Structural neural markers of response to cognitive behavioral therapy in pediatric obsessive‐compulsive disorder

• Published in: Journal of child psychology and psychiatry 2020-12, Vol.61 (12), p.1299-1308
• Main Authors: Pagliaccio, David, Cha, Jiook, He, Xiaofu, Cyr, Marilyn, Yanes‐Lukin, Paula, Goldberg, Pablo, Fontaine, Martine, Rynn, Moira A., Marsh, Rachel
• Format: Article
• Language: English
• Subjects: Adolescents; Behavior modification; Brain; Child & adolescent psychiatry; Child development; Children; Circuits; Clinical outcomes; Cognitive behavioral therapy; Cognitive Restructuring; Cognitive therapy; Cognitive-behavioral factors; Cortex; Magnetic resonance imaging; Obsessive compulsive disorder; Outcomes of Treatment; Patients; Pediatrics; Structural MRI (sMRI)
• ISSN: 0021-9630; 1469-7610
• DOI: 10.1111/jcpp.13191

Background Cognitive behavioral therapy (CBT) is an effective, first‐line treatment for pediatric obsessive‐compulsive disorder (OCD). While neural predictors of treatment outcomes have been identified in adults with OCD, robust predictors are lacking for pediatric patients. Herein, we sought to identify brain structural markers of CBT response in youth with OCD. Methods Twenty‐eight children/adolescents with OCD and 27 matched healthy participants (7‐ to 18‐year‐olds, M = 11.71 years, SD = 3.29) completed high‐resolution structural and diffusion MRI (all unmedicated at time of scanning). Patients with OCD then completed 12–16 sessions of CBT. Subcortical volume and cortical thickness were estimated using FreeSurfer. Structural connectivity (streamline counts) was estimated using MRtrix. Results Thinner cortex in nine frontoparietal regions significantly predicted improvement in Children’s Yale‐Brown Obsessive‐Compulsive Scale (CY‐BOCS) scores (all ts > 3.4, FDR‐corrected ps  3.12, Cohen’s ds > 0.92) compared with healthy participants. These connections predicted post‐treatment CY‐BOCS scores, beyond pretreatment severity and demographics, though not above and beyond cortical thickness. Conclusions The current study identified group differences in structural connectivity (reduced among cingulo‐opercular regions) and cortical thickness predictors of CBT response (thinner frontoparietal cortices) in unmedicated children/adolescents with OCD. These data suggest, for the first time, that cortical and white matter features of task control circuits may be useful in identifying which pediatric patients respond best to individual CBT.