3.91 Temperamental Dimensions of Pediatric OCD: Influence of ADHD and Tourette’s Disorder

Abstract

ObjectivesPediatric OCD is frequently co-occurrent with ADHD and Tourette’s disorder (TD), which are disorders characterized by disinhibition. This study explores the temperamental profile in the complex phenotype OCD + (ADHD and TD).MethodsA clinical registry of 126 youth with OCD (61.90% male, 88.90% White) between ages 6 and 18 years (12.68 ± 3.05) was used to record psychiatric diagnoses by an experienced clinician (MG), and data on temperamental traits were collected from the parent-reported Junior Temperament and Character Inventory (JTCI). Temperamental dimensions include novelty seeking (exploratory behaviors and excitability), harm avoidance (worry and fear of uncertainty), reward dependence (sentimentality and support seeking), and persistence (perseverance and perfectionism). Participants were divided into 3 groups: 1) OCD only; 2) OCD + (ADHD or TD); 3) OCD + (ADHD and TD). The 3 clinical groups were tested for: 1) differences in traits between groups using t tests; 2) the effects of ADHD and/or TD in the traits using test of trends; and 3) the effects of sex, age, and OCD symptom dimensions.ResultsNovelty seeking (exploratory behaviors and excitability) is significantly increased in the OCD + (ADHD and TD) group (p < .001), most notably due to comorbid ADHD combined, and not ADHD inattentive. Persistence (perseverance and perfectionism) is inversely correlated with novelty seeking (p < .001) and significantly decreased in the OCD + (ADHD and TD) group (p < .001). Harm avoidance (fear of uncertainty) is high in all clinical groups regardless of ADHD and/or TD diagnoses, and thus it can be surmised as a core feature of OCD. Sex and age subanalyses show that novelty seeking increases in the OCD + (ADHD and TD) in males only (p < .01). Harm avoidance (fear of uncertainty) is associated with the aggressive/somatic/checking cluster (p < .01) and persistence with the repeating/counting/ordering cluster (p < .05). A limitation of this study is the lack of a temperamental trait control group.ConclusionsOCD + (ADHD and TD), a phenotype plausibly characterized by a high level of disinhibitory symptoms, is associated with high novelty seeking and low persistence. Temperamental traits can refine the phenotype of pediatric OCD for future research.TEMP, OCD, CM ObjectivesPediatric OCD is frequently co-occurrent with ADHD and Tourette’s disorder (TD), which are disorders characterized by disinhibition. This study explores the temperamental profile in the complex phenotype OCD + (ADHD and TD). Pediatric OCD is frequently co-occurrent with ADHD and Tourette’s disorder (TD), which are disorders characterized by disinhibition. This study explores the temperamental profile in the complex phenotype OCD + (ADHD and TD). MethodsA clinical registry of 126 youth with OCD (61.90% male, 88.90% White) between ages 6 and 18 years (12.68 ± 3.05) was used to record psychiatric diagnoses by an experienced clinician (MG), and data on temperamental traits were collected from the parent-reported Junior Temperament and Character Inventory (JTCI). Temperamental dimensions include novelty seeking (exploratory behaviors and excitability), harm avoidance (worry and fear of uncertainty), reward dependence (sentimentality and support seeking), and persistence (perseverance and perfectionism). Participants were divided into 3 groups: 1) OCD only; 2) OCD + (ADHD or TD); 3) OCD + (ADHD and TD). The 3 clinical groups were tested for: 1) differences in traits between groups using t tests; 2) the effects of ADHD and/or TD in the traits using test of trends; and 3) the effects of sex, age, and OCD symptom dimensions. A clinical registry of 126 youth with OCD (61.90% male, 88.90% White) between ages 6 and 18 years (12.68 ± 3.05) was used to record psychiatric diagnoses by an experienced clinician (MG), and data on temperamental traits were collected from the parent-reported Junior Temperament and Character Inventory (JTCI). Temperamental dimensions include novelty seeking (exploratory behaviors and excitability), harm avoidance (worry and fear of uncertainty), reward dependence (sentimentality and support seeking), and persistence (perseverance and perfectionism). Participants were divided into 3 groups: 1) OCD only; 2) OCD + (ADHD or TD); 3) OCD + (ADHD and TD). The 3 clinical groups were tested for: 1) differences in traits between groups using t tests; 2) the effects of ADHD and/or TD in the traits using test of trends; and 3) the effects of sex, age, and OCD symptom dimensions. ResultsNovelty seeking (exploratory behaviors and excitability) is significantly increased in the OCD + (ADHD and TD) group (p < .001), most notably due to comorbid ADHD combined, and not ADHD inattentive. Persistence (perseverance and perfectionism) is inversely correlated with novelty seeking (p < .001) and significantly decreased in the OCD + (ADHD and TD) group (p < .001). Harm avoidance (fear of uncertainty) is high in all clinical groups regardless of ADHD and/or TD diagnoses, and thus it can be surmised as a core feature of OCD. Sex and age subanalyses show that novelty seeking increases in the OCD + (ADHD and TD) in males only (p < .01). Harm avoidance (fear of uncertainty) is associated with the aggressive/somatic/checking cluster (p < .01) and persistence with the repeating/counting/ordering cluster (p < .05). A limitation of this study is the lack of a temperamental trait control group. Novelty seeking (exploratory behaviors and excitability) is significantly increased in the OCD + (ADHD and TD) group (p < .001), most notably due to comorbid ADHD combined, and not ADHD inattentive. Persistence (perseverance and perfectionism) is inversely correlated with novelty seeking (p < .001) and significantly decreased in the OCD + (ADHD and TD) group (p < .001). Harm avoidance (fear of uncertainty) is high in all clinical groups regardless of ADHD and/or TD diagnoses, and thus it can be surmised as a core feature of OCD. Sex and age subanalyses show that novelty seeking increases in the OCD + (ADHD and TD) in males only (p < .01). Harm avoidance (fear of uncertainty) is associated with the aggressive/somatic/checking cluster (p < .01) and persistence with the repeating/counting/ordering cluster (p < .05). A limitation of this study is the lack of a temperamental trait control group. ConclusionsOCD + (ADHD and TD), a phenotype plausibly characterized by a high level of disinhibitory symptoms, is associated with high novelty seeking and low persistence. Temperamental traits can refine the phenotype of pediatric OCD for future research.TEMP, OCD, CM OCD + (ADHD and TD), a phenotype plausibly characterized by a high level of disinhibitory symptoms, is associated with high novelty seeking and low persistence. Temperamental traits can refine the phenotype of pediatric OCD for future research.