Impaired cognitive plasticity and goal-directed control in adolescent obsessive-compulsive disorder.

Julia Gottwald,Akeem Sule,Sharon Morein-Zamir,Trevor W Robbins,Annemieke M Apergis-Schoute,Francesca Cormack,Anna Conway Morris,Sanne De Wit,Barbara J Sahakian,Muzaffer Kaser,Winifred Limmer

doi:10.1017/s0033291717003464

Abstract

Youths with obsessive-compulsive disorder (OCD) experience severe distress and impaired functioning at school and at home. Critical cognitive domains for daily functioning and academic success are learning, memory, cognitive flexibility and goal-directed behavioural control. Performance in these important domains among teenagers with OCD was therefore investigated in this study. A total of 36 youths with OCD and 36 healthy comparison subjects completed two memory tasks: Pattern Recognition Memory (PRM) and Paired Associates Learning (PAL); as well as the Intra-Extra Dimensional Set Shift (IED) task to quantitatively gauge learning as well as cognitive flexibility. A subset of 30 participants of each group also completed a Differential-Outcome Effect (DOE) task followed by a Slips-of-Action Task, designed to assess the balance of goal-directed and habitual behavioural control. Adolescent OCD patients showed a significant learning and memory impairment. Compared with healthy comparison subjects, they made more errors on PRM and PAL and in the first stages of IED involving discrimination and reversal learning. Patients were also slower to learn about contingencies in the DOE task and were less sensitive to outcome devaluation, suggesting an impairment in goal-directed control. This study advances the characterization of juvenile OCD. Patients demonstrated impairments in all learning and memory tasks. We also provide the first experimental evidence of impaired goal-directed control and lack of cognitive plasticity early in the development of OCD. The extent to which the impairments in these cognitive domains impact academic performance and symptom development warrants further investigation.

Highlights

Obsessive–compulsive disorder (OCD) in children and adolescents is a distressing condition, which is often chronic and persists into adulthood (Micali et al 2010)
Thirty-six participants diagnosed with obsessive–compulsive disorder (OCD) (69% female) were recruited from Child and Adolescent Mental Health Services, through independent charities, and adverts on social media
It was adopted by the NIHR Clinical Research Network (CRN) Portfolio (9532) and the study information was publicly available on the UK CRN Portfolio website

Summary

Introduction

Obsessive–compulsive disorder (OCD) in children and adolescents is a distressing condition, which is often chronic and persists into adulthood (Micali et al 2010). Goal-directed action control, on the other hand, allows us to base our actions on the value of the anticipated outcome and to flexibly adjust our actions when the outcome is no longer desirable (de Wit & Dickinson, 2009). Impairments in these domains could have serious widespread consequences, especially in young, still developing individuals. Critical cognitive domains for daily functioning and academic success are learning, memory, cognitive flexibility and goal-directed behavioural control. Performance in these important domains among teenagers with OCD was investigated in this study. The extent to which the impairments in these cognitive domains impact academic performance and symptom development warrants further investigation

Methods

Results

Conclusion