Neuroimaging and neuropsychological findings in pediatric obsessive–compulsive disorder: a review and developmental considerations

Abstract

Pediatric obsessive-compulsive disorder (OCD) appears to be distinct from its adult counterpart, especially in preadolescent patients.In contrast to the majority of adult imaging studies, a volumetric increase has been identified in the frontal and, in particular, striatal regions in pediatric OCD.Imaging research indicates increased frontostriatal metabolism in the pediatric OCD population, but decreased activation in preadolescent young children.The decreased activation correlates with OCD symptomatology in young children and increased activation correlates with symptom severity in adolescents.Abnormalities in frontostriatal activity tend to normalize following successful treatment.Maturational reorganization, including neuronal pruning and myelination, further complicates the isolation of specific neurobiological underpinnings of OCD.Even more so than in the adult population, research is inconsistent with regard to the executive function deficits of children with OCD, in part because of hypothesized abnormal maturation processes in this population.Studies of executive functioning may be complicated by heterogeneous sample bases that span large developmental ranges.More neuropsychological and neurobiological pediatric OCD studies are needed and future studies are advised to incorporate a developmental perspective.For reprint orders, please contact: reprints@futuremedicine.com

Neuropsychological investigations in obsessive–compulsive disorder: A systematic review of methodological challenges

“…Due to the small body of neuropsychological research in pediatric OCD (for a review and meta analysis see Abramovitch et al, 2012b;Abramovitch et al, In-press), this review focuses on adult studies. A total of 207 published research articles were identified through February 2012.…”

Don’t judge a book by its cover: ADHD-like symptoms in obsessive compulsive disorder

“…(For a review see Abramovitch et al, 2012b). In brief, early onset OCD may be characterized by abnormal neuronal maturational processes.…”

Obsessive-Compulsive Disorder

“…Impairments have also been observed in some studies of planning and decisionmaking, although other studies have failed to replicate these fi ndings (Menzies et al 2008 ). Other studies have found few or no impairments on a range of executive functioning tasks in individuals with OCD (Abramovitch et al 2012 ).…”

“…Compared to healthy controls, adults with OCD tend to show reduced OFC volume (Menzies et al 2008 ;Rotge et al 2009 ) but increased glucose metabolism at rest (Harrison et al 2009 ) and in response to symptom-provocation paradigms, wherein OCD symptoms are elicited in the scanner (Rotge et al 2009 ). Notably, this hypermetabolism in the OFC and in several other regions is normalized following effective cognitive-behavioral therapy or pharmacotherapy for OCD (see Abramovitch et al 2012 for a review).…”

“…Inconsistencies in neuropsychological and neurobiological OCD research may be due to a number of factors, including small sample sizes, insuffi ciently sensitive tests, or heterogeneity of OCD symptoms (Abramovitch et al 2012 ;Milad and Rauch 2012 ). For example, compulsive hoarding was previously considered a subtype of OCD (APA 1994 ) but has been reclassifi ed as a distinct OC-spectrum disorder in DSM -5 (APA 2013 ).…”