth ERP relative to in-person for different (1) patient age-groups, (2) levels of OCD severity, and (3) provider ability to identify and address factors interfering with ERP during in-person and telehealth ERP (e.g., cognitive avoidance, reassurance seeking, etc.). Providers reported significantly greater feasibility of delivering telehealth ERP to individuals ages 13-to-65-years relative to other age groups assessed. Greater perceived feasibility for telehealth relative to in-person ERP was reported for lower versus higher symptom severity levels. Lastly, providers felt better able to identify and address problematic factors in-person. These findings suggest that providers should practice appropriate caution when offering telehealth ERP for certain patients with OCD. Future research may examine how to address these potential limitations of telehealth ERP delivery.

Hand Washing: When Ritual Behavior Protects! Obsessive-Compulsive Symptoms in Young People during the COVID-19 Pandemic: A Narrative Review

The Coronavirus Disease 2019 (COVID-19) pandemic had a profound impact on the lifestyles and mental health of young people. It has been hypothesized that the focus on hygiene and the fear of contamination/infection during the pandemic may have exacerbated obsessive–compulsive (OC) symptoms in this population. OC symptoms are widespread in the general population, with varying degrees of intensity. At their most extreme, they manifest in obsessive–compulsive disorder (OCD), which is characterized by obsessive thoughts and compulsive behaviors. The present narrative review aimed at evaluating the relationship between the COVID-19 pandemic and OCD and OC symptoms in young people, especially children and adolescents with and without OCD, focusing on vulnerability and risk factors and the impact of lockdown measures. Of the six studies identified, four examined clinical samples diagnosed with OCD and two looked at community-based adolescent samples. Five of the six studies found that OC symptoms increased during the pandemic. Additionally, vulnerability to anxiety may constitute a risk condition and the lockdown measures and personal stressful life events can constitute potential triggers of OC symptoms, while ongoing treatment for OCD had a protective effect. The results suggest that, during the COVID-19 pandemic, obsessive and compulsive behavior (e.g., hand washing) in young people at the greatest risk should be monitored, and the intervention of mental health services should be maintained. More research is needed in this area.

Impaired differential learning of fear versus safety signs in obsessive-compulsive disorder

Pavlovian learning mechanisms are of great importance both for models of psychiatric disorders and treatment approaches, but understudied in obsessive-compulsive disorder (OCD). Using an established Pavlovian fear conditioning and reversal procedure, we studied skin conductance responses in 41 patients with OCD and in 32 matched healthy control participants. Within both groups, fear acquisition and reversal effects were evident. When comparing groups, patients showed impaired differential learning of threatening and safe stimuli, consistent with previous research. In contrast to prior findings, differential learning impairments were restricted to fear acquisition, and not observed in the reversal stage of the experiment. As previous and present fear reversal experiments in OCD differed in the use of color coding to facilitate stimulus discrimination, the studies converge to suggest that differential learning of threatening versus safe stimuli is impaired in OCD, but manifests itself differently depending on the difficulty of the association to be learned. When supported by the addition of color, patients with OCD previously appeared to acquire an association early but failed to reverse it according to changed contingencies. In absence of such color coding of stimuli, our data suggest that patients with OCD already show differential learning impairments during fear acquisition, which may relate to findings of altered coping with uncertainty previously observed in OCD. Impaired differential learning of threatening versus safe stimuli should be studied further in OCD, in order to determine whether impairments in differential learning predict treatment outcomes in patients, and whether they are etiologically relevant for OCD.