Neuropsychological performance in youth with obsessive-compulsive disorder

Area of Science:

• Neuropsychology
• Child and Adolescent Psychiatry
• Cognitive Neuroscience

Background:

• Limited research exists on neuropsychological deficits in youth with obsessive-compulsive disorder (OCD).
• Previous studies often have small sample sizes and inconsistent findings, with a recent meta-analysis finding no significant impairments.
• Existing literature suggests potential cognitive alterations in adults with OCD, particularly related to executive functions.

Purpose of the Study:

• To investigate a broad range of neuropsychological functions in a large sample of youth diagnosed with OCD.
• To compare the performance of youth with OCD to a control group of healthy peers.
• To identify specific cognitive domains affected by OCD in adolescents and young adults.

Main Methods:

• A large cohort of youth with OCD (n=97) and a control group (n=50) were assessed on multiple neuropsychological tests.
• Tests included measures of attention, verbal fluency, working memory, set-shifting, response inhibition, planning, and visuospatial abilities.
• Statistical analyses controlled for potential confounding factors such as age, sex, comorbid conditions (ADHD, tic disorders), depression and anxiety severity, and non-verbal intelligence.

Main Results:

• Youth with OCD demonstrated significant underperformance, with large effect sizes, specifically on the Object Alternation Test measuring behavioral reversal (set-shifting).
• Patients with OCD showed significantly more trials to criterion and perseverative errors compared to controls.
• While a trend towards underperformance in planning was observed, it did not reach statistical significance. Comorbidities, antipsychotic use, and age of onset did not significantly impact results.

Conclusions:

• This study provides strong evidence for impaired set-shifting, specifically behavioral reversal, in youth with OCD.
• Findings suggest potential planning deficits in this population, consistent with adult OCD research and the fronto-striatal model of OCD.
• Neuropsychological impairments may accumulate over time as OCD progresses into adulthood, highlighting the need for early intervention.