1/2 Task control circuit targets for obsessive compulsive behaviors in children - Abstract. Subclinical Obsessive-Compulsive symptoms (OCS) in early development increase risk for OC-
related impairment in adulthood, but wax and wane in middle childhood, suggesting a critical period for
overcoming symptoms. Clinically significant OCS (Obsessive compulsive Disorder, OCD) also emerge during
school age and also follow a variable course --- some patients remit, while others continue to suffer OCS, even
after gold standard, cognitive behavioral therapy (CBT). Such different OCS trajectories may derive from
differential engagement of cognitive control circuits, specifically fronto-parietal (FP) and cingulo-opercular (CO)
task control (TC) circuits, since the normal development of these circuits parallels the maturation of cognitive
control processes that are altered in pediatric OCD. Modulation of TC circuits could help to reduce childhood
OCS, but identification of the specific changes in TC circuits that coincide with OCS reductions is first required.
Our preliminary data suggests that TC alterations (e.g., increased or decreased activation) and associations
with OCS depend on the specific TC circuit (CO or FP) and component cognitive control process engaged (i.e.,
conflict resolution, error processing), as well as the age, medication status and clinical severity of the patients
studied. Accordingly, we will administer two cognitive control tasks embedded within a multi-modal imaging
protocol, using pulse sequences consistent with the Adolescent Brain and Cognitive Development study and
Human Connectome Project. We will use these cutting-edge MRI sequences to elucidate how TC circuit
changes associate with OCS reductions in unmedicated children, aged 7-12 years. Drawing from the RDoC
framework, imaging, behavioral, and clinical/self-report measures of symptoms will be collected in a large
sample of children with OCD, subclinical OCS or no OCS (n = 180 total), recruited across 2 sites. Leveraging
the normal to abnormal range of OCS represented by the combined sample, we will test the relation of TC
circuitry and cognitive control processes with OCS across the full spectrum of severity (Aim 1). In OCD-
affected children, OCS will then be manipulated with a standard, 16-week course of CBT to determine how TC
circuit changes associate with changes in OCS severity across the remission, partial response and no
response outcomes known to occur after CBT (Aim 2). Circuit-based changes will be compared to non-specific
changes in healthy children who remain OCS-free. By pinpointing which cognitive control processes and TC
circuit changes associate with reductions in OCS, this work will inform the selection of processes and neural
targets to direct cognitive trainings to treat and prevent childhood OCS, setting the stage for future clinical
trials.
