Neuroimaging and neuropsychological findings in pediatric obsessive-compulsive disorder: a review and developmental considerations

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From: Neuropsychiatry(Vol. 2, Issue 4)
Publisher: Future Medicine Ltd.
Document Type: Article
Length: 11,679 words
Lexile Measure: 1550L

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Author(s): Amitai Abramovitch [*] 3 , Andrew Mittelman 2 , Aude Henin 1 2 , Daniel Geller 1 2

Practice points

* Pediatric obsessive-compulsive disorder (OCD) appears to be distinct from its adult counterpart, especially in preadolescent patients.

* In contrast to the majority of adult imaging studies, a volumetric increase has been identified in the frontal and, in particular, striatal regions in pediatric OCD.

* Imaging research indicates increased frontostriatal metabolism in the pediatric OCD population, but decreased activation in preadolescent young children.

* The decreased activation correlates with OCD symptomatology in young children and increased activation correlates with symptom severity in adolescents.

* Abnormalities in frontostriatal activity tend to normalize following successful treatment.

* Maturational reorganization, including neuronal pruning and myelination, further complicates the isolation of specific neurobiological underpinnings of OCD.

* Even more so than in the adult population, research is inconsistent with regard to the executive function deficits of children with OCD, in part because of hypothesized abnormal maturation processes in this population.

* Studies of executive functioning may be complicated by heterogeneous sample bases that span large developmental ranges.

* More neuropsychological and neurobiological pediatric OCD studies are needed and future studies are advised to incorporate a developmental perspective.

Cognitive neuroscience approaches, including neuroimaging and neuropsychological assessment, have demonstrated utility as paradigms for understanding neuropsychiatric disorders, particularly obsessive-compulsive disorder (OCD) [1,2] . An integrative approach may prove especially useful in characterizing the neuropsychological strengths or deficits associated with specific regional brain abnormalities. For example, several studies have suggested that adult OCD is characterized by a prominent impairment in response inhibition [3,4] , which could be conceptualized as an adult OCD endophenotype [5,6] . In examining pediatric OCD, neuropsychological performance may serve as a bridge between brain functioning and the phenomenology of the disorder [7] . Until recently, there has been little examination of the applicability of these models to pediatric OCD. However, studies on the developmental progression of neuronal maturation and reorganization, recent imaging and neuropsychological studies together with the extant literature on age-related progress in neuropsychological performance, suggest that neuropsychiatric models of pediatric OCD must consider the developmental context in which abnormal neuropsychological findings are expressed [8] .

The goal of this review is to present a developmental perspective on neuroanatomical and neuropsychological findings of OCD in children and adolescents. Following a brief overview of the epidemiology of OCD in youth, we review neuroanatomical theories of OCD, including evidence from structural and functional neuroimaging studies. Furthermore, we examine the neuropsychological correlates of pediatric OCD. Notably, we present a succinct review of findings from adult OCD studies in each section, and where applicable, pediatric-adult comparisons are discussed. Finally, we integrate these findings within a developmental framework that stresses both normal and abnormal processes in the pathogenesis of OCD, and caution the use of adult models in the evaluation of childhood disorders.


Worldwide prevalence rates of pediatric OCD range from 1 to 3% [9,10] , similar to prevalence estimates in adults [11] . As such, this similarity appears puzzling when considering the appearance of new adult cases and in light of reports suggesting that 25-50%...

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Gale Document Number: GALE|A323966339