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Heightened performance monitoring in early childhood linked to OCD

Findings published in JAMA Psychiatry showed that heightened performance monitoring evident in early childhood was associated with the onset of obsessive-compulsive disorder during adolescence and smaller right dorsal anterior cingulate cortex volume.

These results suggest that identifying young children who exhibit heightened performance monitoring may lead to better identification of those at high risk for developing OCD.

“In general, monitoring one's performance is adaptive and helps us learn from mistakes and flexibly adapt to changing environments. However, monitoring our performance too much has been associated with different psychiatric illnesses, including OCD,” Kirsten E. Gilbert, PhD, from the department of psychiatry, Washington University School of Medicine in St Louis, told Healio Psychiatry. “As such, we need to understand when too much of a good thing can become harmful, especially in young children, when there is great opportunity for changing long-lasting outcomes.”

In this longitudinal observational cohort study, the investigators assessed whether an observed indicator of heightened performance monitoring in preschool-age children was tied to later onset of OCD and altered dorsal anterior cingulate cortex (dACC) volume through adolescence.

A sample of 292 children completed a performance-based observational task, during which they received persistent negative evaluation, then they completed annual diagnostic assessments over the next 12 years. Overall, 133 completed the last behavioral follow-up and 152 contributed up to three MRI scans. Researchers measured onset of OCD from baseline to the last behavioral assessment and whole-brain-adjusted dACC volume at the three waves of scanning.

After controlling for demographic and clinical indicators, children who exhibited observed heightened performance monitoring were twice as likely to develop OCD (n = 35) over the next 12 years (OR = 2; 95% CI, 1.06-3.78).

“Young children aged 3 to 6 [years] who exhibited elevated performance monitoring, or, in other words, perfectionistic tendencies and self-critical performance-focused mindset, when completing a task of drawing a 'perfect' circle, predicted onset of OCD and smaller dACC volume 12 years later,” Gilbert said.

Multilevel modeling of dACC volume across three waves of MRI scans taken from 152 children showed that heightened performance monitoring was linked with smaller right dACC volume (P = .03), but not left dACC volume. Before the first MRI scan, 16 children developed OCD. Even when Gilbert and colleagues excluded these children from analyses, the results remained the same: heightened performance monitoring remained tied to right dACC reductions (P = .04), but not left dACC reductions.

“This study demonstrated that observable heightened performance monitoring is an early emerging risk factor for OCD in very young children,” Gilbert told Healio Psychiatry. “Although this finding is preliminary, with further research the hope is that if we can identify and potentially target elevated performance monitoring in early ages, this could lead to earlier intervention and lifelong trajectories of better mental health.” – by Savannah Demko

Disclosures : Gilbert reports no relevant financial disclosures. Please see the study for other authors’ relevant financial disclosures.