Brain Structural Alterations in Pediatric OCD Patients Predict Treatment Response

A new study from researchers in the Department of Psychiatry at the Columbia University Vagelos College of Physicians and Surgeons used magnetic resonance imaging (MRI) to understand brain structural alterations in children and adolescents with OCD that predict psychotherapy treatment response. The findings were published in The Journal of Child Psychology and Psychiatry.  

We spoke with the senior author, Dr. Rachel Marsh, about the key findings from the paper.

Columbia Psychiatry: What is Obsessive-compulsive disorder (OCD) and what are the primary methods for treating OCD in children?

Dr. Marsh: Obsessive-compulsive disorder (OCD) is an impairing mental health condition, which often onsets during childhood and is characterized by the presence of obsessions (i.e. intrusive thoughts, images, or urges) and compulsions (i.e. repetitive actions aimed at preventing or reducing distress). Cognitive behavioral therapy (CBT) with exposure and ritual prevention is one of the primary psychotherapy methods for treating OCD in children. While CBT is an effective treatment for OCD, not all patients will show improvements with therapy.

Columbia Psychiatry: Your team used MRI to study brain structure in children and adolescents with OCD. How big was the sample size that you examined?

Dr. Marsh: We examined data from 28 7-18-year-olds with OCD and 27 unaffected youths who completed MRI scans. The patients with OCD then completed exposure and ritual prevention CBT.

Columbia Psychiatry: What did the MRIs show and how was brain structure different in the group with OCD?

Dr. Marsh: The patients with OCD showed reduced white matter connectivity in brain networks that typically support cognitive control processes (i.e., the ability to control one’s thoughts and behaviors). Thus, the communication between these regions might be altered in pediatric OCD. We also found that the thickness of several regions in these networks predicted patients’ response to therapy. That is, the thinner the cortices, the better response they had to the CBT. Since these regions that support control processes tend to get thinner over typical development, these findings suggest that advanced cortical maturation may relate to better CBT response.

Columbia Psychiatry: What does this finding mean for researchers and for clinicians?

Dr. Marsh: These findings contribute to our understanding of the neural mechanisms underlying pediatric OCD. Our identification of pre-treatment neural markers could help to identify patients most likely to respond to exposure-based therapy or other treatments in the future. We are now conducting a larger study of younger children with OCD aimed at identifying neural risk markers for the development of OCD. For this study, we are recruiting children (ages 6 to 12 years) with a range of OCD symptoms, from none to some to clinically severe. Our overall goal is to try to prevent this disabling illness in young children.

To learn more about the Cognitive Development & Neuroimaging Lab’s ongoing research and to participate in a study, click here: https://childadolescentpsych.cumc.columbia.edu/professionals/research-programs/cognitive-development-and-neuroimaging-lab/ocd-cbt-study.

This paper was written by David Pagliaccio and other authors are Jiook Cha, Xiaofu He, Marilyn Cyr, Paula Yanes-Lukin, Pablo Goldberg, Martine Fontaine, and Moira A. Rynn.

The work is funded by NIMH 1R21MH101441‐01A1; MPIs: Marsh and Rynn.