Using latent patient-centered fear extinction profiles to guide treatment in pediatric OCD

While exposure with response prevention (ERP) is the frontline treatment for pediatric obsessive-compulsive disorder (OCD), not all patients benefit. Impairments in extinction learning are implicated in pediatric OCD's etiology and treatment, with impaired pre-treatment extinction learning associated with worse ERP outcomes. However, available methods for assessing patients' difficulties with fear extinction are costly and underdeveloped. In response, we used person-centered profiles to characterize latent fear extinction patterns among youth with OCD, and investigated the degree to which scores on common rating scales correspond to profile membership.

Youth with OCD (n=98) completed a diagnostic clinical battery followed by a differential fear conditioning/extinction task, in which skin conductance response (SCR) to stimuli served as the primary outcome. Parallel process growth mixture modeling (i.e., person-centered trends in concurrent change over time SCR to differential stimuli) was used to illuminate latent profiles of fear conditioning/extinction processes. The Bose-Chaudhuri-Hocquenghem method compared latent classes to identify clinical correlates of impaired extinction.

A 2-profile solution was retained. Profile 1 (85%) was characterized by typical patterns of fear acquisition and extinction learning. Profile 2 (15%) exhibited elevated levels of SCR and impairments in threat discrimination during extinction. Several items on anxiety and OCD rating scales were significantly different between profiles.

Findings identified two distinct profiles in how youth with OCD responded to a fear extinction task, with one demonstrating substantial difficulty. Future directions should examine the extent to which impaired fear extinction ability inhibits ERP effectiveness, and consider utilizing patient-centered profiles as an initial prognostic indicator of ERP appropriateness.