title: Developmental aspects of error and high-conflict-related brain activity in pediatric obsessive-compulsive disorder: a fMRI study with a Flanker task before and after CBT.
abstract: BACKGROUND
  Heightened error and conflict monitoring are considered central mechanisms in obsessive-compulsive disorder (OCD) and are associated with anterior cingulate cortex (ACC) function. Pediatric obsessive-compulsive patients provide an opportunity to investigate the development of this area and its associations with psychopathology.
  
  
  METHODS
  Repeated measures were carried out using functional magnetic resonance imaging (fMRI) during the performance of an interference task, the arrow version of the Flanker paradigm, before and after cognitive-behavioral treatment of 25 medication-free pediatric obsessive-compulsive patients compared with age- and gender-matched healthy controls.
  
  
  RESULTS
  During error trials compared to correct trials, pediatric OCD patients and controls showed an interaction effect of Group × Time × Age in the ACC and insula. This effect was mainly driven by an increased activation in older OCD subjects, which was also present after treatment. During high-conflict trials compared with low-conflict trials, a Group × Time × Age interaction effect was found in bilateral insula. This effect was driven by an increase of BOLD (blood oxygen level dependent) signal in older OCD patients before but not after treatment. In addition, a Group × Time interaction effect in dorsomedial prefrontal cortex, premotor region and ACC was found. This effect was driven by an increase of BOLD signal in OCD subjects relative to controls over time.
  
  
  CONCLUSIONS
  Compared to healthy controls, children and adolescents with OCD show increased activation of the ACC during error responses and in bilateral insular cortex during high-conflict tasks, which is age dependent and which is only partially affected by cognitive-behavioral therapy (CBT). Therefore, we suggest that ACC functioning is a vulnerability marker in pediatric OCD, whereas insular dysfunction may be state dependent.
authors.affiliation: De Bascule, Center for Child and Adolescent Psychiatry, Amsterdam, The Netherlands. c.huyser@debascule.com
authors.forename: Chaim
authors.initials: C
authors.lastname: Huyser
authors.forename: Dick J
authors.initials: DJ
authors.lastname: Veltman
authors.forename: Lidewij H
authors.initials: LH
authors.lastname: Wolters
authors.forename: Else
authors.initials: E
authors.lastname: de Haan
authors.forename: Frits
authors.initials: F
authors.lastname: Boer
mesh_terms: D000293:Adolescent; D000375:Aging / Q000523:psychology*; D001921:Brain / Q000503:physiopathology; D016022:Case-Control Studies; D002648:Child; D015928:Cognitive Behavioral Therapy / Q000379:methods; D003220:Conflict, Psychological; D005260:Female; D006179:Gyrus Cinguli / Q000503:physiopathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009483:Neuropsychological Tests; D009771:Obsessive-Compulsive Disorder / Q000503:physiopathology* / Q000523:psychology / Q000628:therapy*; D011597:Psychomotor Performance; D055815:Young Adult