Hostname: page-component-586b7cd67f-t7fkt Total loading time: 0 Render date: 2024-11-25T10:05:27.080Z Has data issue: false hasContentIssue false

Continuous performance test in pediatric obsessive-compulsive disorder and tic disorders: the role of sustained attention

Published online by Cambridge University Press:  09 October 2014

Ilse M. Lucke
Affiliation:
Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
Charlotte Lin
Affiliation:
Johns Hopkins University, Baltimore, Maryland, USA
Fatmata Conteh
Affiliation:
Johns Hopkins University, Baltimore, Maryland, USA
Amanda Federline
Affiliation:
Loyola University, Baltimore, Maryland, USA
Huyngmo Sung
Affiliation:
Department of Psychiatry, CHA University School of Medicine, Seoul, South Korea
Matthew Specht
Affiliation:
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
Marco A. Grados*
Affiliation:
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
*
*Address for correspondence: Marco A. Grados, MD, MPH, Johns Hopkins University School of Medicine, Psychiatry and Behavioral Sciences, 1800 Orleans St., 12th floor, Baltimore, MD 21287, USA. (Email: [email protected])

Abstract

Objective

Pediatric obsessive-compulsive disorder (OCD) and tic disorders (TD) are often associated with attention-deficit hyperactivity disorder (ADHD). In order to clarify the role of attention and inhibitory control in pediatric OCD and TD, a continuous performance test (CPT) was administered to a cohort of children and adolescents with OCD alone, TD alone, and OCD+TD.

Methods

A clinical cohort of 48 children and adolescents with OCD alone (n=20), TD alone (n=15), or OCD+TD (n=13) was interviewed clinically and administered the Conners Continuous Performance Test II (CPT-II). The Conners CPT-II is a 14-minute normed computerized test consisting of 6 blocks. It taps into attention, inhibitory control, and sustained attention cognitive domains. Key parameters include errors of omission (distractability), commission (inhibitory control), and variable responding over time (sustained attention). Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) criteria were applied in a best-estimate process to diagnose OCD, TD, ADHD, and anxiety disorders.

Results

Children with OCD+TD had more errors of omission (p=0.03), and more hit RT block change (p=0.003) and hit SE block change (p=0.02) than subjects with OCD alone and TD alone. These deficits in sustained attention were associated with younger age and hoarding tendencies. A clinical diagnosis of ADHD in the OCD+TD group also determined worse sustained attention.

Conclusions

A deficit in sustained attention, a core marker of ADHD, is also a marker of OCD+TD, compared to OCD alone and TD alone. Biological correlates of sustained attention may serve to uncover the pathophysiology of OCD and TD through genetic and imaging studies.

Type
Original Research
Copyright
© Cambridge University Press 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Heyman, I, Fombonne, E, Simmons, H, Ford, T, Meltzer, H, Goodman, R. Prevalence of obsessive-compulsive disorder in the British nationwide survey of child mental health. Int Rev Psychiatry. 2003; 15(1–2): 178184.CrossRefGoogle ScholarPubMed
2.Rapoport, JL, Inoff-Germain, G, Weissman, MM, et al.Childhood obsessive-compulsive disorder in the NIMH MECA study: parent versus child identification of cases. Methods for the Epidemiology of Child and Adolescent Mental Disorders. J Anxiety Disord. 2000; 14(6): 535548.CrossRefGoogle ScholarPubMed
3.Swedo, SE, Rapoport, JL, Leonard, H, Lenane, M, Cheslow, D. Obsessive-compulsive disorder in children and adolescents: clinical phenomenology of 70 consecutive cases. Arch Gen Psychiatry. 1989; 46(4): 335341.CrossRefGoogle ScholarPubMed
4.de Mathis, MA, Diniz, JB, Hounie, AG, et al.Trajectory in obsessive-compulsive disorder comorbidities. Eur Neuropsychopharmacol. 2013; 23(7): 594601.CrossRefGoogle ScholarPubMed
5.Zohar, AH. The epidemiology of obsessive-compulsive disorder in children and adolescents. Child Adolesc Psychiatr Clin N Am. 1999; 8(3): 445460.CrossRefGoogle ScholarPubMed
6.Nestadt, G, Samuels, J, Riddle, MA, et al.The relationship between obsessive-compulsive disorder and anxiety and affective disorders: results from the Johns Hopkins OCD Family Study. Psychol Med. 2001; 31(3): 481487.CrossRefGoogle ScholarPubMed
7.Eddy, CM, Cavanna, AE. Altered social cognition in Tourette syndrome: nature and implications. Behav Neurol. 2013; 27(1): 1522.CrossRefGoogle ScholarPubMed
8.Comings, DE. Tourette’s syndrome: a behavioral spectrum disorder. Adv Neurol. 1995; 65: 293303.Google Scholar
9.Apter, A, Pauls, DL, Bleich, A, et al.An epidemiologic study of Gilles de la Tourette’s syndrome in Israel. Arch Gen Psychiatry. 1993; 50(9): 734738.CrossRefGoogle ScholarPubMed
10.Robertson, MM, Cavanna, AE. The Gilles de la Tourette syndrome: a principal component factor analytic study of a large pedigree. Psychiatr Genet. 2007; 17(3): 143152.Google ScholarPubMed
11.Hanna, GL. Demographic and clinical features of obsessive-compulsive disorder in children and adolescents. J Am Acad Child Adolesc Psychiatry. 1995; 34(1): 1927.Google ScholarPubMed
12.Ivarsson, T, Melin, K, Wallin, L. Categorical and dimensional aspects of co-morbidity in obsessive-compulsive disorder (OCD). Eur Child Adolesc Psychiatry. 2008; 17(1): 2031.CrossRefGoogle ScholarPubMed
13.Flessner, CA, Allgair, A, Garcia, A, et al.The impact of neuropsychological functioning on treatment outcome in pediatric obsessive-compulsive disorder. Depress Anxiety. 2010; 27(4): 365371.CrossRefGoogle ScholarPubMed
14.Palumbo, D, Maughan, A, Kurlan, R. Hypothesis III. Tourette syndrome is only one of several causes of a developmental basal ganglia syndrome. Arch Neurol. 1997; 54(4): 475483.CrossRefGoogle ScholarPubMed
15.Sheppard, B, Chavira, D, Azzam, A, et al.ADHD prevalence and association with hoarding behaviors in childhood-onset OCD. Depress Anxiety. 2010; 27(7): 667674.CrossRefGoogle ScholarPubMed
16.Middleton, FA, Strick, PL. Basal ganglia output and cognition: evidence from anatomical, behavioral, and clinical studies. Brain Cogn. 2000; 42(2): 183200.CrossRefGoogle ScholarPubMed
17.Pauls, DL, Towbin, KE, Leckman, JF, Zahner, GE, Cohen, DJ. Gilles de la Tourette’s syndrome and obsessive-compulsive disorder: evidence supporting a genetic relationship. Arch Gen Psychiatry. 1986; 43(12): 11801182.CrossRefGoogle ScholarPubMed
18.Grados, MA, Riddle, MA, Samuels, JF, et al.The familial phenotype of obsessive-compulsive disorder in relation to tic disorders: the Hopkins OCD family study. Biol Psychiatry. 2001; 50(8): 559565.CrossRefGoogle ScholarPubMed
19.O’Rourke, JA, Scharf, JM, Platko, J, et al.The familial association of Tourette’s disorder and ADHD: the impact of OCD symptoms. Am J Med Genet B Neuropsychiatr Genet. 2011; 156B(5): 553560.CrossRefGoogle ScholarPubMed
20.Mathews, CA, Grados, MA. Familiality of Tourette syndrome, obsessive-compulsive disorder, and attention-deficit/hyperactivity disorder: heritability analysis in a large sib-pair sample. J Am Acad Child Adolesc Psychiatry. 2011; 50(1): 4654.CrossRefGoogle Scholar
21.Conners, CK, Epstein, JN, Angold, A, Klaric, J. Continuous performance test performance in a normative epidemiological sample. J Abnorm Child Psychol. 2003; 31(5): 555562.CrossRefGoogle Scholar
22.Scahill, L, Riddle, MA, McSwiggin-Hardin, M, et al.Children’s Yale–Brown Obsessive Compulsive Scale: reliability and validity. J Am Acad Child Adolesc Psychiatry. 1997; 36(6): 844852.Google ScholarPubMed
23.Leckman, JF, Riddle, MA, Hardin, MT, et al.The Yale Global Tic Severity Scale: initial testing of a clinician-rated scale of tic severity. J Am Acad Child Adolesc Psychiatry. 1989; 28(4): 566573.CrossRefGoogle ScholarPubMed
24.American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text rev. Washington, DC: American Psychiatric Press; 2000.Google Scholar
25.Conners, CK. Continuous Performance Test II. Toronto, Ontario: Multi-Health Systems Inc., 2003.Google Scholar
26.Frankel, M, Cummings, JL, Robertson, MM, Trimble, MR, Hill, MA, Benson, DF. Obsessions and compulsions in Gilles de la Tourette’s syndrome. Neurology. 1986; 36(3): 378382.CrossRefGoogle ScholarPubMed
27.Zohar, AH, Ratzoni, G, Pauls, DL, et al.An epidemiological study of obsessive-compulsive disorder and related disorders in Israeli adolescents. J Am Acad Child Adolesc Psychiatry. 1992; 31(6): 10571061.CrossRefGoogle ScholarPubMed
28.Coffey, BJ, Miguel, EC, Biederman, J, et al.Tourette’s disorder with and without obsessive-compulsive disorder in adults: are they different? J Nerv Ment Dis. 1998; 186(4): 201206.CrossRefGoogle ScholarPubMed
29.Ozonoff, S, Strayer, DL, McMahon, WM, Filloux, F. Inhibitory deficits in Tourette syndrome: a function of comorbidity and symptom severity. J Child Psychol Psychiatry. 1998; 39(8): 11091118.CrossRefGoogle ScholarPubMed
30.Roessner, V, Albrecht, B, Dechent, P, Baudewig, J, Rothenberger, A. Normal response inhibition in boys with Tourette syndrome. Behav Brain Funct. 2008; 4: 29.CrossRefGoogle ScholarPubMed
31.Wanderer, S, Roessner, V, Freeman, R, Bock, N, Rothenberger, A, Becker, A. Relationship of obsessive-compulsive disorder to age-related comorbidity in children and adolescents with Tourette syndrome. J Dev Behav Pediatr. 2012; 33(2): 124133.CrossRefGoogle ScholarPubMed
32.Lebowitz, ER, Motlagh, MG, Katsovich, L, et al.Tourette syndrome in youth with and without obsessive compulsive disorder and attention deficit hyperactivity disorder. Eur Child Adolesc Psychiatry. 2012; 21(8): 451457.CrossRefGoogle ScholarPubMed
33.Stephens, RJ, Sandor, P. Aggressive behaviour in children with Tourette syndrome and comorbid attention-deficit hyperactivity disorder and obsessive-compulsive disorder. Can J Psychiatry. 1999; 44(10): 10361042.CrossRefGoogle ScholarPubMed
34.Coffey, BJ, Biederman, J, Smoller, JW, et al.Anxiety disorders and tic severity in juveniles with Tourette’s disorder. J Am Acad Child Adolesc Psychiatry. 2000; 39(5): 562568.CrossRefGoogle ScholarPubMed
35.Cath, DC, Spinhoven, P, van de Wetering, BJ, et al.The relationship between types and severity of repetitive behaviors in Gilles de la Tourette’s disorder and obsessive-compulsive disorder. J Clin Psychiatry. 2000; 61(7): 505513.CrossRefGoogle ScholarPubMed
36.Clayton, IC, Richards, JC, Edwards, CJ. Selective attention in obsessive-compulsive disorder. J Abnorm Psychol. 1999; 108(1): 171175.CrossRefGoogle ScholarPubMed
37.Abramovitch, A, Abramowitz, JS, Mittelman, A. The neuropsychology of adult obsessive-compulsive disorder: a meta-analysis. Clin Psychol Rev. 2013; 33(8): 11631171.CrossRefGoogle ScholarPubMed
38.de Geus, F, Denys, DA, Sitskoorn, MM, Westenberg, HG. Attention and cognition in patients with obsessive-compulsive disorder. Psychiatry Clin Neurosci. 2007; 61(1): 4553.CrossRefGoogle ScholarPubMed
39.Beers, SR, Rosenberg, DR, Dick, EL, et al.Neuropsychological study of frontal lobe function in psychotropic-naive children with obsessive-compulsive disorder. Am J Psychiatry. 1999; 156(5): 777779.CrossRefGoogle ScholarPubMed
40.Shin, MS, Choi, H, Kim, H, Hwang, JW, Kim, BN, Cho, SC. A study of neuropsychological deficit in children with obsessive-compulsive disorder. Eur Psychiatry. 2008; 23(7): 512520.CrossRefGoogle ScholarPubMed
41.Taner, YI, Bakar, EE, Oner, O. Impaired executive functions in paediatric obsessive-compulsive disorder patients. Neuropsychiatrica. 2011; 23(6): 272281.CrossRefGoogle Scholar
42.Bornstein, RA, Baker, GB, Bazylewich, T, Douglass, AB. Tourette syndrome and neuropsychological performance. Acta Psychiatr Scand. 1991; 84(3): 212216.CrossRefGoogle ScholarPubMed
43.Mahone, EM, Koth, CW, Cutting, L, Singer, HS, Denckla, MB. Executive function in fluency and recall measures among children with Tourette syndrome or ADHD. J Int Neuropsychol Soc. 2001; 7(1): 102111.CrossRefGoogle ScholarPubMed
44.Yordanova, J, Dumais-Huber, C, Rothenberger, A. Coexistence of tics and hyperactivity in children: no additive at the psychophysiological level. Int J Psychophysiol. 1996; 21(2–3): 121133.CrossRefGoogle ScholarPubMed
45.Ballard, JC. Computerized assessment of sustained attention: interactive effects of task demand, noise, and anxiety. J Clin Exp Neuropsychol. 1996; 18(6): 864882.CrossRefGoogle ScholarPubMed
46.Yerkes, RM, Dodson, JD. The relation of strength of stimulus to rapidity of habit formation. J Comp Neurol Psychol. 1908; 18(5): 459482.CrossRefGoogle Scholar
47.Cheng, I-J, Chang, C-C. Cognitive load theory: an empirical study of anxiety and task performance in language learning. Electronic Journal of Research in Educational Psychology. 2009; 7(2): 729746.Google Scholar
48.Lavie, N, Hirst, A, de Fockert, JW, Viding, E. Load theory of selective attention and cognitive control. J Exp Psychol Gen. 2004; 133(3): 339354.CrossRefGoogle ScholarPubMed
49.Eysenck, MW, Derakshan, N, Santos, R, Calvo, MG. Anxiety and cognitive performance: attentional control theory. Emotion. 2007; 7(2): 336353.CrossRefGoogle ScholarPubMed
50.Eysenck, MW, Calvo, MG. Anxiety and performance: the processing efficiency theory. Cognition and Emotion. 1992; 6(6): 409434.CrossRefGoogle Scholar
51.Abramovitch, A, Dar, R, Hermesh, H, Schweiger, A. Comparative neuropsychology of adult obsessive-compulsive disorder and attention deficit/hyperactivity disorder: implications for a novel executive overload model of OCD. J Neuropsychol. 2012; 6(2): 161191.CrossRefGoogle ScholarPubMed
52.Osinsky, R, Gebhardt, H, Alexander, N, Hennig, J. Trait anxiety and the dynamics of attentional control. Biol Psychol. 2012; 89(1): 252259.CrossRefGoogle ScholarPubMed
53.Forster, S, Nunez Elizalde, AO, Castle, E, Bishop, SJ. Unraveling the anxious mind: anxiety, worry, and frontal engagement in sustained attention versus off-task processing. Cereb Cortex. In press. DOI: 10.1093/cercor/bht248.Google Scholar
54.Bishop, SJ. Trait anxiety and impoverished prefrontal control of attention. Nat Neurosci. 2009; 12(1): 9298.CrossRefGoogle ScholarPubMed
55.Heise, KF, Steven, B, Liuzzi, G, et al.Altered modulation of intracortical excitability during movement preparation in Gilles de la Tourette syndrome. Brain. 2010; 133(Pt 2): 580590.CrossRefGoogle ScholarPubMed
56.Gilbert, DL, Bansal, AS, Sethuraman, G, et al.Association of cortical disinhibition with tic, ADHD, and OCD severity in Tourette syndrome. Mov Disord. 2004; 19(4): 416425.CrossRefGoogle ScholarPubMed
57.Greenberg, BD, Ziemann, U, Cora-Locatelli, G, et al.Altered cortical excitability in obsessive-compulsive disorder. Neurology. 2000; 54(1): 142147.CrossRefGoogle ScholarPubMed
58.Vloet, TD, Marx, I, Kahraman-Lanzerath, B, Zepf, FD, Herpertz-Dahlmann, B, Konrad, K. Neurocognitive performance in children with ADHD and OCD. J Abnorm Child Psychol. 2010; 38(7): 961969.CrossRefGoogle ScholarPubMed
59.Sergeant, JA. Modeling attention-deficit/hyperactivity disorder: a critical appraisal of the cognitive-energetic model. Biol Psychiatry. 2005; 57(11): 12481255.CrossRefGoogle ScholarPubMed
60.Lipszyc, J, Schachar, R. Inhibitory control and psychopathology: a meta-analysis of studies using the stop signal task. J Int Neuropsychol Soc. 2010; 16(6): 10641076.CrossRefGoogle ScholarPubMed
61.Channon, S, Drury, H, Martinos, M, Robertson, MM, Orth, M, Crawford, S. Tourette’s syndrome (TS): inhibitory performance in adults with uncomplicated TS. Neuropsychology. 2009; 23(3): 359366.CrossRefGoogle ScholarPubMed
62.Sukhodolsky, DG, Landeros-Weisenberger, A, Scahill, L, Leckman, JF, Schultz, RT. Neuropsychological functioning in children with Tourette syndrome with and without attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 2010; 49(11): 11551164.Google ScholarPubMed
63.Eddy, CM, Rickards, HE, Cavanna, AE. Physiological awareness is negatively related to inhibitory functioning in Tourette syndrome. Behav Modif. 2013; 38(2): 319335.CrossRefGoogle ScholarPubMed
64.Oades, RD. Differential measures of ’sustained attention’ in children with attention-deficit/hyperactivity or tic disorders: relations to monoamine metabolism. Psychiatry Res. 2000; 93(2): 165178.CrossRefGoogle ScholarPubMed
65.Epstein, JN, Erkanli, A, Conners, CK, Klaric, J, Costello, JE, Angold, A. Relations between Continuous Performance Test performance measures and ADHD behaviors. J Abnorm Child Psychol. 2003; 31(5): 543554.CrossRefGoogle ScholarPubMed
66.Vaurio, RG, Simmonds, DJ, Mostofsky, SH. Increased intra-individual reaction time variability in attention-deficit/hyperactivity disorder across response inhibition tasks with different cognitive demands. Neuropsychologia. 2009; 47(12): 23892396.CrossRefGoogle ScholarPubMed
67.Thibeault, M, Lemay, M, Chouinard, S, Lesperance, P, Rouleau, GA, Richer, F. Response inhibition in tic disorders: waiting to respond is harder when ADHD is present. J Atten Disord. In press. DOI: 10.1177/1087054713513638.Google Scholar
68.Yeates, KO, Bornstein, RA. Attention deficit disorder and neuropsychological functioning in children with Tourette’s syndrome. Neuropsychology. 1994; 8(1): 6574.CrossRefGoogle Scholar
69.Grisham, JR, Brown, TA, Savage, CR, Steketee, G, Barlow, DH. Neuropsychological impairment associated with compulsive hoarding. Behav Res Ther. 2007; 45(7): 14711483.CrossRefGoogle ScholarPubMed
70.Tolin, DF, Villavicencio, A. Inattention, but not OCD, predicts the core features of hoarding disorder. Behav Res Ther. 2011; 49(2): 120125.CrossRefGoogle Scholar
71.Tolin, DF, Witt, ST, Stevens, MC. Hoarding disorder and obsessive-compulsive disorder show different patterns of neural activity during response inhibition. Psychiatry Res. 2014; 221(2): 142148.CrossRefGoogle ScholarPubMed
72.Frost, RO, Steketee, G, Tolin, DF. Comorbidity in hoarding disorder. Depress Anxiety. 2011; 28(10): 876884.CrossRefGoogle ScholarPubMed
73.Fullana, MA, Vilagut, G, Mataix-Cols, D, et al.Is ADHD in childhood associated with lifetime hoarding symptoms? An epidemiological study. Depress Anxiety. 2013; 30(8): 741748.CrossRefGoogle ScholarPubMed
74.Jaisoorya, TS, Reddy, YC, Srinath, S, Thennarasu, K. Obsessive-compulsive disorder with and without tic disorder: a comparative study from India. CNS Spectr. 2008; 13(8): 705711.CrossRefGoogle ScholarPubMed
75.Gomes, dA, de Mathis, MA, Dominguez Alves, AC, et al.Clinical features of tic-related obsessive-compulsive disorder: results from a large multicenter study. CNS Spectr. 2012; 17(2): 8793.Google Scholar
76.Koetsier, GC, Volkers, AC, Tulen, JH, Passchier, J, van den Broek, WW, Bruijn, JA. CPT performance in major depressive disorder before and after treatment with imipramine or fluvoxamine. J Psychiatr Res. 2002; 36(6): 391397.CrossRefGoogle ScholarPubMed
77.Wang, LJ, Huang, YS, Chiang, YL, Hsiao, CC, Shang, ZY, Chen, CK. Clinical symptoms and performance on the Continuous Performance Test in children with attention deficit hyperactivity disorder between subtypes: a natural follow-up study for 6 months. BMC Psychiatry. 2011; 11: 65.CrossRefGoogle ScholarPubMed
78.Kebir, O, Joober, R. Neuropsychological endophenotypes in attention-deficit/hyperactivity disorder: a review of genetic association studies. Eur Arch Psychiatry Clin Neurosci. 2011; 261(8): 583594.CrossRefGoogle ScholarPubMed
79.Bellgrove, MA, Hawi, Z, Gill, M, Robertson, IH. The cognitive genetics of attention deficit hyperactivity disorder (ADHD): sustained attention as a candidate phenotype. Cortex. 2006; 42(6): 838845.CrossRefGoogle ScholarPubMed
80.Esterman, M, Rosenberg, MD, Noonan, SK. Intrinsic fluctuations in sustained attention and distractor processing. J Neurosci. 2014; 34(5): 17241730.CrossRefGoogle ScholarPubMed
81.Pironti, VA, Lai, MC, Muller, U, et al.Neuroanatomical abnormalities and cognitive impairments are shared by adults with attention-deficit/hyperactivity disorder and their unaffected first-degree relatives. Biol Psychiatry. In press. DOI: 10.1016/j.biopsych.2013.09.025.Google Scholar
82.Brocki, K, Clerkin, SM, Guise, KG, Fan, J, Fossella, JA. Assessing the molecular genetics of the development of executive attention in children: focus on genetic pathways related to the anterior cingulate cortex and dopamine. Neuroscience. 2009; 164(1): 241246.CrossRefGoogle Scholar
83.Weible, AP. Remembering to attend: the anterior cingulate cortex and remote memory. Behav Brain Res. 2013; 245: 6375.CrossRefGoogle ScholarPubMed
84.Milad, MR, Rauch, SL. Obsessive-compulsive disorder: beyond segregated cortico-striatal pathways. Trends Cogn Sci. 2012; 16(1): 4351.CrossRefGoogle ScholarPubMed
85.Hajcak, G, Franklin, ME, Foa, EB, Simons, RF. Increased error-related brain activity in pediatric obsessive-compulsive disorder before and after treatment. Am J Psychiatry. 2008; 165(1): 116123.CrossRefGoogle ScholarPubMed
86.Soreni, N, Crosbie, J, Ickowicz, A, Schachar, R. Stop signal and Conners’ continuous performance tasks: test–retest reliability of two inhibition measures in ADHD children. J Atten Disord. 2009; 13(2): 137143.CrossRefGoogle ScholarPubMed