![]() ![]() The Enhancing Neuro-Imaging Genetics through Meta-Analysis (ENIGMA) consortium has recently published a number of large-scale structural studies uncovering distinct group differences between OCD and controls in adult versus childhood OCD with respect to cortical thickness, surface area ( Boedhoe et al., 2018) and symmetry ( Kong et al., 2019), as well as subcortical volumes ( Boedhoe et al., 2017). Structural and functional imaging studies have reported differences in adult- versus child-onset OCD patients. A better understanding of dimension-specific neural correlates in pediatric OCD could illuminate paths to more informed treatment options for the childhood-onset form of this disorder. Published research has recently shown that Just Right symptoms may predict treatment response ( Højgaard et al., 2018) and individuals treated in their youth are more likely to reach full remission ( Mancebo et al., 2014), whereas children who go untreated have poorer long-term prognoses ( Stewart et al., 2004). An examination across dimensions is necessary, particularly in children, given the known associations between specific symptom dimensions and clinical outcomes in this population. ![]() For instance, only one adult study has examined the sexual obsession category of the Bad Thoughts symptom dimension ( Thiel et al., 2014). Most SPT studies have not, however, studied the full range of OCD symptom dimensions ( Brooks et al., 2018). ![]() ![]() These SPT studies have been instrumental in solidifying the cortico-striato-thalamo-cortical (CSTC) neurobiological model of OCD ( Brennan and Rauch, 2017), and have demonstrated that symptoms likely emerge from five distinct but overlapping brain circuits including the CSTC ( van den Heuvel et al., 2009): the dorsal cognitive circuit, the ventral cognitive circuit, the affective circuit, the frontolimbic circuit, and the sensorimotor circuit ( van den Heuvel et al., 2016). Additionally, pediatric studies sometimes differ from adult studies with respect to factor loading: somatic symptoms can load onto the Contamination factor and checking symptoms can load onto the Just Right factor in children (for review see Bloch et al., 2008).Īlmost 30 adult and two pediatric OCD studies have used a symptom provocation task (SPT) during functional neuroimaging to probe the neural correlates of OCD symptom factors, primarily focusing on washing and checking subfactor symptoms. In some factor analyses hoarding symptoms separate out onto a forth distinct factor ( Højgaard et al., 2017). OCD-affected individuals exhibit a wide array of symptoms, with factor analyses identifying three to four dimensions: (1) a ‘Contamination’ factor comprised of obsessions around contagions and washing or cleaning compulsions (2) a taboo, forbidden, or ‘Bad Thoughts’ factor comprised of aggressive, religious, sexual, and somatic obsessions, as well as checking compulsions and (3) a symmetry or ‘Just Right’ factor comprised of symmetry obsessions as well as ordering, counting, repeating, and hoarding compulsions. Pediatric obsessive-compulsive disorder (OCD) is a common (1–3% lifetime prevalence rate Flament et al., 1988) and debilitating neuropsychiatric illness characterized by intrusive thoughts and rituals ( American Psychiatric Association, 2013). ![]()
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