Symptom profiles and executive function in childhood obsessive-compulsive disorder

Abstract

Obsessive-compulsive disorder (OCD) often becomes manifest in childhood. It has been suggested that the symptom heterogeneity of the disorder could mask subgroups associated with executive function (EF) impairment. Though supported in adult studies, this is scarcely investigated in children. The aims of the present study were to: (i) investigate OCD symptom subgroups using an empirically supported and age-appropriate definition of symptom dimensions (SD) as well as latent profile analysis (LPA); (ii) compare the identified subgroups with respect to EFs, demographic, and clinical descriptives; and (iii) explore the associations between SDs and EFs. The study included 50 pediatric OCD patients and 50 matched controls. Patients were assessed with the Children's Yale-Brown Obsessive-Compulsive Scale from which three SD factor scores were generated. Participants were assessed with EF tasks from which latent variables measuring working memory, set shifting and response inhibition were derived. Parents rated executive function behaviors in their children. Three subgroups were identified, each predominantly characterized by one of the SDs. Subgroups differed with respect to parent-rated working memory and several demographic and basic clinical characteristics. The findings suggest the presence of clinically relevant child and adolescent OCD SD subgroups, but do not support the relevance of EFs in distinguishing SDs. Highlights • Three obsessive-compulsive subgroups were identified, each mapping onto one of the symptom dimensions of symmetry/hoarding, harm/sexual, or contamination/cleaning. • The subgroups differed with respect to parent-reported working memory, and several basic clinical characteristics, but not performance-based executive functions.

Neural Correlates of Executive Functioning in Anorexia Nervosa and Obsessive–Compulsive Disorder

“…Set shifting difficulties have also been reported in children with OCD compared to HCs (e.g., Andrés et al, 2007 ; Shin et al, 2008 ); however, more recent studies contradict these findings, as they did not find significant associations between OCD symptoms and set shifting performance (e.g., Hybel et al, 2017a ; Geller et al, 2018 ). It is worth noting that although there is some evidence for poorer set shifting performance in children with OCD compared to HCs, this difference in performance may not be clinically meaningful (for more details, see Abramovitch et al, 2013 ) as effect sizes are relatively small (e.g., Abramovitch et al, 2015 ).…”

Everyday executive functioning in pediatric obsessive-compulsive disorder: diagnostic specificity, clinical correlations, and outcome

“…Based on previous research [ 28 ], we expect that EF deficits are elevated among youth with OCD compared to peers and that differences are largest for the EF domains of Shift, Working memory, Planning, and Inhibition. Based on previous research [ 23 , 28 ], we do not expect EF to be statistically significantly linked to OCD symptom dimensions. With respect to the comparison to youth with anxiety disorders and treatment outcome for youth with OCD, we proceed without predefined hypotheses based on non-existent studies (comparison to youth with anxiety disorders) and inconsistent results in previous studies (treatment outcome).…”

“…Differences in EF across different OCD symptom dimensions have been observed in adults [ 21 ], but few studies have examined EF across OCD symptom dimensions in pediatric OCD. However, a recent study that included parent ratings of EF using the Behavior Rating Inventory of Executive Function (BRIEF) [ 22 ] in combination with EF tasks, showed no support for the relevance of EF in relation to the symptom heterogeneity of pediatric OCD [ 23 ]. Last, few studies have examined whether EF predicts treatment outcome for youth with OCD, with current studies yielding inconsistent results [ 24 – 26 ].…”

“…As mentioned, research on rating-based EF in youth with OCD is limited, but the few published studies have shown worse EF among youth with OCD compared to healthy controls [ 23 , 26 ]. For example, one study [ 23 ] found that all three subgroups of youth with OCD (symmetry/hoarding, harm/sexual, and contamination/cleaning symptoms) had increased parent-reported difficulties with inhibition and shifting compared to healthy controls, while no associations were found between EF scores (ratings or task-based performance) and symptom dimensions.…”

“…As mentioned, research on rating-based EF in youth with OCD is limited, but the few published studies have shown worse EF among youth with OCD compared to healthy controls [ 23 , 26 ]. For example, one study [ 23 ] found that all three subgroups of youth with OCD (symmetry/hoarding, harm/sexual, and contamination/cleaning symptoms) had increased parent-reported difficulties with inhibition and shifting compared to healthy controls, while no associations were found between EF scores (ratings or task-based performance) and symptom dimensions. A recent study [ 28 ] used both EF tasks and rating scales (BRIEF) to assess EF in OCD and found that youth with OCD demonstrated greater executive dysfunction in real-life contexts (as measured with BRIEF) compared to their EF ability on performance-based tasks in controlled settings.…”