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

抽象的。早期发展中的亚临床强迫症状(OCS)增加了OC的风险 成年期的相关损害，但在童年中期消长，表明 克服症状。临床上有意义的强迫症(强迫症，OCD)也出现在 -一些患者病情缓解，而另一些患者则继续遭受OCS的折磨，甚至 继黄金标准之后，认知行为疗法(CBT)。这种不同的OCS轨迹可以从 认知控制回路的不同接合，特别是额顶(FP)和扣带盖(CO) 任务控制(TC)回路，因为这些回路的正常发展与认知的成熟是平行的 控制儿童强迫症发生改变的过程。TC电路的调制可以帮助减少儿童期 OCS，但首先需要确定TC电路中与OCS减少一致的具体变化。 我们的初步数据表明，TC改变(例如，激活增加或减少)及其关联 OCS取决于特定的TC电路(CO或FP)和所使用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、用药状况和临床严重性 学习。因此，我们将管理嵌入在多模式成像中的两个认知控制任务 协议，使用与青少年大脑和认知发展研究和 人类连接计划。我们将使用这些尖端的MRI序列来阐明TC电路是如何 7-12岁未服用药物儿童的OCS减少相关的变化。从RDoC中提取 将大量收集对症状的框架、成像、行为和临床/自我报告的测量 有强迫症、亚临床OCS或无OCS的儿童样本(n=180)，跨2个地点招募。利用 用组合样本代表的接触网正常到异常的范围，我们将检验TC的关系 电路和认知控制过程与整个严重程度的OCS(目标1)。在强迫症中- 对于受影响的儿童，OCS将接受为期16周的标准CBT疗程，以确定TC如何 电路变化与缓解、部分反应和NO中OCS严重性的变化相关 已知的反应结果发生在CBT之后(目标2)。基于电路的更改将与非特定更改进行比较 保持无OCS的健康儿童的变化。通过找出哪些认知控制过程和TC 电路变化与OCS的减少相关，这项工作将通知过程和神经的选择 目标是指导认知训练以治疗和预防儿童OCS，为未来的临床奠定基础 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.