Functional magnetic resonance imaging during planning before and after cognitive-behavioral therapy in pediatric
Chaim Huyser1, Dick J Veltman, Lidewij H Wolters
1De Bascule, Center for Child and Adolescent Psychiatry, Amsterdam, The Netherlands. c.huyser@debascule.com
Insights
Pediatric obsessive compulsive disorder (OCD) involves planning deficits and altered brain activity, which improve with cognitive behavioral therapy. These planning impairments are likely a temporary state, not a permanent trait, in children with OCD.
Area of Science:
- Neuroscience
- Child and Adolescent Psychiatry
- Cognitive Psychology
Background:
- Pediatric obsessive compulsive disorder (OCD) is linked to executive function deficits, particularly in planning.
- Dysfunction in frontal-striatal-thalamic circuitry is implicated in pediatric OCD.
- Executive impairments may be a core feature of pediatric OCD.
Purpose of the Study:
- To investigate planning deficits in pediatric OCD.
- To examine the association between planning impairments and frontal-striatal-thalamic dysfunction.
- To determine if these deficits and dysfunction normalize after treatment.
Main Methods:
- Functional magnetic resonance imaging (fMRI) using a planning task (Tower of London) was performed on 25 children with OCD and 25 controls.
- Patients underwent fMRI before and after 16 cognitive behavioral therapy sessions.
- Controls were rescanned after a similar interval.
Main Results:
- Children with OCD were slower but equally accurate on the planning task compared to controls.
- Patients showed reduced recruitment of frontal and parietal regions during planning.
- Post-treatment, brain activity differences normalized, with reduced right posterior prefrontal activity in patients.
Conclusions:
- Pediatric OCD is associated with subtle planning impairments and altered prefrontal and parietal brain activity.
- Cognitive behavioral therapy effectively normalized these planning deficits and associated neural dysfunction.
- Planning dysfunction appears to be a state-dependent feature of pediatric OCD, not a trait.
Objective:
Pediatric obsessive compulsive disorder (OCD) has been associated with cognitive abnormalities, in particular executive impairments, and dysfunction of frontal-striatal-thalamic circuitry. The aim of this study was to investigate if planning as an executive function is compromised in pediatric OCD and is associated with frontal-striatal-thalamic dysfunction, and if this dysfunction would normalize after successful treatment.
Method:
Twenty-five medication-free pediatric patients (mean ± SD 13.95 ± 2.52 years old, range 9 to 19 years) with OCD and 25 healthy controls, matched by age and gender, were scanned twice using a self-paced pseudo-randomized event-related functional magnetic resonance imaging version of the Tower of London. Patients were rescanned after 16 sessions of protocol-based cognitive behavioral therapy; healthy controls were rescanned after a similar interval.
Results:
Patients performed the task significantly slower but with similar accuracy compared with controls. Neuroimaging results showed less recruitment of frontal and parietal regions in patients with OCD compared with controls during the planning versus control task. With increasing task load patients compared with controls showed more recruitment of ventrolateral and medial prefrontal cortex and insula and anterior cingulate cortex. After treatment, these differences ceased to be significant, with time by group by task load interaction analyses showing a significant decrease in right posterior prefrontal activity in patients with OCD compared with healthy controls.
Conclusion:
Pediatric patients with OCD showed subtle planning impairments and decreased dorsolateral prefrontal and parietal recruitment that normalized after cognitive behavioral treatment. Planning dysfunction is likely to be a state rather than a trait feature of pediatric OCD.
