1/2 Task control circuit targets for obsessive compulsive behaviors in children

抽象的。早期发育中的亚临床强迫症症状（OCS）会增加OC-的风险 相关的损害在成年期，但蜡和减弱在童年中期，这表明一个关键时期， 克服症状。临床上显著的OCS（强迫症，OCD）也出现在 学龄，也遵循一个可变的过程-一些患者缓解，而其他人继续遭受OCS，甚至 在金标准之后，认知行为疗法（CBT）。这种不同的OCS轨迹可以源自于 认知控制回路的不同参与，特别是额顶叶（FP）和扣带回-盖（CO） 任务控制（TC）回路，因为这些回路的正常发育与认知功能的成熟平行。 儿童强迫症患者的控制过程发生改变。TC电路的调制可以帮助减少儿童 但首先需要识别与OCS降低一致的TC电路的具体变化。 我们的初步数据表明TC改变（例如，增加或减少激活）和关联 与OCS依赖于特定的TC电路（CO或FP）和参与的组件认知控制过程（即， 冲突解决、错误处理），以及患者的年龄、用药状态和临床严重程度 研究了因此，我们将管理两个认知控制任务嵌入在一个多模态成像 方案，使用与青少年大脑和认知发展研究一致的脉冲序列， 人类连接组计划。我们将使用这些最先进的MRI序列来阐明TC电路如何 变化与7-12岁未用药儿童的OCS减少有关。来自RDoC的绘图 框架，成像，行为和临床/自我报告的症状措施将收集在一个大的 在2个研究中心招募的患有强迫症、亚临床强迫症或无强迫症的儿童样本（共180例）。利用 合并样本代表的接触网状态的正常到异常范围，我们将测试TC的关系 电路和认知控制过程与OCS在整个频谱的严重性（目标1）。强迫症- 受影响的儿童，然后将使用标准的16周CBT课程来操纵OCS，以确定TC如何影响儿童， 回路变化与缓解、部分缓解和无缓解期间OCS严重程度的变化相关。 CBT后已知发生的反应结果（目标2）。基于电路的变化将与非特定 保持无强迫症的健康儿童的变化。通过查明哪些认知控制过程和TC 电路的变化与减少接触网，这项工作将告知选择的过程和神经 目标是指导认知训练，以治疗和预防儿童OCS，为未来的临床 审判

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.